Stemless shoulder arthroplasty—current results and designs

Churchill, R. Sean; Athwal, George S.

doi:10.1007/s12178-016-9320-4

Cited by 82 publications

(46 citation statements)

References 29 publications

(31 reference statements)

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“…Stemless arthroplasty was introduced to decrease the rate of humeral stem-related complications such as humeral fracture, bone loss secondary to stress shielding, and osteolysis 209,210 . Proposed advantages include ease of revision 209,210 and management of arthritis associated with proximal humeral malunion 209,211 .…”

Section: Stemless Modular Shoulder Arthroplastymentioning

confidence: 99%

“…Proposed advantages include ease of revision 209,210 and management of arthritis associated with proximal humeral malunion 209,211 . Three prospective, randomized and nonrandomized studies 78,212,213 and 1 case-control study with early follow-up 214 demonstrated favorable clinical and radiographic results for both hemiarthroplasty and anatomic TSA.…”

Section: Stemless Modular Shoulder Arthroplastymentioning

confidence: 99%

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Complications of Shoulder Arthroplasty

Bohsali

Bois

Wirth³

2017

The Journal of Bone and Joint Surgery

283

199

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d The most common complications after reverse shoulder arthroplasty in order of decreasing frequency included instability, periprosthetic fracture, infection, component loosening, neural injury, acromial and/or scapular spine fracture, hematoma, deltoid injury, rotator cuff tear, and venous thromboembolism (VTE).d The most common complications after anatomic total shoulder arthroplasty (TSA) in order of decreasing frequency were component loosening, glenoid wear, instability, rotator cuff tear, periprosthetic fracture, neural injury, infection, hematoma, deltoid injury, and VTE.d Glenoid component wear and loosening remain a common cause of failure after anatomic TSA, despite advances in surgical technique and implant design.d Diagnostic confirmation of infection after shoulder arthroplasty remains a challenge. In the setting of a painful and stiff shoulder after arthroplasty, the surgeon should have a heightened suspicion for infection. Inflammatory markers may be normal, radiographs may be inconclusive, and prosthetic joint aspiration may be negative for a causative organism.Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work and "yes" to indicate that the author had a patent and/or copyright, planned, pending, or issued, broadly relevant to this work. 99:256-69 d http://dx.doi.org/10.2106/JBJS.16.00935 frequency) included instability, periprosthetic fracture, infection, component loosening, neural injury, acromial and/or scapular spine fracture, hematoma, deltoid injury, rotator cuff tear, and venous thromboembolism (VTE)The most common complications after anatomic TSA (in order of decreasing frequency) were component loosening, glenoid wear, instability, rotator cuff tear, periprosthetic fracture, neural injury, infection, hematoma, deltoid injury, and VTE (

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Section: Stemless Modular Shoulder Arthroplastymentioning

confidence: 99%

Section: Stemless Modular Shoulder Arthroplastymentioning

confidence: 99%

Complications of Shoulder Arthroplasty

Bohsali

Bois

Wirth³

2017

The Journal of Bone and Joint Surgery

283

199

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“…The impacted corolla of the TESS prosthesis provides a peripheral metaphyseal anchoring[ 9 ]. This relatively stable fixation close to the cortical bone might explain why findings indicating a loosening were not noticed.…”

Section: Discussionmentioning

confidence: 99%

“…The Total Evolutive Shoulder System (TESS, Biomet-Zimmer, Warsaw, IN, United States) uses different sizes of an impaction-implanted 6-armed corolla for a peripheral metaphyseal anchoring close to the cortical bone. This method of fixation is different to those with a much more central anchoring within the metaphysis, e.g ., the threaded central cage of the Arthrex Eclipse (Arthrex, Karlsfeld, Germany) or the Simpliciti system with a nucleus and 3 fins for central impaction (Wright Medical, formerly Tornier, Montbonnot, France)[ 9 ]. The principle of a peripheral metaphyseal anchoring might influence the reconstruction of the individual anatomy of the proximal humerus.…”

Section: Introductionmentioning

confidence: 99%

Restoration of the joint geometry and outcome after stemless TESS shoulder arthroplasty

Engelhardt

Manzke

Breil-Wirth

et al. 2017

WJO

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AIMTo evaluate the joint geometry and the clinical outcome of stemless, anatomical shoulder arthroplasty with the TESS system.METHODSTwenty-one shoulders with a mean follow-up 18 of months were included. On scaled digital radiographs the premorbid center of rotation (CoR) was assessed and compared to the CoR of the prosthesis by using the MediCAD® software. Additionally, the pre- and post-operative geometry of the CoR was assessed in relation to the glenoid, the acromion as well as to the proximal humerus. Radiological changes, such as radiolucencies, were also assessed. Clinical outcome was assessed with the Constant and DASH score.RESULTSBoth, the Constant and DASH scores improved significantly from 11% to 75% and from 70 to 30 points, P < 0.01 respectively. There were no significant differences regarding age, etiology, cemented or metal-backed glenoids, etc. (P > 0.05). The pre- and postoperative humeral offset, the lateral glenohumeral offset, the height of the CoR, the acromiohumeral distance as well as neck-shaft angle showed no significant changes (P > 0.05). The mean deviation of the CoR of the prosthesis from the anatomic center was 1.0 ± 2.8 mm. Three cases showed a medial deviation of more than 3 mm. These deviations of 5.1, 5.7 and 7.6 mm and were caused by an inaccurate humeral neck cut. These 3 patients showed a relatively poor outcome scoring.CONCLUSIONTESS arthroplasty allows an anatomical joint reconstruction with a very good outcome. Outliers described in this study sensitize the surgeon for an accurate humeral neck cut.

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“…In an effort to mimic native bone stress and to preserve bone in the case of revision surgery, design modifications led to the fourth generation of shoulder arthroplasty with stemless or short-stem humeral components aimed at metaphyseal fixation [7,11,14]. In 2016, Harmer et al performed a systematic review of stemless and short-stem shoulder prosthesis and found that only one study reported results of anatomical shoulder replacement with an uncemented short stem [11].…”

Section: Short-stem Anatomical Shoulder Replacement-a Systematic Reviewmentioning

confidence: 99%