These authors systematically compared the short- to midterm effectiveness of stemless prostheses to that of stemmed prostheses for patients who underwent total shoulder arthroplasty (TSA). They found two randomized controlled trials and six case-controlled studies with a total of 347 shoulders for inclusion in this meta-analysis.
They found no significant differences between the stemless and stemmed prostheses in terms of the Constant score, pain score, strength, activities of daily living, postoperative range of motion (ROM), and postoperative maximum active ROM.
Comment: These authors did not find evidence for increased benefit of stemless components. If value = benefit/cost, stemless implants would have to have superior outcomes to attain the same value as standard stemmed implants because of their increased cost.
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To see a YouTube of our technique for total shoulder arthroplasty, click on this link.
Comment: These authors did not find evidence for increased benefit of stemless components. If value = benefit/cost, stemless implants would have to have superior outcomes to attain the same value as standard stemmed implants because of their increased cost.
The 2019 Orthopaedic Network News, provides a cost comparison (ASP = average selling price).
The rationale behind stemless implants, according to these authors, include "bone preserving", "less stress shielding distally", "no diaphysial stress riser", and "less lateralization".
We observe that an impaction grafted standard stem is also bone preserving, without distal stress shielding, without a diaphysial stress riser, and with the desired amount of lateralization.
We continue to use an impaction grafted standard humeral component, finding that it is safe, efficient, cost effective, and adaptable to almost all situations.
A standard stem also enables us to use an anteriorly eccentric humeral head if necessary to manage excessive posterior translation if this is encountered at surgery.
Finally, we note that every new prosthesis requires a new learning curve for each surgeon
To see a YouTube of our technique for total shoulder arthroplasty, click on this link.
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To see our new series of youtube videos on important shoulder surgeries and how they are done, click here.
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