Sunday, July 13, 2014

Stemless humeral components for shoulder arthroplasty

Stemless shoulder arthroplasty: current status

This article reviews five different stemless shoulder arthroplasty systems. The author concludes that "Early results for stemless shoulder arthroplasty indicate clinical results similar to standard stemmed shoulder arthroplasty."

Comment: There have been many marketing-driven attempts to improve on the classical stemmed humeral component: these include partial surface humeral components,  full surface humeral components, short stemmed humeral components and now stemless humeral components. It is stated that these efforts are directed at combating "stem-related complications", such as intraoperative humeral fracture, loosening, stress shielding, traumatic periprosthetic humeral fracture, difficulty with stem extraction, bone loss due to proximal stress shielding, osteolysis due to polyethylene wear debris, and difficulty with cement extraction at revision.  It is important to point out, however, that many of these issues can be avoided using modern techniques for stemmed arthroplasty, including conservative broaching to avoid stem weakening, fixation with impaction grafting to avoid cement, stress shielding and fracture, and avoidance of ingrowth stems that complicate revision. 

It is also important that the use of stemless components may limit the surgeons ability to use eccentric components to manage commonly encountered issues of stability in glenohumeral arthritis and to reconstruct shoulders with proximal humeral deformity or bone loss.


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