Short to mid-term results of stemless reverse shoulder arthroplasty in a selected patient population compared to a matched control group with stem

Abstract

Purpose Little scientific evidence on the clinical and radiological outcome after stemless reverse shoulder arthroplasty (RSA) exists. The hypothesis of this study was that stemless RSA has an inferior outcome compared to RSA with stem. Methods All cases of cuff-arthropathy fullfilling strict selection criteria (selection rate 18.4 %) were treated with stemless RSA between 2009 and 2013. Twenty nine of 37 cases (78.4 %) were clinically and radiologically examined by an independent observer. Twenty four of the 29 cases could be matched with 24 patients that underwent conventional stemmed RSA at a different institution based on the following criteria: indication (cuff-arthropathy), age (within 5 years), gender, and time of follow-up (within 2 years). Clincial and radiological outcomes of both groups were compared. Results After mean follow-up of 35 months (range 24-75) no significant difference regarding constant score, ASES, subjective shoulder value, pain score, patient satisfaction, strength, and range of motion was detected. One case of traumatic dislocation was observed in the stemless RSA group. Scapular notching grade 1 was detected in two cases of the stemless group while in the stemmed group five cases with grade 1 and four cases with grade 2 notching were observed. Average post-operative humeral component inclination (neck-shaft angle) in the stemless RSA group (134.4°) was significantly steeper than in the stemmed RSA group (155°) (p < 0.001). No loosening of the humeral component was observed in both groups. Conclusion At short to mid-term follow-up, stemless RSA does not feature inferior clinical or radiological outcomes in a strictly selected patient population.

The short- to midterm effectiveness of stemless prostheses compared to stemmed prostheses for patients who underwent total shoulder arthroplasty: a meta-analysis

“…Eight studies with a total of 347 shoulders (investigative group, 172 prostheses; control group, 175 prostheses) were presented in this meta-analysis. Four studies [3, 11, 13, 15] were performed in Germany, and the remaining 4 studies were from Switzerland [14], Austria [12], Italy [10], and Canada [16]. The publication years were from 2013 to 2017.…”

“…There were three studies [10–12] with sufficient data about the maximum internal rotation and external rotation of the two shoulder prostheses. The fixed-effects model was used for data analysis on the premise of no statistical heterogeneity (internal rotation: P = 0.205 and I 2 = 36.9%; external rotation: P = 0.365 and I 2 = 0.7%).…”

Reverse Total Shoulder Arthroplasty: Implant Design Considerations

“…Much like the other components of the traditional Grammont prosthesis, the length of the humeral stem has continued to evolve over time. Although cemented fixation of the humeral component was the gold standard for RTSA, the success of uncemented humeral fixation has allowed for the introduction of bone preserving short-stemmed [74,75], and even stemless [76][77][78] components [79]. In fact, Moroder and colleagues [78] compared the clinical and radiological outcomes of stemless RTSA with a matched cohort of patients undergoing conventional uncemented stemmed RTSA for rotator cuff arthropathy and found no differences between groups.…”

“…Although cemented fixation of the humeral component was the gold standard for RTSA, the success of uncemented humeral fixation has allowed for the introduction of bone preserving short-stemmed [74,75], and even stemless [76][77][78] components [79]. In fact, Moroder and colleagues [78] compared the clinical and radiological outcomes of stemless RTSA with a matched cohort of patients undergoing conventional uncemented stemmed RTSA for rotator cuff arthropathy and found no differences between groups. Considering the indication when selecting the stem length is crucial, as a stemless prosthesis may be appropriate in patients with primary cuff tear arthropathy, while a proximal humerus fracture will necessitate the use of a stemmed prosthesis [80].…”

Schulterendoprothetik

“…Auch bei den inversen Schulterendoprothetiksystemen gibt es mittlerweile den Trend zur Verkürzung der humeralen Komponente bis hin zu einer schaftfreien Variante. Erste Kurzzeituntersuchungen zeigen, dass diese klinisch und radiologisch ähnlich gute Ergebnisse erzielen können wie die klassischen Schaftprothesen [22]. Langzeitstudien sind aber nötig, um vor allem eine mögliche Lockerung der humeralen Komponente zu erfassen.…”