Friday, October 11, 2019

Stemless shoulder arthroplasty - what is its value?

Stemless shoulder arthroplasty: review of short and medium-term results

These authors suggest that "stemless" humeral components have theoretical advantages, including preserved bone stock, decreased operating time, reduced rate of intraoperative humerus fracture, and flexibility of anatomic reconstruction.

They reviewed the MEDLINE database to identify all studies reporting outcomes regarding anatomic or reverse stemless shoulder arthroplasty. Two examples are shown below

They found 19 TSA and HA studies with a total of 1115 patients, with 4 studies and 162 patients with a mean follow-up between 60 and 120 months. Six RTSA studies with a total of 346 patients were identified, all with a mean follow-up between 18 and 60 months. 

In the studies reporting similar outcome measures, the clinical improvements were similar to those reported for stemmed counterparts. The complication rates were similar to those reported for stemmed components. A cumulative 0.7% (8 of 1115) humeral component complication rate was found for TSA and HA components. There was a cumulative 1.7% (6 of 346) humeral complication rate for RTSA prostheses.

While it is stated that stemless humeral components are "bone preserving", it is not clear that less bone is removed with the stemless designs shown above in comparison to that with an impaction autografted standard humeral stem shown below

Both stemmed and stemless designs lead to significant improvement in shoulder comfort and function. However, this study does not show that patients receiving stemless humeral components fare better than those with standard humeral components. 

As shown in 

the average selling price for some stemless and short stem designs has been substantially greater than that for conventional designs.

Thus, it appears that future studies are needed to demonstrate increased clinical value (i.e. increased benefit to the patient divided by increased cost) of stemless designs.


Be sure to visit "Ream and Run - the state of the art"  regarding this radically conservative approach to shoulder arthritis at this link and this link. Also see the essentials of the ream and run.

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