Prospective, Blinded, Randomized Controlled Trial of Stemless Versus Stemmed Humeral Components in Anatomic Total Shoulder Arthroplasty
These authors directly compared the 2 year clinical and radiographic outcomes of short stemmed (below left) and stemless (below right) humeral implants in a prospective, multicenter, single-blinded randomized controlled trial of 265 shoulders.
At 2 years, the mean ASES score was 92.5 ± 14.9 for the stemless cohort and 92.2 ± 13.5 for the short stemmed cohort.
The proportion of shoulders without device-related complications was 92% (107 of 116) for the stemless cohort and 93% (114 of 123) for the short stemmed cohort. Complications included humeral and glenoid fractures, anterior subluxation, infection, dislocation, ad subscapularis tear.
No shoulder in either cohort had radiographic signs of loosening. Range-of-motion measurements and ASES, SANE, and Constant scores did not differ significantly between cohorts at any time point within the 2-year follow-up.
The authors noted no significant difference between the 2 cohorts in terms of operative time. They also noted 4 glenoid fractures in the stemless cohort on postoperative radiographs. The reasons for this finding were unclear as there were no differences between the stemmed and stemless procedures with regard to the humeral neck cut or the glenoid exposure and preparation.
Comment: This is a well done randomized controlled trial comparing stemless and short stemmed humeral components.
The authors suggest that stemless humeral implants have several potential benefits over stemmed implants, including simplified recreation of native anatomy, decreased risk of intraoperative periprosthetic humeral shaft fractures, decreased operative time and blood loss, preservation of humeral bone stock, less bone loss over time (due to decreased stress shielding), and easier explantation if revision is needed. However, none of these potential benefits were demonstrated in this study.
Furthermore, it is not clear that the amount of bone removed with a stemless humeral component (below left) is less than that removed for an impaction grafted standard stem (below right).
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