Survival of Stemless Humeral Head Replacement in Anatomic Shoulder Arthroplasty.
These authors reviewed their experience at a mean followup of 126 months with a stemless humeral head component.
The review included 75 patients with a mean age of 57 years at surgery (40 hemi- (HSA), 35 total shoulder arthroplasties (TSA), 38 females, 37 male).
The patient and shoulder characteristics are shown in the table below,
There was no significant difference in pre- and post-op CS between the hemiarthroplasty group (44.8 pre-op, 67.1 post-op) and the total shoulder group (44.4 pre-op, 68.9).
They found no evidence of humeral component loosening or stress shielding.
Upward migration of the humeral head was observed in 17.5% (21.6% HSA, 11.5% TSA).
18.3% had a rotator-cuff deficiency at follow-up (HSA: 13.9%, TSA 25%;p=0.280).
The overall revision rate was 15.1%: 20% for TSA and 7.5% for hemiarthroplasty.
9.3% of stemless shoulder arthroplasties were revised to a reverse total shoulder arthroplasty (5% of HSA, 14.3% of TSA.
For the hemiarthroplasties, secondary glenoid wear occurred in 64.3% but none were converted to TSA.
For the total shoulders, an incomplete radiolucent line < 2mm was observed in 36.4% and glenoid loosening was found in 11.4% of cemented glenoid components.
Comment: It is of interest to see the authors' use of hemiarthroplasty in over half of these cases, the issue of upward migration of the humeral head, the glenoid component failure rate in the total shoulder group, the equivalency of the clinical outcomes between total shoulder and hemiarthroplasty, and the higher revision rate for the total shoulder group.
The authors state that "the clinical and radiological long-term results of anatomic shoulder arthroplasty using a stemless humeral head implant have comparable good to the long-term results compared to standard stemmed anatomic shoulder arthroplasty". It is unclear whether the stemless component offers increased value to the patient in comparison to the standard approach to shoulder arthroplasty.
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