Why do standard length humeral stems get the short end of the stick?

As pointed out in a prior post (see this link), short stemmed humeral components have been designed to "solve the problems" of a standard length stem, which are said to include intraoperative humeral fractures, stem loosening, periprosthetic fractures, stress shielding, and difficulties with revision surgery. Yet the overall failure rate published for standard length stems is less than half a percent.

For over four decades, this has been our experience as well: no problems with intraoperative fractures or stem loosening (except in cases of infection) and very rare instances of periprosthetic fracture, stress shielding or difficulties in revising the stem. 

The key to avoiding the issues that have been attributed to standard length stem is selecting a stem diameter that will give a low diaphysial filling ratio and fixing it with impaction autografting.

Here are typical results for two shoulders in the same patient. The x-ray of the right shoulder is a 27 year followup

The x-ray of the left shoulder is an 11 year followup.

Each shows maximal bone preservation, no stress shielding and no evidence of loosening. 

In contrast to the situation with short stems (see this link), the standard length stem minimizes the risk of malpositioning and does not require grit blasted or porous coated surfaces for fixation (which can complicate stem removal).

Comment: It appears that much of the "bad rap" placed on standard length stems comes from problems related to oversized implants, which risk improper positioning, fracture and stress shielding as shown below

In terms of cost, safety, and effectiveness, the smooth, relatively thin, standard length stems appear to have advantages over many currently marketed short stemmed humeral components. Yet, for reasons known only to them, companies are choosing not to continue to provide the smooth, standard length stems.

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).