Press-fit humeral implants in revision shoulder arthroplasty are as effective as cemented arthroplasty: a retrospective cohort study

Abstract

BackgroundRevision shoulder arthroplasty (RSA) is an increasingly common procedure that can involve cemented or uncemented humeral implants. Although cement fixation is often advocated, it is not clear if the outcome is comparable to that of press-fit fixation. This study evaluated the survivorship and outcomes of cemented and press-fit humeral components in patients undergoing RSA at our institution. MethodsMedical records from adult patients who underwent RSA were reviewed retrospectively. Demographics and surgical data as well as subjective and objective outcome measures were collected. Patients were stratified into 3 groups according to their humeral revision type: cemented, uncemented, and retained stems. ResultsA total of 70 RSA patients with an average follow-up of 51.8 ± 43.9 months were included in the analysis: stems were cemented in 18.6% of the patients, uncemented in 61.4%, and retained in 20.0%. There were no significant group differences in patient characteristics. Follow-up data were available for 54 (77.1%) patients 2 or more years after RSA. There were no differences in patient-reported outcome measures among the groups. Active abduction at 1 year was greater for uncemented revisions than for cemented and retained stem components (128.9° ± 49.7° vs. 98.1° ± 55.7° and 100.8° ± 49.9°, respectively; P < .05). Patients in the uncemented and retained stem cohorts had greater strength in forward flexion, abduction, and external rotation than those in the cemented cohort, whereas patients in the cemented stem group had lower internal rotation strength at 1 and 2+ years of follow-up (P < .05). Postoperative radiographs indicated that none of the stems were at risk for failure. However, humeral bone loss was more common among those with uncemented stems (P = .02); in most of the cases, the loss was attributable to stress shielding. Survivorship of the implants did not differ among the groups, ranging from 91.1% to 92.3%. ConclusionPress-fit humeral components may be a viable option for RSA in patients with adequate humeral bone stock.