Total shoulder arthroplasty - is a stemless humeral component a better value?

 Radiographic humeral head restoration after total shoulder arthroplasty: does the stem make a difference?

These authors note that there is a recent trend toward the use of shorter stems in total shoulder arthroplasty. They examined the relationship between humeral component stem length and the restoration of native humeral head anatomy in a retrospective review of 261 patients who underwent total shoulder arthroplasty for primary osteoarthritis.

Preoperative and postoperative radiographic measurements of the center of rotation (COR), humeral head height (HH), and neck-shaft angle were performed. Restoration of the native humeral anatomy was deemed ‘‘acceptable’’ based on postoperative differences in the COR 3 mm, HH 5 mm, and neck-shaft angle > 130. 

They found that stemless arthroplasty implants were more likely to be placed in varus (22.6%) compared with short-stem (7.0%) and standard-stem (3.7%) designs.

They concluded that the stem of a shoulder arthroplasty implant aids surgeons in accurately restoring patient-specific anatomy.

Unfortunately, this study did not compare the clinical outcomes among the different humeral component designs.

Comment: Some surgeons are advocates of "humeral shrinkage". 

However, as seen in a recent publication, short or stemless components are associated with problems that are uncommon with the use of a standard stem.

Positioning can be a problem with stemless components.

It is of interest that the average selling price of stemless humeral components is reported to be greater than standard stemmed components (see this link).

In that "value" is defined as the improvement in patient reported comfort and function divided by the cost, the added value of stemless components remains undefined.

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