Cemented Humeral Stem Fixation: Standard of Care

Abstract

Cemented humeral stem fixation in shoulder joint arthroplasty has been, and continues to be, the gold standard to ensure satisfactory implant orientation and stability. The most commonly performed type of shoulder arthroplasty is hemiarthroplasty in the face of comminuted fracture. Appropriate stem height and version relative to the glenoid is paramount in obtaining a satisfactory result. This has been proven to be reliably reproducible through cement fixation of the stem with careful reattachment of the tuberosities. Total shoulder arthroplasty in rheumatoid patients with questionable bone stock likewise has relied upon cementation of the humeral component to ensure secure fixation, prevent loosening, and avoid subsidence. In younger patients, it is tempting to want to avoid cement in the proximal humerus; nonetheless, most studies have demonstrated loosening of the humeral component not to be problematic once cement has been used. In addition, newer modular components allow head removal (without stem removal), providing ready access to the glenoid should glenoid revision be needed. In addition, the ability to add antibiotics within the cement mantle in high-risk patients affords an advantage in treating and/or avoiding infection. Survivorship studies have not demonstrated an advantage of cementless versus cement fixation of the humeral component in shoulder arthroplasty.