These authors analyzed 36 studies with 927 cemented humeral stems and 1555 press-fit stems. The revision rate was 5.4% (95% confidence interval (CI) 3.9 to 7.4) at a mean of 89 months for cemented stems, and 2.4% (95% CI 1.1 to 4.7) at a mean of 40 months for press-fit stems. A priori subgroup analysis to control for follow-up periods demonstrated similar revision rates: 2.3% (95% CI 1.1 to 4.7) for cemented stems versus 1.8% (95% CI 1.4 to 2.9) for press-fit stems.
They concluded that cement fixation had similar revision rates when compared to press-fit stems at short- to midterm follow-up. Rotator cuff pathology was a prevalent complication in both groups but is likely not related to fixation type. Overall, with comparable revision rates, possible easier revision, and decreased operative time, humeral press-fit fixation may be an optimal choice for primary anatomical TSA in patients with sufficient bone stock.
Comment: Here are some principles we use for humeral component fixation
(1) "Press-fit" of the stem in the humeral canal carries the risk of "too-high" positioning because the component is tight in the diaphysis. We call this "diaphyseal incarceration."
(2) "Platform" stems are designed to facilitate revision without stem removal, but in most revision cases, the stem is malpositioned so that stem removal is needed.
(3) Impaction grafting enables a standard smaller sized implant to be secured in the canal, minimizing the risk of stress shielding and facilitating component removal should revision be necessary.
Here are the x-rays from two cases done this week in which impaction grafting was used to secure the humeral component. Note the absence of diaphyseal incarceration.
(4) Cement is reserved for cases in which the height and version of the humeral component cannot be achieved with impaction grafting
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