UW Shoulder and Elbow Academy: Do short stemmed or stemless reverse humeral components add value for the patient?

Stemless Reverse Total Shoulder Arthroplasty: A Systematic Review

Stemless humeral components in reverse total shoulder arthroplasty are only approved for clinical trials with an Investigational Device Exception (IDE) in the United States. These authors conducted a systematic review of 10 studies that utilized either a TESS or Verso implant.

There were 430 total patients and 437 total procedures; 266 in the TESS group underwent a total of 272 procedures and 164 patients in the Verso group underwent a total of 165 procedures.

Mean age at time of surgery was 73.8 years (range, 38 to 93 years. The mean follow-up per study ranged from 6.4 to 101.6 months.

There was a 0.2% humeral component loosening rate and a 11.2% complication rate.

The review did not establish an advantage to patients for these implants in comparison to the standard stemmed implants.

Comment: The Verso implant is actually a short stemmed humeral component. Intraoperative "cracks" and fractures were not uncommon in the review of this implant. As shown below this metaphyseal fit reverse humeral implant has the same risk of stress shielding as has been noted for anatomic short stems.

The review of the TESS implant revealed issues of migration of the humeral cup and intraoperative metaphyseal fracture. This implant requires removal of substantial proximal humeral bone and would seem to risk fracture of the tuberosity.

It is unclear what percent of patients needing a reverse total shoulder are not candidates for short stemmed or stemless humeral implants because of proximal humeral deformity, humeral deficiency or osteopenia. Of note, most of the failures of stemless and short stemmed humeral components were revised to standard stemmed implants.

These implants should be compared to the flexibility of a standard stemmed implant inserted with impaction grafting as shown below and in this video (see link).