Abstract

PurposeTraditionally and since Neer, the humeral side of shoulder arthroplasty consisted of a stemmed component but the real need for stem fixation in total shoulder arthroplasty (TSA) has barely been investigated. The current study evaluated the clinical and radiological outcomes with a stemless TSA.MethodsForty-seven patients, 20 female and 27 male patients with an average age of 63, were selected in four orthopaedic centres during a four year period, and implanted with a humeral head prosthesis with a three-fin design and titanium coating. Aetiologies were: primary osteoarthritis (29), fracture sequelae (12) and avascular osteonecrosis (6). Minimum follow-up was two years (range 24–51 months). The patients were evaluated with the Constant score (CS) and radiological exams.ResultsTwo patients had revision of the implants, one for persistent pain and one for secondary massive rotator cuff tear. At the final follow-up, the mean CS was 69, with an average gain of 36. All parameters improved with a foremost in pain relief. Mean satisfaction rate was 87%. Average anterior active elevation was 131° with a gain of 48. Radiologic evaluations showed stable implants in all cases. However, 17 cases demonstrated radiolucent areas, particularly superior and lateral to the implant, which neither decreased nor increased with time. No revisions were related to humeral component loosening.ConclusionsStemless TSA provides the same results as compared to TSA with a humeral stem. We are still unsure as to the nature of the lucent zones and we are continuing our investigation to better understand this radiological phenomenon.

Highlights

  • Designs of early total shoulder arthroplasty (TSA) implants were based, in principle, on those of total hip arthroplasty (THA), with a cemented humeral stem

  • Numerous authors reported the clinical outcomes of stemless shoulder arthroplasty designs with good results [7, 8]

  • Our hypothesis was that outcomes of stemless TSA would be equivalent to those of classic stemmed TSA designs

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Summary

Introduction

Designs of early total shoulder arthroplasty (TSA) implants were based, in principle, on those of total hip arthroplasty (THA), with a cemented humeral stem. Since their introduction [1], four generations of stemmed TSA designs were developed, and demonstrated satisfactory clinical outcomes for reduction of pain and improvement of mobility. The most frequently reported complication, is loosening of the glenoid component [2,3,4]. The most common humeral complications are: intra-operative fracture, loosening, stress-shilding and periprosthetic fracture [4,5,6]. Numerous authors reported the clinical outcomes of stemless shoulder arthroplasty designs with good results [7, 8]. Our hypothesis was that outcomes of stemless TSA would be equivalent to those of classic stemmed TSA designs

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