An impaction grafted standard length humeral stems provides secure fixation that preserves bone, enables the use of eccentric head components of different thickness, avoids stress shielding and fracture, and permits easy removal should revision become necessary.
Impaction grafting effectively manages the challenge of the variable medullary anatomy of the humerus (which cannot be matched by any prosthesis), while avoiding the problem of endosteal notching.
Boorman, R., Hacker, S., Lippitt, S.B., and Matsen III, F.A.: A Conservative Broaching and Impaction Grafting Technique for Humeral Component Placement and Fixation in Shoulder Arthroplasty: The Procrustean Method. Techniques in Shoulder & Elbow Surgery. 2(3): 166-175, September 2001.
Denard PJ, Hsu JE, Whitson A, Neradilek MB, Matsen FA 3rd. Radiographic outcomes of impaction-grafted standard-length humeral components in total shoulder and ream-and-run arthroplasty: is stress shielding an issue? J Shoulder Elbow Surg. 2019 Nov; 28(11): 2181-2190.