UW Shoulder and Elbow Academy: Short stemmed humeral implants

Current state of short-stem implants in total shoulder arthroplasty: a systematic review of the literature

These authors conducted a systematic review of 13 articles published in the last 8 years on the outcomes with short-stem humeral implants for total shoulder arthroplasty. The average followup was 33 months. They found that 85% disclosed conflicts of interest. The average age was 67 years with an equal percent of males and females. The implants included those by Tornier (70%), Arthrex (16%), Mathys (8%), and Biomet (was 8%). Almost all (12/13, 92%) reported results of uncemented components. Only 20% of the patient had a lesser tuberosity osteotomy (the rest with peel or tenotomy); the authors suggest that this may be due to surgeon concern about weakening the proximal humerus with the LTO.

Improvements were seen in all measured range of motion planes and patient-reported outcome scores. The Simple Shoulder Test scores improved from 4 to 10.
They found a 2% humeral loosening rate, a 3% overall revision rate, and a 1% rate of revision for aseptic humeralbloosening. Radiographic results showed a 13% rate of radiolucent lines, a 16% rate of condensation lines, and a 22% rate of calcar osteolysis.

An example of loosening

An example of stress shielding

Comment: This is an informative review of the current information on short stemmed humeral components.

Our current practice continues to use an uncemented smooth standard length humeral stem fixed with impaction autograft to distribute loads evenly between the component and bone.

This approach results in small filling ratios (the percent of the humerus occupied by the stem). Note that the amount of bone removed with this method is essentially the same as that removed with a short stem.

Impaction allografting has been useful in revising loose short stems. Below is the pre-revision x-ray showing the loose short stem as well as wear of the glenoid component.

Below is the post-revision x-ray at 6 months after removal of the short stem and glenoid component followed by impaction allograft of a long stem.

Here is a video of the patient's function at 6 months after revision.

To see a YouTube of our technique for total shoulder arthroplasty, click on this link.

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