These authors sought compare the short-term survival rate of total stemless, metaphyseal fixated, shoulder arthroplasty (n=761) with that of total stemmed shoulder arthroplasty (n=4398) in the treatment of osteoarthritis using data from the national arthroplasty registries in Denmark, Finland, Norway, and Sweden.
Different designs of stemless humeral components were included in this study.
The trends in usage are shown below (green - standard stem, red - stemless).
A total of 21 (2.8%) stemless and 116 (2.6%) stemmed shoulder arthroplasties were revised. The 6-year unadjusted cumulative survival rates were not different: 0.953 for stemless shoulder arthroplasty and 0.958 for stemmed shoulder arthroplasty, P = 77. The most common indication for revision of both arthroplasty types was infection. Five (0.7%) stemless and 16 (0.4%) stemmed shoulder arthroplasties were revised because of loosening of either the glenoid or the humeral component.
Male gender (HR . 1.50 [95% CI, 1.06-2.13], P . .02) and previous surgery (HR . 2.70 [95% CI, 1.82-4.01], P < .001) were associated with increased risk of revision.
A total of 21 (2.8%) stemless and 116 (2.6%) stemmed shoulder arthroplasties were revised. The 6-year unadjusted cumulative survival rates were not different: 0.953 for stemless shoulder arthroplasty and 0.958 for stemmed shoulder arthroplasty, P = 77. The most common indication for revision of both arthroplasty types was infection. Five (0.7%) stemless and 16 (0.4%) stemmed shoulder arthroplasties were revised because of loosening of either the glenoid or the humeral component.
Male gender (HR . 1.50 [95% CI, 1.06-2.13], P . .02) and previous surgery (HR . 2.70 [95% CI, 1.82-4.01], P < .001) were associated with increased risk of revision.
One of the designs had a substantially higher revision rate:
Comment: This study does not present functional outcomes for the different humeral components. The data do not demonstrate an advantage in survivorship for the stemless over the conventional stemmed implant, which continues to be the most preferred design for these surgeons (see first graph above).
Our standard remains the impaction-grafted standard length smooth stemmed humeral component, because it is bone preserving, secure, adaptable, and enabling of safe removal should revision become necessary.
The amount of bone preserved with this technique is comparable to that with the stemless designs.
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