These authors propose that the benefits of a stemless humeral implant include greater bone preservation, less stress shielding, less risk of a diaphyseal stress riser, decreased surgical time, and less intraoperative blood loss. Potential downsides include the dependence on proximal bone quality for fixation, increased cost, the dependence on the strength of subscapularis fixation, and pending FDA approval for multiple implants.
It seems that many companies are coming up with their own patentable versions of a stemless component
Yet as these authors point out, "To date, no author has suggested that stemless or canal-sparing unconstrained shoulder arthroplasty outcomes are superior to those of stemmed implants from clinical and radiologic perspectives." A recent meta analysis came to the same conclusion (see this link).
They also point out the downside of increased cost as shown below, with a typical stemless implant costing more that $1,000 more than other types of humeral components. One might wonder, "where does that $1,000 go?"
While it is stated that stemless humeral components are "bone preserving", it is not clear that less bone is removed with the stemless designs in comparison to that with an impaction autografted standard humeral stem
Especially in these times with huge strains on the nation's medical budget, we need to be thoughtful about how our health care dollars are spent.
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