Short-stem uncemented primary reverse shoulder arthroplasty

Abstract

Short uncemented humeral stems can preserve humeral bone stock and facilitate revision surgery but may be prone to malalignment or loosening, especially when used in reverse total shoulder replacement (TSR). We undertook a retrospective review of 44 patients with a mean age of 76 years (59 to 92) who underwent primary reverse TSR with a short uncemented humeral stem. There were 29 females. The indications for joint replacement included cuff tear associated arthropathy (33), avascular necrosis (six), post-traumatic arthritis (two), and inflammatory arthritis (three). At a mean follow-up of 27 months (24 to 40), pain was rated as mild or none in 43 shoulders (97.7%). The mean active elevation improved from 54° (sd 20°) to 142° (sd 25°) and the mean active external rotation from 14° (sd 13°) to 45° (sd 9°). The outcome, as assessed by the modified Neer score, was excellent in 27 (61.3%), satisfactory in 15 (34.1%), and unsatisfactory in two shoulders (4.5%). Stems were well-positioned, without evidence of significant valgus or varus malalignment in 42 TSRs (95.5%). There was no radiological evidence of loosening of the humeral stem in any patient; 13 TSRs (29.5%) had evidence of proximal humeral remodelling and scapular notching was noted in three (6.8%).

Radiographic changes and clinical outcomes associated with an adjustable diaphyseal press-fit humeral stem in primary reverse shoulder arthroplasty

“…Although a number of studies have evaluated the radiographic changes observed with these implants, most analyzed results with anatomic shoulder replacement. 14,18,24,28,29,38,45,48,51,52,54 Early …”

“…23,24,39,43 Recently, however, the use of press-fit humeral components has become more prevalent. 12,14,18,28,38,45,54 Proposed advantages of press-fit fixation include decreased operative time and lower complication rates with stem removal during revision surgery. Early-generation press-fit humeral components were associated with high loosening rates and poor results.…”

“…44,48,51 With improvements in technology and techniques, later-generation implants have shown much more favorable results with low loosening rates. 12,14,18,24,28,38,45,54 However, significant radiographic humeral changes, including stress shielding, osteolysis, and radiolucent lines, have been observed. 28,29,34,38,45 Stress shielding and osteolysis of the femur have been associated with poor clinical outcomes with hip arthroplasty, 13,34,38 but these radiographic changes have not yet been shown to correlate with poor clinical results in anatomic shoulder arthroplasty.…”

The incidence of radiographic aseptic loosening of the humeral component in reverse total shoulder arthroplasty

“…8 Among RTSA, the glenoid component has a relatively low rate of loosening. 5 The effect of wear debris in the RTSA may instead be associated with a higher rate of loosening of the humeral stem. 3 Since approval by the United States Food and Drug Administration in 2004, RTSA prostheses are increasingly used for glenohumeral arthropathy associated with a deficiency of the rotator cuff.…”

Total shoulder arthroplasty: are the humeral components getting shorter?

“…Giuseffi et al also reported on 44 reverse total shoulders performed using the Comprehensive Mini stem (Biomet, Warsaw, IN) with at least 24-months follow-up [35]. Unfortunately, a functional outcome score was not reported but 97% had no pain or only mild pain.…”