Friday, November 4, 2016

Stemless reverse total shoulder arthroplasty - an advantage?

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

These authors compared a group of 24 shoulders with cuff tear arthropathy having a stemless reverse total shoulder arthroplasties to a group of 24 shoulders with cuff tear arthropathy having a stemmed reverse total shoulder.

After mean follow-up of 35 months (range 24-75) they found 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. No loosening of the humeral component was observed in either group.

Comment: The argument often offered for stemless prostheses is that they preserve more bone. These authors provide some nicely comparable radiographs showing that the amount of bone preserved is not different between the (a) press fit stemless design and (b) the press fit stemmed design.

Much of the historical concern about humeral stems relates to cemented and bone-ingrowth designs.