Saturday, March 1, 2014

Cementless reverse total shoulder

Clinical and radiographic results of cementless reverse total shoulder arthroplasty: a comparative study with 2 to 5 years of follow-up.

The authors report a retrospective review of  patients having reverse total shoulder arthroplasty for a diagnosis of cuff tear arthropathy or severe rotator cuff deficiency. Of these, 37 patients had cemented RTSA and 64 patients had cementless RTSA. The cemented RTSAs were implanted between 2005 and 2007, and the uncemented RTSAs were implanted between 2007 and 2008.

There were no significant differences in clinical or radiographic outcomes between the two groups of patients. There was one revision for prosthetic instability  in the cemented group and three such cases in two patients in the cemented group.

Comment: This series represents the results by a surgeon with extensive experience with reverse total shoulders in patients with the optimal diagnoses: cuff tears and cuff tear arthropathy. Results are not presented for patients having reverse total shoulders for failed anatomic arthroplasty or fractures.

The authors observed stress shielding exclusively in the cement less stems, noting that stress shielding has been noted to be inversely proportional to the diameter of the stem: increased stiffness of the larger diameter press-fit implants leads to more stress shielding and increased proximal bone resorption around the implant.

In order to achieve fixation without cement, the average stem diameters were greater in the uncemented group.

This observation suggests that care needs to be exerted when inserting press-fit humeral stems in fragile bone because of the risk of fracture at surgery. Many patients having reverse total shoulders have poor humeral bone quality. Special approaches may be needed to avoid the risk of fracture at and after surgery.

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