These authors present their results with the Arthrex Eclipse prosthesis with a mean follow-up of 70 months for 53 arthroplasties in 51 patients with a mean age of 65 years at the time of implantation.
They found significant improvements from preoperative to last follow-up were documented in the Constant-Murley score (53.8%-83.5%) and active range of motion. They found no significant difference in outcome between total and hemiarthroplasty.
Loss of bone mineral density was observed in anteroposterior radiographs at the humeral component in 24.5% and at the glenoid component in 33.3%.
The overall complication rate was noted at 18.9%. There was one transient upper trunk brachial plexus palsy. One patient suffered a subscapularis insufficiency with chronic anterior luxation of the glenohumeral joint and concomitant dislocation of the glenoid component, but refused surgical revision. A total of 8 patients (15.7%) underwent surgical revision. One early periprosthetic infection led to a component change. Because of recurring subluxations, one humeral head had to be changed to a larger size. Two revisions were performed for glenoid wear. An arthroscopic arthrolysis was performed for arthrofibrosis in 1 patient. Five patients underwent surgical revision because of rotator cuff and biceps tears.
Comment: A substantial amount of time and money has been devoted to the development of stemless implants, such as the Sidus (Zimmer Biomet), Easytech (FX Solutions, Viriat, France), Affinis Short (Mathys, Bettlach, Switzerland), Simpliciti (Wright, Memphis, TN, USA), SMR Stemless (Lima Corporate, Udine, Italy), Icon (DePuy Synthes, Raynham, MA, USA), and the Biomet Nano (Zimmer-Biomet).
While theoretical advantages of these prosthesis have been proposed, evidence is needed to demonstrate that the value (benefit to the patient divided by the cost (including complications)) of stemless prostheses exceeds that of standard stemmed implants.
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