How should the humeral component be secured in reverse total shoulder arthroplasty?

Are Short Press-Fit Stems Comparable to Standard Length Cemented Stems in Reverse Shoulder Arthroplasty? A Prospective Randomized Clinical Trial

These authors note "there has been a trend away from standard length cemented humeral implants to press-fit stems, and recently to shorter stem implants, " but minimal literature to support this trend.

The goal of their study was to compare clinical outcomes and implant migration between cemented standard length humeral stems and press-fit short stems using radio-stereometric analysis in 41 shoulders randomized to receive each of the two stems. 

Following surgery, the shoulders were imaged sequentially with stereo x-rays.

At six months, one year, and two years postoperatively, press-fit short stems migrated significantly more than cemented stems along the superior-inferior translation axis.

They noted stress shielding at the proximal medial calcar (solid arrow), and increased sclerosis at the medial metaphyseal diaphyseal junction (dashed arrow) with the use of press-fit stems (below).

The authors did not detect a significant difference in the clinical outcomes between the two types of stem fixation.

Comment: The are many different designs of reverse humeral stems with different approaches to lateralization and fixation. 

Our favored approach is shown in this link. It enables secure prothesis alignment in the proximal humerus so that subsidence is minimized

and cementless fixation of a relatively thin stem using impaction autografting. 

so that stress shielding is avoided.

See also Avoiding stress shielding around the humeral implant - are short stems the answer or the problem? 

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Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link)

Shoulder arthritis - x-ray appearance (see this link)

The smooth and move for irreparable cuff tears (see this link)

The total shoulder arthroplasty (see this link).

The ream and run technique is shown in this link.

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).