The cemented humerus and non-cemented glenoid: The optimal hybrid solution for total shoulder arthroplasty

Abstract

Hybrid fixation of total joint arthroplasty has been recognized as an accepted form of surgical approach in multiple joints. Principles of implant fixation should focus on durability and on providing secure long-term function. To date, there is no conclusive evidence that pressed-fit humeral stem fixation has an advantage over well-secured cemented humeral fixation. Although revision may require cement removal, a well-fixed bone—ingrowth implant may require slatting and osteotomy of the humerus. On the contrary, need for revision in arthroplasty due to inadequate implant fixation has almost universally revolved around the failure of cement fixation and loosening of the glenoid component. A case will be made based on 30 years of experience of a surgeon performing total shoulder arthroplasty using secure modern cement-fixation techniques of humeral components. More recently, over the past 10 years an extremely high rate of durable secure glenoid implant fixation has been achieved using press-fit tantalum porous anchorage of polyethylene glenoid components. This has resulted in no cases of loosening of glenoid fixation and only one case of glenoid component fracture with greater than 95% survivorship over a 10-year period. A combination of well-cemented humeral stem and trabecular metal anchorage of the glenoid has provided durable and long-lasting function in primary total shoulder arthroplasty.