These authors compared the two year outcomes, revisions, and complications for a first-generation cemented modular humeral implant (n=400) to those for a second-generation monolithic, primarily uncemented humeral implant (n=231) in reverse total shoulder arthroplasty with 135 neck-shaft angle and varying degrees of metallic glenosphere offsets.
Both groups of patients had similar improvement of clinical outcomes.
The incidence of humeral loosening for the cemented group was 3.6%, whereas in the uncemented group it was 0.4%.
28 shoulders treated with the cementing technique (4.0%) were revised; the causes for revision were recurrent instability (7), infection (8), humeral loosening (5), periprosthetic fracture (5), glenosphere dissociation (1), baseplate failure (1), and failure at the modular junction (1)
6 patients treated with the press fit technique (1.5%) were revised; the causes for revision included baseplate failure (3), instability (2), and glenosphere dissociation (1).
Comment: Impaction grafting (whether for an anatomic or reverse total shoulder) has the advantages of bone preservation, secure fixation, reduced risk of fracture and ease of revision.
Our technique for impaction grafting of a reverse stem is shown in this link.
