Stemless Shoulder Arthroplasty Research Articles

Two-year follow-up of the SMR stemless platform shoulder system. A multicentre, prospective clinical study.

BackgroundThe use of stemless shoulder arthroplasty for osteoarthritis has grown substantially over the past decades. The goal of this study is to evaluate the clinical and radiological outcomes of the Lima SMR Stemless anatomic and reverse total shoulder arthroplasty. Methods73 implants in 73 patients (61 anatomic total shoulder arthroplasties (aTSA) and 12 reverse shoulder arthroplasties (RSA)) were analyzed with a minimum follow-up of 2 years. Average age in the aTSA group was 65,8±8,7 and 78,3±4,8 in the RSA group. Primary osteoarthritis was the indication in most cases (aTSA 93,7%, RSA 67%). Patients were evaluated preoperatively, at 4, 12, and 24 months postoperatively using the Constant Score, the ASES, OSS, EQ-5D-5L, range of motion scores and radiographically. Statistical significance was evaluated using the paired t-test (p<0,05). ResultsAt 2-year follow-up, the overall average Constant Score significantly improved from 40.0 ± 16.7 to 80.9 ± 21.4 (p<0.001). Improvement of the ASES (from 31.7 ± 15.6 to 82.5 ± 19.4) and OSS (from 19.1 ± 7.4 to 41.9 ± 7.9) was also significant (p<0.001). In the aTSA group, all range of motion scores improved significantly (p<0.001). In the RSA group, all range of motion scores improved but only active forward flexion and external rotation in abduction improved significantly (p<0.05). Most patients were satisfied or completely satisfied at 24 months (aTSA 93.9%, RSA 100%). Two humeral implants in the RSA configuration showed loosening on the first postoperative day related to excessive forces exerted on the shoulder, both requiring revision to a stemmed implant.In the aTSA group, no signs of radiolucencies, osteolysis, gradual loosening or migration of the components were seen at final follow-up. In the RSA group, one case had radiolucent lines with subsidence of the humeral core at 12 months which had not progressed at 24 months and was asymptomatic. All other RSA cases showed no radiolucent lines, migration, scapular notching or osteolysis. 3 anatomic implants were converted with retention of the glenoid baseplate and humeral core to a reverse arthroplasty due to atraumatic cuff failure (N=2) and traumatic cuff failure (N=1). After these procedures, patients were satisfied with their results. There were no other complications. ConclusionThe 2-year results presented in this study show good functional and radiological outcomes using the SMR Stemless system.

Influence of humeral position of the Affinis short® stemless shoulder arthroplasty system on long-term survival and clinical outcome

The purpose of this study was to evaluate the influence of humeral position of Affinis short implant in stemless anatomic total shoulder arthroplasties (STSA) on clinical and radiological results and mid- to long-term survival in the treatment of primary osteoarthritis (OA) of the shoulder. 80 patients treated with a stemless shoulder arthroplasty for OA of the shoulder were evaluated with a mean follow-up (FU) of 92 ± 14 months (range 69 to 116 months) by Constant (CS)-Score, Disability of Shoulder, Arm and Hand (DASH)-Score and active range of motion (ROM). Radiographic assessment for bone adaptations and humeral implant position was performed by plain X-rays. Determination of pre- and postoperative center of rotation (COR) was used to assess the restoration of the geometry of the humeral head. The appraisal of proper humeral component positioning was correlated with the functional outcomes. A Kaplan-Meier analysis was calculated, investigating the influence of humeral implant position compared to survival time. Complications were noted. The ROM (p < 0.001), CS-Score (p < 0.001) and DASH-Score (p < 0.001) showed significant improvements after surgery for the entire series. The COR restoration was anatomical in 75 % (n = 60) of all implants and in 25 % (n = 20) non-anatomical (pre- and postoperative COR deviation of 2.7 ± 1.8 mm vs. 5.1 ± 3.2 mm, p = 0.0380). The humeral component position did not affect the functional outcome whereas the ten-year unadjusted cumulative survival rate for the anatomic group was significant higher in comparison with the non-anatomical group (96.7 % vs. 75 %, p = 0.002). The radiological evaluation revealed minor periprosthetic bone adaptions in various forms without clinical significance or further intervention. No revision was necessary due to a failed fixation of the stemless humeral component. Regarding primary OA of the shoulder, STSA derives excellent long-term survival and clinical outcome. These types of implants are able to restore the geometry of the humeral head. Non-anatomical reconstruction may influence the survival over a long-term period on different pathways. Further studies are necessary to elucidate the effect of humeral component position in STSA on functionality, pain and implant survival rate.

Return to Sport after Stemless Shoulder Arthroplasty

Zusammenfassung Hintergrund Das Verfahren der schaftfreien anatomischen oder inversen Schulterprothese ist für die Behandlung einer Vielzahl von Schultererkrankungen vorgesehen, darunter primäre, zentrierte oder sekundäre Omarthrosen, irreparable Rotatorenmanschettenläsionen und Rotatorenmanschetten-defiziente Omarthrosen („Cuff-Arthropathien“) und chronische Instabilitäten. Die schaftfreie Schulterprothese bietet gegenüber der herkömmlichen schaftgeführten Schulterprothese mehrere theoretische Vorteile, darunter kürzere Operationsdauer, knochensparende Technik und weniger perioperative Komplikationen wie Humerusschaftfrakturen oder „stress shielding“. Durch den Knochenerhalt und den natürlichen Kraftabbau bei unversehrter Elastizität der Epi- und Diaphyse zeigen sich langfristige osteologische Vorteile. Methoden Dieser Beitrag befasst sich anhand der aktuellen Literatur mit den Möglichkeiten und Auswirkungen der Rückkehr zum Sport nach schaftfreier anatomischer und inverser Schulterprothetik. Ergebnisse Die Studienlage zeigt bei deutlich gestiegener Anzahl von Schulterimplantationen eine klare Tendenz zu verbesserter Beweglichkeit sowie eine signifikante Verbesserung des Constant-Murley-Scores und der Sportfähigkeit sowohl von anatomischen als auch inversen Prothesen. Das präoperative Aktivitätsniveau, die Konfiguration und Art der Prothese spielen aber eine wichtige Rolle für die Rückkehr zum Sport. Zudem steigt auch der Anspruch von Patienten nach Versorgung mit inversen Schulterprothesen sportlich aktiv zu sein. Schlussfolgerung Diese Übersichtsarbeit befasst sich mit der aktuellen Literatur, den Möglichkeiten und Auswirkungen der Rückkehr zum Sport von schaftfreien anatomischen und inversen Schulterprothesen und weist auf die markanten Unterschiede zwischen anatomischer und inverser Versorgung hin.

Stemless Shoulder Arthroplasty for Glenohumeral Arthritis with Underlying Varus Malunion of the Proximal Humerus - A Case Report with Mid-Term Follow Up

We present a 65 year old right hand dominant female with a varus malunion of her right proximal humerus who went on to develop post-traumatic arthritis of her right glenohumeral joint refractory to years of conservative management. Due to inability to pass a stemmed humeral implant as well as concerns associated with a proximal humerus osteotomy, we performed a total shoulder arthroplasty using a stemless humeral implant. We present mid-term follow up at six years showing excellent range of motion, excellent functional scores, and radiographs. This is one of the only US based studies to our knowledge to report mid-term data on clinical and radiographic outcomes for the use of a stemless humeral implant during a total shoulder arthroplasty in the setting of a proximal humerus deformity

Midterm results of stemless impaction shoulder arthroplasty for primary osteoarthritis: a prospective, multicenter study.

Stemless shoulder arthroplasty using 4 open-fin press-fit anchors has been showing promising short-term clinical and radiographic results for patients' primary osteoarthritis. This prospective, multicenter study presents 5-year postoperative clinical and radiological outcomes of a stemless shoulder arthroplasty for primary osteoarthritis. Between November 2012 and December 2015, 100 patients were treated for primary osteoarthritis with the Sidus stem-free shoulder system at 7 European centers. Clinical assessment included the Constant-Murley Score, American Shoulder and Elbow Standardized Shoulder Assessment Form score, Subjective Shoulder Value, and range of motion. True anteroposterior, axial and lateral radiographs were reviewed for osteolysis, glenoid and humerus loosening, heterotopic ossification, radiolucent lines, component migration and humeral bone resorption. In addition to a Kaplan-Meier survival analysis, a comparative analysis between total shoulder arthroplasty and hemiarthroplasty was performed. Seventy-one patients (36 females) with a mean age of 63.8 years (range: 47-79 years) were available for the 5-year clinical and radiographic follow-up (range: 52-79 months). There was a significant increase (P<.0001) in all outcome scores compared to baseline values. Patients with total shoulder arthroplasty (n=48) achieved significantly better functional outcome than patients with shoulder hemiarthroplasty (n=23) with regard to the absolute and relative Constant-Murley Score, American Shoulder and Elbow Standardized Shoulder Assessment Form score, and Subjective Shoulder Value as well as greater abduction strength and range of motion in forward elevation and external rotation (P≤.004). There were no cases of osteolysis or humeral loosening. There were some cases of heterotopic ossification (1.4%), radiolucency around the humerus (1.4%) or glenoid (25%), glenoid migration (2.1%), inferior osteophytes (1.4%) or humerus bone resorption (9.9%). The 5-year survival was 94%. Patients treated with the Sidus stem-free shoulder system for primary osteoarthritis continue to achieve good clinical and radiographic results without any signs of aseptic humeral implant loosening at 5 years postsurgery.

High prevalence of early stress shielding in stemless shoulder arthroplasty

IntroductionThe rates of early stress shielding in stemless total shoulder arthroplasty (TSA) in current literature are very low and inconsistent with our observations. We hypothesized that the incidence of early stress shielding in stemless TSA would be higher than previously reported. MethodsAll stemless TSA in a prospective database using a single humeral implant comprised the study cohort of 104 patients, of which 76.0% (79 patients) had a minimum one year radiographic and clinical follow-up. Radiographs were reviewed for humeral stress shielding, humeral radiolucent lines, and humeral or glenoid loosening/migration. Stress shielding and radiolucent lines were classified by location. Demographics and clinical outcomes, including American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS) pain score, were compared between patient cohorts with and without stress shielding. ResultsAt one year, 41.8% of patients had humeral stress shielding. Medial calcar osteolysis was seen in 32.9% of all patients and 78.8% of the stress shielding cohort. There were no cases of radiolucent lines or humeral or glenoid loosening/migration. There was no significant difference in age between cohorts (P = .308), but there were significantly more females (P = .034) and lower body mass index in the stress shielding cohort (P = .004). There were no significant differences in preoperative ASES (P = .246) or VAS scores (P = .402) or postoperative ASES (P = .324) or VAS scores (P = .323). ConclusionStress shielding in stemless TSA is more prevalent than previously published, largely due to infrequently reported medial calcar osteolysis. Stress shielding is more common in women and patients with lower body mass index. At early follow-up there were no significantly worse outcomes in the stress shielding cohort, but longer-term follow-up is needed to fully understand the impact of stress shielding on function and stability.

Short Stems and Stemless Shoulder Arthroplasty: Current Concepts Review.

Historically, the shoulder arthroplasty humeral component has been designed for the management of infections, tumours and fractures. In all these cases the stem was needed as a scaffold. Original humeral components were not developed for use in shoulder arthritis, so these designs and derivates had a long stem. The newest humeral implants innovations consist in shortening of the implant, or even removing the whole stem, to rely on stemless fixation at the level of the metaphysis. This implies the advantages of preserved bone stock, less stress shielding, eliminating the diaphyseal stress riser, easier implant removal at revision, and humeral component placement independent from the humeral diaphyseal axis. Nowadays, surgeons try to balance the need for a stable fixation of the humeral component with the potential need for revision surgery. Complications of revision shoulder arthroplasty are related to the need for removing a well-fixed humeral stem, the length of the procedure, and the need to treat severe bone loss.

Short-term results of a new anatomic stemless shoulder arthroplasty - A prospective multicentre study.

Anatomic total shoulder arthroplasty (TSA) has been continuously developed and current designs include stemless or canal-sparing humeral components. In the literature stemless and canal sparing TSA showed good clinical and radiographic results, which were comparable to stemmed TSA. The aim of this study was to determine the short-term clinical and radiological outcomes of a new stemless TSA design. A prospective multicentre study including 154 total shoulder arthroplasty patients with a follow up of 12 months was performed. At the time of follow up 129 patients were available for review. The adjusted Constant Murley score,1 Oxford Shoulder Score, EQ-5D-5L score and radiographs were examined preoperatively, 3 and 12 months after the implantation of the new stemless TSA implant GLOBAL ICON™ (DePuy Synthes, Warsaw, IN, USA). Complications were documented. Implant Kaplan-Meier survivorship was 98.7% at 12 months. From baseline to 12 months follow-up, all scores showed a progressive significant mean improvement. The mean adjusted Constant score increased from 42.3 to 96.1 points (p<0.001). The Oxford Shoulder Score showed an increase of 21.6 points (p<0.001). The postoperative radiographs showed no continuous radiolucent lines, subsidence, aseptic loosening or progressive radiolucency, but one osteolytic lesion was observed. Only 2 prostheses were revised. The new GLOBAL ICON stemless TSA showed good clinical and radiographic results at short-term follow up which were comparable to early results of other stemless TSA. Further studies with longer follow up are needed in the future.

Proximal humeral bone loss in stemless shoulder arthroplasty: potential factors influencing bone loss and a new classification system.

Proximal humeral bone loss in total shoulder arthroplasty (TSA) is more frequent than in hemiarthroplasty. Factors such as age, gender, inclination angle, and radiolucent lines may also contribute. Additionally, current bone loss grading systems are often not sensitive enough to detect slight bone changes, especially at the medial calcar where bone loss is commonly observed. This study uses a new, more detailed bone loss grading system to evaluate factors that could influence bone loss at the proximal humerus. In this single-center prospective study, patients underwent hemiarthroplasty or TSA with an anatomic stemless prosthesis. Bone loss was measured at the proximal humerus using the new grading system. The effect of treatment type, age, gender, radiolucent lines, and inclination angle on bone loss was evaluated. The Constant-Murley score of patients was assessed and complications recorded. Ninety-one shoulders were available for the final follow-up examination at a median of 85.0months (range 82.6-121.1months). Bone loss was found at the proximal humerus in approximately one-third of shoulders, and significantly more shoulders had bone loss in TSA than in hemiarthroplasty (P = 0.03). However, this difference was no longer significant after stratifying by gender and age (P > 0.05). Bone loss significantly correlated with gender (P = 0.03) but not with treatment type, radiolucent lines, and the postoperative inclination angle (P > 0.05). Most Constant-Murley score components did not differ significantly between shoulders with and without bone loss (P > 0.05). Lastly, six complications and four revisions were reported. Results showed gender had the greatest influence on bone loss after stemless shoulder arthroplasty. Furthermore, both patients with or without bone loss can expect similar clinical outcomes with the stemless prosthesis used in this study. Lastly, the new grading system is simple and straightforward to use.

Short-term survival and patient-reported outcome of total stemless shoulder arthroplasty for osteoarthritis are similar to that of stemmed total shoulder arthroplasty: a study from the Danish Shoulder Arthroplasty Registry

BackgroundThe use of stemless total shoulder arthroplasty (TSA) for osteoarthritis increases, but there is a paucity on its safety and efficacy and how it performs in comparison with stemmed TSA. The aim was to compare the 5-year cumulative survival rate and patient-reported outcome after stemless and stemmed TSA for osteoarthritis.MethodsWe included all stemmed (n = 1197) and stemless (n = 253) TSA for osteoarthritis reported to the Danish shoulder arthroplasty registry from January 1, 2014, to December 31, 2018.ResultsSix (2.4%) stemless and 24 (2%) stemmed TSA were revised. The 5-year cumulative implant survival rates were 0.96 for stemless TSA and 0.97 for stemmed TSA. In the multivariate Cox regression model, the hazard ratio for revision was 1.1 (95% confidence interval, 0.5-2.6) for stemless TSA compared with stemmed TSA. The mean Western Ontario Osteoarthritis of the Shoulder (WOOS) index was 82 (standard deviation = 21) for stemmed and 86 (standard deviation = 19) for stemless TSA. The stemless TSA had a statistically significant better WOOS compared with stemmed TSA, but the difference of 6.2 (95% confidence interval, 1.4-10.4) was not regarded as clinically relevant. There was no difference in WOOS between the Nano and the Eclipse systems.DiscussionWe found a good 5-year cumulative implant survival rate of stemless TSA, which was comparable with stemmed TSA. Although the stemless TSA had a statistically significant better patient-reported outcome compared with stemmed TSA, the difference was not clinically relevant. Sparing the humeral shaft canal for later revision could be an argument for using stemless TSA instead of stemmed TSA.

Food and Drug Administration–reported complications of anatomic stemless total shoulder arthroplasty vary with implant model

BackgroundStemless shoulder arthroplasty not only allows for shorter operative time and less blood loss but also for placement of the humeral head independent of the diaphysis, thereby preserving bone that may be needed for further revisions. The purpose of this study was to evaluate the current adverse event profile for anatomic stemless shoulder arthroplasty using the Manufacturer and User Facility Device database. MethodsThe adverse event reports mandated by the US Food and Drug Administration for all hospitals housed in the Manufacturer and User Facility Device database were screened for mention of anatomic stemless total shoulder arthroplasty (TSA). Each applicable report was then characterized by implant design and failure mode. ResultsThe most commonly reported stemless implants were the Zimmer Biomet Sidus, Zimmer Biomet Nano, and Arthrex Eclipse. The most common complications were pain/stiffness (16.8%), glenoid component loosening (12%), glenoid component failure (11%), and problems with attachment onto the humeral insert (9.9%). ConclusionsBecause of the benefits of increased bone preservation with less operative time and decreased blood loss compared with anatomic stemmed TSA, stemless implants are becoming increasingly popular in clinical practice. There were no findings that discourage the use of stemless TSA in the right candidate. Level of evidenceLevel III; Database Case Series Treatment Study

A biomechanical comparison of subscapularis tenotomy repair techniques for stemless shoulder arthroplasty.

One of the leading challenges for surgeons shifting to stemless anatomic total shoulder arthroplasty (TSA) is subscapularis repair. In the available literature reporting outcomes after stemless TSA, subscapularis tenotomy with side-to-side repair is the most common technique despite some concerns regarding this technique in the biomechanical and clinical literature. Accordingly, this study investigated subscapularis tenotomy repair with stemless TSA with 2 primary objectives: (1) to evaluate the subscapularis tendon dimensions with reference to subscapularis tenotomy to determine the amount of tendon remaining for side-to-side repair after shoulder arthroplasty and (2) to biomechanically compare 2 methods of subscapularis tenotomy repair after stemless TSA-side-to-side repair and anchor-based repair. We used 12 male shoulder specimens for this study. To address our first objective, measurements were made to calculate the dimensions of the subscapularis tendon at the superior, middle, and inferior levels to determine the amount of tendon remaining after tenotomy. These specimens were then divided into 2 groups (n = 6 in each group) to biomechanically compare subscapularis tenotomy repair with (1) traditional side-to-side repair and (2) anchor-based repair. The shoulders then underwent biomechanical testing with primary outcomes including load to failure and cyclic displacement. The mean subscapularis tendon width measured from the medial insertion at the lesser tuberosity to the muscle-tendon junction varied depending on the level: 19.5 mm superiorly (95% confidence interval [CI], 16.2-22.8 mm); 18.3 mm at the midportion (95% CI, 13.6-23.0 mm); and 13.1 mm inferiorly (95% CI, 9.1-17.1 mm). With a tenotomy made 1 cm medial to the lesser tuberosity insertion, a mean of 3.1 mm of tendon remained medially at the inferior subscapularis, with one-third of specimens having no tendon left medially at this level. On comparison of tenotomy repair techniques, the anchor-based technique had a 57% higher ultimate load to failure compared with the side-to-side repair (448 N vs. 249 N, P < .001). There were no significant differences in cyclic displacement (6.1 mm vs. 7.1 mm, P = .751) and construct stiffness (38.1 N/mm vs. 42.9 N/mm, P = .461) between techniques. With traditional techniques for subscapularis tenotomy for anatomic TSA, there is very little tendon remaining inferiorly for side-to-side repair. When subscapularis tenotomy is performed for stemless TSA, a double-row anchor-based repair has a better time-zero ultimate load to failure compared with side-to-side repair.

Restoration of the joint geometry after stemless shoulder arthroplasty.

This study aims to evaluate restoration of anatomy following Total Shoulder Arthroplasty (TSA) with the Mathys Affinis Short prosthesis. Over the last decade stemless shoulder arthroplasty has increased in popularity. One of the reported advantages of the stemless designs is the ability to restore anatomy following surgery. However, very few studies have evaluated restoration of anatomy following stemless shoulder arthroplasty. The study included all patients who had undergone TSA using the Affinis Short (Mathys Ltd, Bettlach, Switzerland) prosthesis for primary osteoarthritis between 2010 and 2016. The mean follow up was 42.8 months (range 9.4 to 83.4 months). Pre and post-operative radiographs were assessed for Centre of Rotation (COR), Humeral Head Height (HHH), Humeral Head Diameter (HHD), Humeral Height (HH) and, Neck Shaft Angle (NSA) using the best fit circle method on PACS software. Measurements were scored and compared to assess the accuracy of the implant in restoring the native geometry, including the intraobserver variability. The same data was collected by another experienced observer to measure the interobserver variability. The deviation of COR of the prosthesis from the anatomical centre was less than 3 mm in 58 cases (85%). Humeral head height and humeral head diameter showed a variation of less than 3 mm in 66 cases (97%) and 43 cases (63%) respectively. Humeral height followed a similar trend, with 62 cases (91.2%) showing a difference of less than 5 mm. The neck shaft angle showed a variation of more than 8 degrees in 38 cases (55%), and 29 cases (42.6%) had a postoperative angle of less than 130 degrees. Overall, stemless total shoulder arthroplasty with the Affinis Short prosthesis allows excellent restoration of anatomy confirmed by most of the measured radiographic parameters. The variability in neck shaft angle might be due to differing surgical techniques, with some surgeons preferring a slightly vertical neck cut to protect the rotator cuff insertion.

Anatomic and Reverse Stemless Shoulder Arthroplasty: Functional and Radiological Evaluation.

BackgroundStemless shoulder arthroplasty was developed to restore the glenohumeral centre of rotation without violation of the humeral shaft. It allows the preservation of humeral bone stock. Complications related to stem malalignment and periprosthetic fractures can be avoided.Patient and methodsThis is a prospective observational study that reports outcomes of 46 patients who received stemless shoulder arthroplasty “Comprehensive Nano implant ®.” The series includes Group (A): 30 anatomic and one hemiarthroplasty. Group (B): 15 reverse stemless replacement. Functional outcomes were assessed by visual analog score (VAS), satisfaction, range motion, Constant score, and American Shoulder and Elbow Score (ASES).ResultsThe mean follow-up was 40.4  ±  12 months (range, 24 months to 60 months). Group (A): VAS and satisfaction improved by 5.3 and 67.5 points respectively. Constant score significantly improved from 28.5  ±  14.5 to 62.5  ±  23 P = <0.001. The radiological assessment showed the mean centre of rotation (COR) deviation was 2.8  ±  1.9 mm. 27% of patients have COR discrepancy of more than 4 mm. In Group (B), patients reported a significant improvement in VAS, Satisfaction, and ASES P  =  0.002, 0.002, and 0.003, respectively.Complications include shoulder pain with progressive loss of movements, aseptic loosening early subscapularis rupture, glenohumeral dislocations, and humeral component migration.ConclusionAnatomic Stemless total shoulder arthroplasty offers acceptable results and improvement of overall functional outcomes.

Sex-related differences in stemless total shoulder arthroplasty.

BackgroundThe use of stemless humeral implants for shoulder arthroplasty is becoming increasingly widespread. However, little is known about the difference in clinical, functional, and radiographic outcomes of stemless shoulder arthroplasty between men and women. Men and women do have reported differences in size, strength, and bone quality. As such, the purpose of this study was to evaluate sex-related differences in outcomes when using stemless humeral implants.MethodsA retrospective review of 227 patients (men = 143 and women = 84) undergoing stemless shoulder arthroplasty was compared for sex-related differences. Clinical, functional, and radiographic outcomes were compared, including American Shoulder and Elbow Surgeons (ASES) scores, visual analog scale pain scores, range of motion, radiolucencies, operative data, implant data, and complications. Statistical analysis included descriptive statistics, t-tests, chi-square tests, and logistic regression.ResultsPreoperatively, men had a statistically significant greater range of motion of forward elevation (P < .01), external rotation (ER) at adduction (P = .04), ER at 90° abduction (P = .03), and baseline ASES scores (P < .01). At 2 years, there were no differences between men and women in ASES score (P = .12), visual analog scale pain score (P = .74), active ER (P = .98), implant migration, or radiolucencies (P > .99). Mean operating time was 9 minutes longer in male patients (P < .01). There was no significant difference in surgical complications, including dislocation, fracture, infection, or loosening. The three-year revision-free survival was 98.8% for women and 97.9% for men.ConclusionPatient sex is not predictive of postoperative functional outcomes after stemless shoulder arthroplasty. The operative time was significantly shorter in female patients, and there was no significant difference in surgical complications between men and women.

Intermediate to long term results of stemless metaphyseal reverse shoulder arthroplasty: A five to nine year follow-up

BackgroundShoulder arthroplasty incidence is increasing as is the volume of revision surgeries. Revision surgery is easier if humeral bone stock is preserved with minimal bone defects and osteolysis. This has led to an increased focus on the development of various short stemmed and stemless implants which provides stable fixation whilst preserving humeral bone stock. PurposeTo review the medium to long term clinical and radiological outcomes, complications and survival rates of a stemless reverse shoulder prosthesis. Patients and methodPatients with a minimum follow-up of 60 months following a reverse stemless shoulder arthroplasty were deemed eligible. Clinical and radiological data on twenty-one patients operated between 2009 and 2014 were recorded prospectively. Survivorship and patient recorded symptoms with the end point of revision surgery were recorded. ResultsMean follow-up of 78 months (60–114 months). Mean range of active elevation was 136° (80–170°). Mean range of active abduction and active external rotation was 122° (70–170°) and 47° (10–75°) respectively. Mean Oxford score improved from 12 pre-operatively to 44 at final follow up (p < 0.0001). Mean Constant Murley Score improved from 18 to 72 (p < 0.0001). Mean ADLEIR score of 13 pre-operatively increased to 32 post-operatively (p < 0.0001). Notching was seen in 23.5% of cases and no radiolucent areas were observed around the glenoid component. There were two cases of post traumatic peri-prosthetic fractures that were managed conservatively and one case of deep-seated infection that required a washout. The survivorship at the most recent follow-up was 100%. ConclusionThe advantages of bone preservation with the stemless metaphyseal prosthesis combined with encouraging medium to long term clinical and radiological results are very promising, particularly with the improved post-operative patient satisfaction scores. This is the first study that reports the results with a minimum of 5 year follow-up and has the longest mean follow-up period. Clinical relevanceThe reverse stemless shoulder prosthesis is an effective and reliable option for elective shoulder arthroplasty.

Long-term survival and failure analysis of anatomical stemmed and stemless shoulder arthroplasties.

The purpose of this study was to compare clinical results, long-term survival, and complication rates of stemless shoulder prosthesis with stemmed anatomical shoulder prostheses for treatment of osteoarthritis and to analyze radiological bone changes around the implants during follow-up. A total of 161 patients treated with either a stemmed or a stemless shoulder arthroplasty for primary osteoarthritis of the shoulder were evaluated with a mean follow-up of 118 months (102 to 158). The Constant score (CS), the Disabilities of the Arm, Shoulder and Hand (DASH) score, and active range of motion (ROM) were recorded. Radiological analysis for bone adaptations was performed by plain radiographs. A Kaplan-Meier survivorship analysis was calculated and complications were noted. The ROM (p < 0.001), CS (p < 0.001), and DASH score (p < 0.001) showed significant improvements after shoulder arthroplasty for both implants. There were no differences between the groups treated with stemmed or stemless shoulder prosthesis with respect to the mean CS (79.2 (35 to 118) vs 74.4 (31 to 99); p = 0.519) and DASH scores (11.4 (8 to 29) vs 13.2 (7 to 23); p = 0.210). The ten-year unadjusted cumulative survival rate was 95.3% for the stemmed anatomical shoulder prosthesis and 91.5% for the stemless shoulder prosthesis and did not differ between the treatment groups (p = 0.251). The radiological evaluation of the humeral components in both groups did not show loosening of the humeral implant. The main reason for revision for each type of arthroplasties were complications related to the glenoid. The use of anatomical stemless shoulder prosthesis yielded good and reliable results and did not differ from anatomical stemmed shoulder prosthesis over a mean period of ten years. The differences in periprosthetic humeral bone adaptations between both implants have no clinical impact during the follow-up. Cite this article: Bone Joint J2021;103-B(7):1292-1300.

Stemless total shoulder arthroplasty in elderly patients with primary osteoarthritis of shoulder – a developing country experience

ABSTRACT Background We evaluated the imaging and functional outcomes of anatomic stemless shoulder arthroplasty (ECLIPSE) in elderly patients with primary osteoarthritis of the glenohumeral joint in Asian developing countries. Methods Thirty patients were treated using stemless TSA in 26 months period (years 2017 and 2019), and were followed for a minimum of 24 months. Functional outcomes were assessed using Constant and ASES scores. Radiolucent lines and osteopenia were analyzed on radiographs. Results Pre-surgery Constant and ASES scores improved from 27.33(21–38) and 29.67(22–38) to 68(54–78) and 71(71.4(56–79) at final follow up. Around the humeral component, one patient had calcar thinning and a radiolucent line thicker than 2 mm, while six patients had radiolucent lines less than 2 mm. The mean glenoid radiolucency score was 2± 1.1. Conclusion In our setting, stemless total shoulder arthroplasty demonstrated significant improvement in functional scores at short- to mid-term follow-up. Radiographic findings did not correlate with functional scores.

Biomechanical evaluation of 2 techniques of repair after subscapularis peel for stemless shoulder arthroplasty.

Stemless anatomic total shoulder arthroplasty (TSA) has been gaining significant popularity but poses unique challenges for subscapularis repair. Tenotomy with side-to-side repair has been the most frequently reported technique for subscapularis repair with stemless TSA but has the poorest biomechanical properties, and clinical failures have been reported. There is limited biomechanical evidence evaluating other subscapularis repair techniques for stemless TSA. Therefore, the goal of this study was to investigate 2 additional techniques using a subscapularis peel for subscapularis repair with a stemless TSA. We used 18 male cadaveric specimens to investigate the native subscapularis (n = 6) and 2 subscapularis repair techniques (n = 12) after stemless anatomic TSA (Eclipse). A subscapularis peel with double-row, knotless anchor-based repair (n = 6) was compared with a subscapularis peel with a "backpack" repair (n = 6). The specimens then underwent biomechanical testing, including cyclic displacement and load-to-failure testing. The mode of failure was also recorded. The native tendon had the highest ultimate load to failure (mean, 1017.1 N). Load to failure was similar between the 2 study groups: 397.9 N for the peel and backpack repair and 593.7 N for the knotless anchor-based repair (P > .05 for all comparisons). Moreover, no significant differences in cyclic displacement or construct stiffness were found between the groups (P > .05 for all comparisons). A double-row, knotless anchor-based repair of a subscapularis peel for stemless anatomic shoulder arthroplasty has similar biomechanical properties to a backpack repair technique; however, both techniques fail to reproduce the native biomechanical properties at time zero.

3D-Analysis of the Proximal Humeral Anatomy Before and After Stemless Shoulder Arthroplasty-A Prospective Case Series Study.

Background: Stemless shoulder arthroplasty (SSA) is used to anatomically reconstruct proximal humerus geometry and preserve proximal humerus bone stock. The current literature lacks 3D-analysis of pre- and postoperative proximal humeral anatomy after SSA. The aim of this study was to prospectively analyze the humeral head anatomy using a computer-assisted topography mapping technique after SSA in relation to the preoperative status and the contralateral (not affected) side. Methods: Twenty-nine patients (mean age: 63.5 ± 11.7 years) affected by primary shoulder osteoarthritis and treated with SSA were included. Preoperative and postoperative CT scans of the affected and contralateral sites were analyzed regarding joint geometry. Clinical outcome was assessed by Constant and Disabilities of the Arm, Shoulder and Hand (DASH) score shortly before and one year after surgery. Results: Clinical outcome improved significantly. No correlation between clinical outcome and the evaluated anatomical parameters was found. There was a significant decrease of the humeral head height (p < 0.01) and radius (p = 0.03) in the preoperative versus the postoperative joint geometry. The comparison to the contralateral site showed also a significant decrease of the humeral head height (p < 0.01). All other parameters showed no significant differences. Conclusion: Proximal humeral anatomy can be almost anatomically reconstructed by SSA. Solely the humeral head height differs significantly to the preoperative as well as contralateral morphology.