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Dixon JE, Rankin IA, Sciberras NC, Khan LAK, Barker SL, Cairns DA, Kumar K. Medium-term outcomes following Mathys Affinis Short stemless anatomic total shoulder replacement: clinical and radiologic findings (minimum 5-year follow-up). J Shoulder Elbow Surg 2025:S1058-2746(25)00145-4. [PMID: 39971089 DOI: 10.1016/j.jse.2025.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 12/30/2024] [Accepted: 01/01/2025] [Indexed: 02/21/2025]
Abstract
BACKGROUND Stemless anatomic total shoulder arthroplasty (aTSA) use has increased in recent years. Despite evidence to suggest good midterm results at 2-year follow-up, there is a scarcity of evidence for longer-term follow-up. This study aimed to investigate outcomes at a minimum of 5 years postoperatively following primary stemless aTSA. METHODS An observational cohort study using prospectively collected data was performed for all patients who underwent a Mathys Affinis stemless aTSA procedure at our institution. The study period ranged from July 2010 to August 2018 (minimum 5-year follow-up). Clinical outcome measures included revision rate, range of motion, and patient-reported outcomes (Oxford Shoulder Score and Numerical Satisfaction Score). Radiologic outcome was an assessment of radiolucency using Lazarus grading. RESULTS A total of 105 stemless TSAs were implanted during the trial period. Following exclusions, 75 aTSAs were included in the final cohort for analysis of 5-year outcomes. Five patients underwent revision (4.8%), and the median follow-up time was 6.1 years. The median age was 69 years, and 81% were female. The Oxford Shoulder Score showed a range of 18-48, with a median score of 47. Satisfied or very satisfied was selected in 94.4%. Median range of motion assessments showed forward elevation 160°, abduction 150°, and external rotation 40°, and mode internal rotation was to the lumbar spine. No glenoid lucency was present in 79.7%. There were 9.5% with Lazarus grade 1 lucency, 5.4% with Lazarus grade 2, and 5.4% Lazarus grade 3. No humeral lucency was observed. CONCLUSIONS This cohort study represents the largest minimum 5-year follow-up data for the Mathys Affinis stemless anatomic total shoulder arthroplasty, demonstrating excellent clinical and radiologic outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Kapil Kumar
- Orthopaedic Department, Woodend General Hospital, Aberdeen, Scotland
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Gosselin C, Lefebvre Y, Joudet T, Godeneche A, Barth J, Garret J, Audebert S, Charousset C, Bonnevialle N. Clinical results and computed tomography analysis of intuitive shoulder arthroplasty (ISA) stemless at a minimum follow-up of 2 years. J Shoulder Elbow Surg 2025; 34:e93-e102. [PMID: 38851524 DOI: 10.1016/j.jse.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/30/2024] [Accepted: 04/08/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND The utilization of stemless anatomic total shoulder arthroplasty is on the rise. Epiphyseal fixation leads to radiological bone remodeling, which has been reported to exceed 40% in certain studies series. The aim of this study was to present the clinical and radiological outcomes of a stemless implant with asymmetric central epiphyseal fixation at an average follow-up of 31 months. MATERIALS AND METHODS This retrospective multicenter study examined prospective data of patients undergoing total anatomic arthroplasty with intuitive shoulder arthroplasty Stemless implant and followed up at least 2 years. Clinical assessment included preoperative and final follow-up measurements of active range of motion, Constant score, and Subjective Shoulder Value. Anatomical epiphyseal reconstruction and bone remodeling at the 2-year follow-up were assessed by standardized computed tomography scanner (CT scan). Statistical analysis employed unpaired Student's t-test or chi-squared test depending on the variable type, conducted using EasyMedStat software (version 3.22; www.easymedstat.com). RESULTS Fifty patients (mean age 68 years, 62% females) were enrolled, with an average follow-up of 31 months (24-44). Primary osteoarthritis (68%) with type A glenoid (78%) was the prevailing indication. The mean Constant score and Subjective Shoulder Value improved significantly from 38 ± 11 to 76 ± 11 (P < .001) and from 31% ± 16 to 88% ± 15 (P < .001) respectively at the last follow-up. Forward elevation, external rotation, and internal rotation range of motion increased by 39° ± 42, 28° ± 21 and 3,2 ± 2,5 points respectively, surpassing the Minimally Clinically Important Difference after total shoulder arthroplasty. No revisions were necessary. CT scans identified 30% osteolysis in the posterior-medial calcar region, devoid of clinical repercussions. No risk factors were associated with bone osteolysis. CONCLUSIONS At an average follow-up of 31 months, intuitive shoulder arthroplasty Stemless implant provided favorable clinical results. CT analysis revealed osteolysis-like remodeling in the posterior-medial zone of the calcar (30%), without decline in clinical outcomes and revisions. Long-term follow-up studies are mandated to evaluate whether osteolysis is associated with negative consequences.
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Affiliation(s)
- Cerise Gosselin
- CHU de Toulouse (Toulouse University Hospital), Toulouse, France
| | - Yves Lefebvre
- Institut de l'épaule de Strasbourg (Strasbourg Shoulder Institute), Strasbourg, France
| | | | - Arnaud Godeneche
- Centre Orthopédique SANTY (SANTY Orthopedic Center), Ramsay Santé, Lyon, France
| | | | | | | | - Christophe Charousset
- Institut Ostéo Articulaire (Bone and Joint Institute) Paris Courcelles, Paris, France
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Peckston DC, D’Costa E, Gill DRJ, Harries D, Page R, Baba M. A comparative analysis of a central metaphyseal humeral fixation stemless shoulder arthroplasty to an anatomic shoulder arthroplasty in a national registry cohort. Shoulder Elbow 2024:17585732241307245. [PMID: 39726794 PMCID: PMC11669123 DOI: 10.1177/17585732241307245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 11/09/2024] [Accepted: 11/29/2024] [Indexed: 12/28/2024]
Abstract
Background This study aimed to determine the revision outcome between a centrally fixed stemless anatomic design and other total anatomic shoulder replacements using data from a large national arthroplasty registry. Methods The study period was from December 2011 to December 2022 and included three cohorts; primary Affinis stemless anatomic (AFS), all other primary total stemless anatomic (sTSA) and primary total stemmed anatomic shoulder arthroplasty (aTSA). The endpoint was all-cause revision using cumulative percent revision (CPR). Hazard ratio (HR) models were adjusted for age and gender. Results There were 2489 primary AFS, 1593 primary sTSA and 11,023 primary aTSA. There was no difference in revision rates between the AFS and the sTSA group. The aTSA group had a significantly higher rate of revision compared to both AFS (HR = 1.63, 95% confidence interval (CI) 1.30-2.05, p < 0.001) and sTSA (HR = 1.61, 95% CI 1.21-2.15, p = 0.001). However, sub-analyses stratifying for highly crosslinked polyethylene (XLPE) showed no differences between the groups. Discussion The rates of revision between the AFS design and other stemless prostheses were similar. Stemless had lower revision rates to aTSA. When only considering XLPE cemented glenoids, there was no significant difference in revision rates.
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Affiliation(s)
| | | | - David RJ Gill
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia
| | - Dylan Harries
- South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Richard Page
- The Barwon Centre of Orthopaedic Research and Education, Barwon Health and St John of God Hospital, Geelong, VIC, Australia
- School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Mohammed Baba
- Specialty Orthopaedic Upper Limbs Surgery Research Foundation, Bella Vista, NSW, Australia
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Schönweger F, Oldrini LM, Feltri P, Filardo G, Candrian C. Stemmed VS stemless total shoulder arthroplasty: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2024; 145:3. [PMID: 39666012 DOI: 10.1007/s00402-024-05645-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 10/25/2024] [Indexed: 12/13/2024]
Abstract
AIM Anatomic total shoulder arthroplasty (TSA) is commonly used for glenohumeral osteoarthritis (OA) in patients with an intact rotator cuff. The aim of this study was to quantify advantages and disadvantages of the stemmed and stemless designs in terms of clinical outcome and complications. METHODS A review was developed based on the PRISMA statement and registered on PROSPERO. Inclusion criteria were comparative studies analyzing stemmed vs. stemless TSA in adults with OA. The literature search was performed in PubMed, Web of Science, and Wiley Cochrane Library up to January 2024. Constant and Murley Score (CMS), Range of Motion, and operative time were documented, as well as complications divided into minor and major complications. The Downs and Black's "Checklist for Measuring Quality" was used to assess risk of bias and quality of evidence. RESULTS Out of 1876 articles retrieved; 14 were included in the meta-analysis for a total of 1496 patients (51.4% men, 48.6% women). The CMS was 74.8 points in the stemmed group and 76.9 points in the stemless group, with no differences in both overall score and subscales. No differences were found in elevation and abduction, while external rotation was 3.9° higher in the stemless group (p < 0.05) No differences were found in operating time and overall complications. However, deep infections were higher in the stemless group (2.2% vs. 0.8%, p < 0.05). The quality was assessed as poor, fair, good, and excellent in 0, 2, 7, and 5 studies, respectively. CONCLUSION Stemless TSA may offer minor advantages in terms of external rotation, although the clinical relevance appears doubtful. On the other hand, a lower deep infection rate was documented for stemmed implants. Overall, stemmed and stemless TSA provided good clinical results, with similar benefits in terms of clinical outcomes and complications.
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Affiliation(s)
- Florian Schönweger
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, 6900, Switzerland
| | - Lorenzo Massimo Oldrini
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, 6900, Switzerland.
| | - Pietro Feltri
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, 6900, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, 6900, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, 6900, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Halm-Pozniak A, Riediger C, Kopsch E, Awiszus F, Lohmann CH, Berth A. Influence of humeral position of the Affinis Short stemless shoulder arthroplasty system on long-term survival and clinical outcome. J Shoulder Elbow Surg 2024; 33:2202-2212. [PMID: 38514008 DOI: 10.1016/j.jse.2024.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND The purpose of this study was to evaluate the influence of humeral position of the Affinis Short implant in stemless anatomic total shoulder arthroplasties (STSAs) on clinical and radiologic results and mid- to long-term survival in the treatment of primary osteoarthritis (OA) of the shoulder. METHODS Eighty patients treated with a stemless shoulder arthroplasty for OA of the shoulder were evaluated with a mean follow-up of 92 ± 14 months (range 69-116 months) by the Constant Score (CS), Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), and active range of motion (ROM). Radiographic assessment for bone adaptations and humeral implant position was performed by plain radiographs. Comparison of the pre- and postoperative centers of rotation (CORs) 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 performed to investigate the influence of humeral implant position compared to survival time. Complications were noted. RESULTS The ROM (P < .001), CS (P < .001), and DASH scores (P < .001) showed significant improvements after surgery for the entire series. The COR restoration was anatomic in 75% (n = 60) of all implants and in 25% (n = 20) nonanatomic implants (pre- and postoperative COR deviation of 2.7 ± 1.8 mm vs. 5.1 ± 3.2 mm, P = .0380). The humeral component position did not affect the functional outcome whereas the 10-year unadjusted cumulative survival rate for the anatomic group was significantly higher in comparison with the nonanatomic group (96.7% vs. 75%, P = .002). The radiologic evaluation revealed minor periprosthetic bone adaptions in various forms without clinical significance or further intervention. No revision was necessary because of a failed fixation of the stemless humeral component. CONCLUSIONS Regarding the treatment of primary OA of the shoulder, STSA shows excellent long-term survival and clinical outcomes. In particular, STSA implants are able to restore the geometry of the humeral head. Nonanatomic reconstruction may influence the survival over the long term in different pathways. Further studies are necessary to elucidate the effect of humeral component position in STSA on function, pain, and implant survival rates.
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Affiliation(s)
| | - Christian Riediger
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Elisabeth Kopsch
- Department of Pediatrics, Otto von Guericke University Children's Hospital, Magdeburg, Germany
| | - Friedemann Awiszus
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Alexander Berth
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
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Rankin IA, Goffin J, Khan LAK, Cairns D, Barker SL, Kumar K. Stress shielding of the proximal humerus in stemless anatomic total shoulder arthroplasty. Shoulder Elbow 2024; 16:493-500. [PMID: 39464830 PMCID: PMC11512461 DOI: 10.1177/17585732231168391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/19/2023] [Indexed: 10/29/2024]
Abstract
Background This study aimed to assess the radiographic proximal humerus bony adaptations to stress shielding and associated clinical outcomes following stemless total shoulder arthroplasty. Methods A retrospective review of all patients who underwent stemless total shoulder arthroplasty surgery at our centre from 2010 to 2020 was performed. Results In total, 115 stemless total shoulder arthroplasty utilising a single implant design with a minimum one-year follow-up were identified over a 10-year period. The median follow-up was 3.5 years (range: 1-8.9 years). Evidence of stress shielding was observed in 20 cases (17%), (9 mild (8%), 0 moderate (0%), 11 severe (9%). No significant differences were seen between stress shielding and gender, body mass index, post-operative range-of-motion, patient satisfaction, or Oxford shoulder score. No significant differences were seen between the operative technique and stress shielding. No cases had evidence of humeral lucency. In total, 24 cases (21%) had evidence of glenoid lucency of Lazarus grade 0-3. No cases had Lazarus grades 4 or 5. There was no association between stress shielding and humeral lucency, glenoid lucency, or revision procedure. Discussion Stress shielding in this study occurred at lower rates than anticipated following stemless total shoulder arthroplasty and was not associated with radiographic evidence of lucency, revision procedures, or adverse effect on clinical outcome measures.
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Affiliation(s)
- Iain A Rankin
- Department of Trauma and Orthopaedics, Aberdeen Upper Limb Unit, Woodend Hospital, Aberdeen, UK
| | - Joaquim Goffin
- Department of Trauma and Orthopaedics, Aberdeen Upper Limb Unit, Woodend Hospital, Aberdeen, UK
| | - L A Kash Khan
- Department of Trauma and Orthopaedics, Aberdeen Upper Limb Unit, Woodend Hospital, Aberdeen, UK
| | - David Cairns
- Department of Trauma and Orthopaedics, Aberdeen Upper Limb Unit, Woodend Hospital, Aberdeen, UK
| | - Scott L Barker
- Department of Trauma and Orthopaedics, Aberdeen Upper Limb Unit, Woodend Hospital, Aberdeen, UK
| | - Kapil Kumar
- Department of Trauma and Orthopaedics, Aberdeen Upper Limb Unit, Woodend Hospital, Aberdeen, UK
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Twomey-Kozak J, Adu-Kwarteng K, Lunn K, Briggs DV, Hurley E, Anakwenze OA, Klifto CS. Recent Advances in the Design and Application of Shoulder Arthroplasty Implant Systems and Their Impact on Clinical Outcomes: A Comprehensive Review. Orthop Res Rev 2024; 16:205-220. [PMID: 39081796 PMCID: PMC11288362 DOI: 10.2147/orr.s312870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024] Open
Abstract
Purpose of Review This narrative review comprehensively aims to analyze recent advancements in shoulder arthroplasty, focusing on implant systems and their impact on patient outcomes. The purpose is to provide a nuanced understanding of the evolving landscape in shoulder arthroplasty, incorporating scientific, regulatory, and ethical dimensions. Recent Findings The review synthesizes recent literature on stemless implants, augmented glenoid components, inlay vs onlay configurations, convertible stems, and associated complications. Notable findings include improved patient-reported outcomes with stemless implants, variations in outcomes between inlay and onlay configurations, and the potential advantages of convertible stems. Additionally, the regulatory landscape, particularly the FDA's 510(k) pathway, is explored alongside ethical considerations, emphasizing the need for standardized international regulations. Summary Recent innovations in shoulder arthroplasty showcase promising advancements, with stemless implants demonstrating improved patient outcomes. The review underscores the necessity for ongoing research to address unresolved aspects and highlights the importance of a standardized regulatory framework to ensure patient safety globally. The synthesis of recent findings contributes to a comprehensive understanding of the current state of shoulder arthroplasty, guiding future research and clinical practices.
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Affiliation(s)
- John Twomey-Kozak
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kwabena Adu-Kwarteng
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kiera Lunn
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Damon Vernon Briggs
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Eoghan Hurley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Nyring MRK, Olsen BS, Jensen SL, Rasmussen JV. High revision rate of metal-backed glenoid component and impact on the overall revision rate of stemless total shoulder arthroplasty: a cohort study from the Danish Shoulder Arthroplasty Registry. Acta Orthop 2024; 95:386-391. [PMID: 39016083 PMCID: PMC11253195 DOI: 10.2340/17453674.2024.41014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 06/13/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND AND PURPOSE There is controversy regarding the results of stemmed and stemless total shoulder arthroplasty (TSA) used for osteoarthritis. Therefore, we aimed to compare revision rates of stemmed and stemless TSA and to examine the impact of metal-backed glenoid components. METHODS We included all patients reported to the Danish Shoulder Arthroplasty Register from January 1, 2012 to December 31, 2022 with an anatomical TSA used for osteoarthritis. Primary outcome was revision (removal or exchange of components) for any reason. RESULTS 3,338 arthroplasties were included. The hazard ratio for revision of stemless TSA adjusted for age and sex was 1.83 (95% confidence interval [CI] 1.21-2.78) with stemmed TSA as reference. When excluding all arthroplasties with a metal-backed glenoid component, the adjusted hazard ratio for revision of stemless TSA was 1.37 (CI 0.85-2.20). For the Eclipse stemless TSA system, the adjusted hazard ratio for revision of a metal-backed glenoid component was 8.75 (CI 2.40-31.9) with stemless Eclipse with an all-polyethylene glenoid component as reference. CONCLUSION We showed that the risk of revision of stemless TSAs was increased and that it was related to their combination with metal-backed glenoid components.
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Affiliation(s)
- Marc R K Nyring
- Department of Orthopedic Surgery, Herlev and Gentofte Hospital, Hellerup.
| | - Bo S Olsen
- Department of Orthopedic Surgery, Herlev and Gentofte Hospital, Hellerup
| | - Steen L Jensen
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Jeppe V Rasmussen
- Department of Orthopedic Surgery, Herlev and Gentofte Hospital, Hellerup
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Hatta T, Mashiko R, Kawakami J, Matsuzawa G, Ogata Y, Hatta W. Evolution of Stemless Reverse Shoulder Arthroplasty: Current Indications, Outcomes, and Future Prospects. J Clin Med 2024; 13:3813. [PMID: 38999379 PMCID: PMC11242655 DOI: 10.3390/jcm13133813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/16/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
Reverse total shoulder arthroplasty (rTSA) is increasingly being used as a reliable option for various shoulder disorders with deteriorated rotator cuff and glenohumeral joints. The stemless humerus component for shoulder arthroplasties is evolving with theoretical advantages, such as preservation of the humeral bone stock and decreased risk of periprosthetic fractures, as well as clinical research demonstrating less intraoperative blood loss, reduced surgical time, a lower rate of intraoperative fractures, and improved center of rotation restoration. In particular, for anatomical total shoulder arthroplasty (aTSA), the utilization of stemless humeral implants is gaining consensus in younger patients. The current systematic review of 14 clinical studies (637 shoulders) demonstrated the clinical outcomes of stemless rTSA. Regarding shoulder function, the mean Constant-Murley Score (CS) improved from 28.3 preoperatively to 62.8 postoperatively. The pooled overall complication and revision rates were 14.3% and 6.3%, respectively. In addition, recent studies have shown satisfactory outcomes with stemless rTSA relative to stemmed rTSA. Therefore, shoulder surgeons may consider adopting stemless rTSA, especially in patients with sufficient bone quality. However, further long-term studies comparing survivorship between stemless and stemmed rTSA are required to determine the gold standard for selecting stemless rTSA.
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Affiliation(s)
- Taku Hatta
- Department of Orthopedic Surgery, Joint Surgery, Sports Clinic Ishinomaki, Ishinomaki 986-0850, Japan;
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai 980-8547, Japan;
| | - Ryosuke Mashiko
- Department of Orthopedic Surgery, Joint Surgery, Sports Clinic Ishinomaki, Ishinomaki 986-0850, Japan;
| | - Jun Kawakami
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai 980-8547, Japan;
| | - Gaku Matsuzawa
- Department of Orthopedic Surgery, Iwaki Medical Center, Iwaki 973-8402, Japan;
| | - Yohei Ogata
- Division of Gastroenterology, Tohoku University School of Medicine, Sendai 980-8574, Japan; (Y.O.); (W.H.)
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University School of Medicine, Sendai 980-8574, Japan; (Y.O.); (W.H.)
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Gill DRJ, Corfield S, Harries D, Page RS. A comparison of revision rates for stemmed and stemless primary anatomic shoulder arthroplasty with all-polyethylene glenoid components: analysis from the Australian Orthopaedic Association National Joint Replacement Registry. J Shoulder Elbow Surg 2024; 33:281-290. [PMID: 37499786 DOI: 10.1016/j.jse.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND We compared the rate of all-cause revision of 2 classes of primary anatomic shoulder arthroplasty, stemmed (stTSA) and stemless (slTSA), undertaken with cemented all-polyethylene glenoid components. METHODS A large national arthroplasty registry identified 2 cohort groups for comparison, stTSA and l undertaken for all diagnoses between January 1, 2011, and December 31, 2021. A subanalysis from January 1, 2017, allowed capturing of additional patient demographics including American Society of Anesthesiologists score, body mass index, and glenoid morphology. The cumulative percent revision (CPR) was determined using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazard models adjusted for age and gender. RESULTS Of the 7995 stTSA procedures, the CPR at 9 years was 5.6% (95% confidence interval [CI]: 5.0, 6.4), and for 3156 slTSA procedures, the CPR was 4.4% (95% CI: 3.6, 5.5). There was no significant difference in the rate of revision between the study groups (HR = 0.76 [95% CI: 0.51, 1.14], P = .189, adjusted for age, gender, humeral head size, humeral fixation, bearing surface, glenoid design, and mean surgeon volume [MSV]). There was an increased rate of revision for stTSA and slTSA undertaken with humeral head sizes <44 mm (stTSA <44 mm vs. 44-50 mm, HR = 1.56 [CI: 1.18, 2.08], P = .001; slTSA <44 mm vs. 44-50 mm, HR = 2.08 [CI: 1.32, 3.33], P = .001). MSV as a continuous predictor was not a revision risk to stTSA vs. slTSA, but categorically, a low MSV (<10 stTSA + slTSA cases per annum) was associated with a higher revision rate for stTSA (10-20 cases/yr vs. <10 cases/yr, HR = 0.72 [CI: 0.55, 0.95], P = .019) but was not in slTSA. Revision rates were increased for stTSA with non-crosslinked polyethylene (XLPE) glenoids vs. XPLE after 2 years (HR = 2.20 [CI: 1.57, 3.08], P < .001) but did not significantly differ for slTSA. Metal/XPLE (humeral/glenoid) bearing surface of stTSA rate of revision was not different from each combination of slTSA bearing surface. Instability/dislocation was a revision risk for slTSA vs. stTSA (HR = 1.93 [CI: 1.28, 2.91], P = .001), but from 2017, neither of American Society of Anesthesiologists score, body mass index, and glenoid morphology changed the rate of revision. CONCLUSIONS Revision rates of stTSA and slTSA did not significantly differ and were associated with humeral head size but not patient characteristics. Surgeon inexperience of anatomic shoulder arthroplasty and non-XLPE glenoids were risk factors for stTSA revision but not slTSA. The metal/XLPE stTSA rate of revision was not found to differ significantly from slTSA regardless of polyethylene or humeral head bearing type. Revision for instability/dislocation was more common for slTSA.
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Affiliation(s)
- David R J Gill
- Orthopaedics Central, Nedlands, WA, Australia; Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia.
| | - Sophia Corfield
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia
| | - Dylan Harries
- South Australia Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Richard S Page
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia; Barwon Centre for Orthopaedic Research and Education (B-CORE), St John of God Hospital and Deakin University, Geelong, VIC, Australia
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Warren E, Levin JM, Rechenmacher AJ, Hurley ET, Lassiter T, Klifto CS, Anakwenze O. Radiographic comparison of eccentric stemmed vs. concentric stemless prosthetic humeral head positioning after anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2024; 33:90-98. [PMID: 37419439 DOI: 10.1016/j.jse.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/11/2023] [Accepted: 05/28/2023] [Indexed: 07/09/2023]
Abstract
INTRODUCTION Maintaining premorbid proximal humeral positioning is an essential consideration of anatomic total shoulder arthroplasty (aTSA), as malposition of the prosthetic humeral head can result in poor clinical outcomes. Stemless aTSA prosthetic heads are usually concentric, while stemmed aTSA prosthetic heads are typically eccentric in nature. Therefore, the purpose of this study was to compare the ability to restore native humeral head position between stemmed (eccentric) vs. stemless (concentric) aTSA. MATERIALS AND METHODS Postoperative anteroposterior radiographs of 52 stemmed and 46 stemless aTSAs were analyzed. A best-fit circle was created using previously published and validated techniques to represent the premorbid humeral head position and axis of rotation. This circle was juxtaposed with another circle following the arc of the implant head. Next, the offset in center of rotation (COR), radius of curvature (RoC), and humeral head height above the greater tuberosity (HHH) were measured. Additionally, based on prior studies, an offset of >3 mm at any point between the implant head surface and premorbid best-fit circle was considered significant and further classified as overstuffed or understuffed. RESULTS RoC deviation was significantly greater in the stemmed cohort than the stemless cohort (1.19 ± 1.37 mm vs. 0.65 ± 1.17 mm, P = .025). There was no statistically significant difference in deviation from premorbid humeral head between the stemmed and stemless cohorts for COR (3.20 ± 2.28 mm vs. 3.23 ± 2.09 mm, P = .800) or HHH (1.12 ± 3.27 mm vs. 0.92 ± 2.70 mm, P = .677). When comparing overstuffed implants to appropriately placed implants, there was a significant difference in overall COR deviation in stemmed implants (3.93 ± 2.51 mm vs. 1.92 ± 1.05 mm, P < .001). Superoinferior COR deviation (stemmed: 2.38 ± 3.01 mm vs. -0.61 ± 1.59 mm, P < .001; stemless: 2.70 ± 1.75 mm vs. -0.16 ± 1.87 mm, P < .001), mediolateral COR deviation (stemmed: 0.79 ± 2.65 mm vs. -0.62 ± 1.27 mm, P = .020; stemless: 0.40 ± 1.41 mm vs. -1.13 ± 1.96 mm, P = .020), and HHH (stemmed: 3.61 ± 2.73 mm vs. 0.50 ± 1.31 mm, P < .001; stemless: 3.98 ± 1.18 mm vs. 0.53 ± 1.41 mm, P < .001) were significantly different between overstuffed implants and appropriate implants in both the stemmed and stemless cohorts. DISCUSSION Stemless and stemmed aTSA implants have similar rates of reproducing satisfactory postoperative humeral head COR with both producing COR deviation most commonly in the superomedial direction. Deviation in HHH contributes to overstuffing in both stemmed and stemless implants, COR deviation contributes to overstuffing in stemmed implants, while RoC (humeral head size) is not associated with overstuffing. Based on this study, it appears that neither eccentric nor concentric prosthetic heads are superior in recreating premorbid humeral head position.
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Affiliation(s)
- Eric Warren
- Duke University School of Medicine, Duke University, Durham, NC, USA.
| | - Jay M Levin
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | - Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Tally Lassiter
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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Werner BC, Burrus MT, Denard PJ, Romeo AA, Lederman E, Griffin JW, Sears B. Stemless anatomic total shoulder arthroplasty is associated with less early postoperative pain. JSES Int 2024; 8:197-203. [PMID: 38312271 PMCID: PMC10837735 DOI: 10.1016/j.jseint.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background Improvements in pain control after shoulder arthroplasty with a reduction in narcotic use continues to be an important postoperative goal. With the increased utilization of stemless anatomic total shoulder arthroplasty (aTSA), it is relevant to compare between stemmed and stemless arthroplasty to assess if there is any association between this implant design change and early postoperative pain. Methods Patients from a multicenter, prospectively-maintained database who had undergone a stemless aTSA with a minimum of two year clinical follow-up were retrospectively identified. Patients who underwent aTSA with a short stem were identified in the same registry, and matched to the stemless aTSA patients by age, sex and preoperative pain score. The primary study outcome was the Visual Analog Scale pain score. Secondary pain outcomes were the American Shoulder and Elbow Surgeons shoulder pain subscore, Western Ontario Osteoarthritis of the Shoulder physical symptoms subscore, and the Single Assessment Numeric Evaluation score. Finally, the percentage of patients who could sleep on the affected shoulder was assessed for each group. These pain-related clinical outcomes were assessed and compared preoperatively, and postoperatively at 9 weeks, 26 weeks, one year and two years. For all statistical comparisons, P > .05 was considered significant. Results 124 patients were included in the study; 62 in each group. At 9 weeks after surgery, statistically significantly improved pain control was reported by patients undergoing stemless aTSA, as assessed by the Visual Analog Scale (stemless: 1.5, stemmed: 2.5, P = .001), American Shoulder and Elbow Surgeons pain subscore (stemless: 42.4, stemmed: 37.3, P < .001), Western Ontario Osteoarthritis of the Shoulder Physical Symptoms (stemless: 80.3, stemmed: 73.1, P = .006) and Single Assessment Numeric Evaluation (stemless: 58.1, stemmed: 47.4, P = .011). Patients who underwent a stemless aTSA were significantly more likely to be able to sleep on the affected shoulder at 9 weeks (29% vs. 11%, odds ratio 3.2, 95% confidence interval 1.2-8.4, P = .014). By 26 weeks postoperatively, there were no differences in all pain-specific outcomes. At two years postoperatively, patient-reported outcomes, range of motion, and strength measures were all similar between the two cohorts. Conclusion Stemless aTSA provides earlier improvement in postoperative shoulder pain compared to matched patients undergoing short-stem aTSA. Additionally, earlier return to sleeping on the affected shoulder was reported in the stemless aTSA group. The majority of these differences dissipate by 26 weeks postoperatively and there were no differences in pain, patient-reported outcomes, range of motion or strength measures between stemless and short-stem aTSA at 2 years postoperatively.
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Affiliation(s)
- Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | | | | | | | - Evan Lederman
- Department of Orthopaedic Surgery, Banner Health, Phoenix, AZ, USA
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Zbeda R, Asaid R, Warby SA, Cassidy JT, Hoy G. Medium-Term Clinical Outcomes of the Global Icon Stemless Shoulder System: Results of a 2-Year Follow-Up. J Clin Med 2023; 12:6745. [PMID: 37959211 PMCID: PMC10648431 DOI: 10.3390/jcm12216745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/21/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
The primary aim of this study was to assess the medium-term outcomes of the Global Icon stemless shoulder replacement in patients who have undergone primary total shoulder arthroplasty (TSA) for glenohumeral joint osteoarthritis. A retrospective review of patients who had undergone a TSA using the Global Icon stemless shoulder system was performed. The Western Ontario Osteoarthritis Shoulder (WOOS) Index and Oxford Shoulder Score (OSS) were evaluated pre-operatively and at 12 to 24 months post-operatively. Radiological outcomes, operation time, and post-operative complications were reported. Primary analysis for the WOOS Index and OSS focused on detecting within-group treatment effects at 24 months using a repeated measures ANOVA. Thirty patients were included in the study. Post-surgery, there was a significant improvement at 24 months on the OSS (ES = 0.932, CI: 41.7 to 47.7, p < 0.001) and the WOOS Index (ES = 0.906, CI: 71.9 to 99.8, p < 0.001). Radiographs revealed that no component loosened, migrated, or subsided. The median operative time was 75.5 (IQR: 12.25, range: 18 to 105) min. No implant-related complications were reported. The Global Icon stemless replacements have excellent clinical outcomes in this cohort at 12- and 24-month follow-up with no implant-related complications.
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Affiliation(s)
- Robert Zbeda
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, VIC 3181, Australia; (R.Z.); (R.A.); (J.T.C.); (G.H.)
| | - Raf Asaid
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, VIC 3181, Australia; (R.Z.); (R.A.); (J.T.C.); (G.H.)
| | - Sarah A. Warby
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Corner of Kingsbury Drive and Plenty Road, Bundoora, VIC 3080, Australia
| | - John Tristan Cassidy
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, VIC 3181, Australia; (R.Z.); (R.A.); (J.T.C.); (G.H.)
| | - Gregory Hoy
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, VIC 3181, Australia; (R.Z.); (R.A.); (J.T.C.); (G.H.)
- Department of Surgery, Monash Medical Centre, Monash University, Level 5, Block E·246 Clayton Road, Clayton, VIC 3168, Australia
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14
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Lukasiewicz P, McFarland E, Hassebrock JD, McCarthy TP, Sylvia SM, McCarty EC, Weber SC. Anatomic glenohumeral arthroplasty: State of the art. J ISAKOS 2023; 8:296-305. [PMID: 37207983 DOI: 10.1016/j.jisako.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/30/2023] [Accepted: 05/11/2023] [Indexed: 05/21/2023]
Abstract
Anatomical total shoulder arthroplasty in its modern form where it reproduces the normal shoulder has been utilized clinically for more than half a century. As the technology and the designs have changed to recreate the humeral and glenoid sides of the joint, the sophistication of design has resulted in the growing number of cases annually worldwide. This increase is due in part to the increasing number of indications that the prosthesis can treat with successful results. On the humeral side, there have been design changes to better reflect the proximal humeral anatomy, and humeral stems are increasingly placed safely without cement. Platform systems which allow conversion of a failed arthroplasty to a reverse configuration without stem extraction is another design change. Similarly, there has been increasing utilization of short stem and stemless humeral components. Extensive experience with shorter stem and stemless devices, however, has yet to demonstrate the purported advantages of these devices, as recent studies have demonstrated equivalent blood loss, fracture rates, operative times, and outcome scores. Easier revision with these shorter stems remains to be definitively established, with only one study comparing the ease of revision between stem types. On the glenoid side, hybrid cementless glenoids, inlay glenoids, cementless all-polyethylene glenoids, and augmented glenoids have all been investigated; however, the indications for these devices remain unclear. Lastly, innovative surgical approaches to implanting shoulder arthroplasty and the use of patient specific guides and computerized planning, while interesting concepts, still await validation before they are utilized on a widespread basis. While reverse shoulder arthroplasty has been increasingly used to reconstruct the arthritic shoulder, anatomic glenohumeral replacement maintains a significant role in the armamentarium of the shoulder surgeon.
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Affiliation(s)
- Piotr Lukasiewicz
- Division of Shoulder Surgery, the Department of Orthopaedic Surgery, The Johns Hopkins University, 733 N Broadway, Baltimore, MD 21205, USA
| | - Edward McFarland
- Division of Shoulder Surgery, the Department of Orthopaedic Surgery, The Johns Hopkins University, 733 N Broadway, Baltimore, MD 21205, USA
| | - Jeffrey D Hassebrock
- The University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Timothy P McCarthy
- The University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Stephen M Sylvia
- The University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Eric C McCarty
- The University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Stephen C Weber
- Division of Shoulder Surgery, the Department of Orthopaedic Surgery, The Johns Hopkins University, 733 N Broadway, Baltimore, MD 21205, USA.
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15
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Raval P, Deore V, Bishnoi A, Armstrong A, Modi A, Pandey R. Mid-term results for a stemless anatomical total shoulder replacement, with a ceramic head, for glenohumeral osteoarthritis. Shoulder Elbow 2023; 15:283-291. [PMID: 37325387 PMCID: PMC10268144 DOI: 10.1177/17585732211058725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 09/20/2023]
Affiliation(s)
- P Raval
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
| | - V Deore
- Department of Trauma and Orthopaedics, The Mid Yorkshire Hospital NHS Trust, UK
| | - A Bishnoi
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
| | - A Armstrong
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
| | - A Modi
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
| | - R Pandey
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
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16
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Authom T, Lascar T, Wahab H, Gournay A, Beaudouin E, Muller JH, Saffarini M, Nourissat G. Mid-Term to Long-Term Follow-Up of Stemless Anatomic Total Shoulder
Arthroplasty. J Shoulder Elb Arthroplast 2023; 7:24715492231163055. [PMID: 36968299 PMCID: PMC10031594 DOI: 10.1177/24715492231163055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/24/2023] [Accepted: 02/19/2023] [Indexed: 03/24/2023] Open
Abstract
Background The purpose was to report mid-term to long-term clinical outcomes in a
multicentre series of patients who received stemless total shoulder
arthroplasty (TSA). The hypothesis was that stemless TSA would be a safe and
effective treatment with satisfactory clinical outcomes. Methods Authors retrospectively reviewed records of 62 stemless TSAs implanted
between March 2013 and December 2014. Six were excluded because they had
fractures or muscular impairment, which left 56: primary osteoarthritis
(n = 49), rheumatoid arthritis (n = 4), avascular necrosis (n = 1), or
glenoid dysplasia (n = 2). Outcomes were absolute Constant Score (CS),
age-/sex-adjusted CS, and the American Shoulder and Elbow Surgeons (ASES)
score. Proportions of patients that achieved substantial clinical benefits
for absolute CS and ASES scores were determined. Results Of the 56 patients, 8 (14%) died (unrelated to TSA), 5 (9%) were lost to
follow-up, and 2 (4%) refused participation. One patient was reoperated for
infection with implant removal (excluded from analysis), and one for
periprosthetic fracture without implant removal. At 7.6 ± 0.5 years (range
6.8-9.3), the remaining 40 patients, aged 71.0 ± 8.5 years, achieved net
improvements of 40.7 ± 15.8 (CS), 62%±23% (age-/sex-adjusted CS), and
59.7 ± 16.4 (ASES). Of patients with complete absolute CS (n = 37) and ASES
score (n = 28), respectively, 33 (89%) and 27 (96%) achieved substantial
clinical benefits. Conclusions Stemless TSA yields improvements in functional outcomes at mid-term to
long-term that exceed the substantial clinical benefits of the absolute CS
and ASES score at a mean follow-up of 7.6 years. Although the findings of
this study revealed low complications and revision rates, more studies are
needed to confirm long-term benefits of stemless TSA. Level of evidence IV, case series.
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Affiliation(s)
| | | | | | | | | | | | - Mo Saffarini
- ReSurg S.A., Nyon, Switzerland
- Mo Saffarini, ReSurg S.A., Rue Saint-Jean
22, 1260 Nyon, Switzerland.
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17
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Edwards GA, Coghlan J, Hughes J, Wright W, Dallalana R, Bell ASN. Encouraging outcomes of stemless ceramic head anatomic shoulder arthroplasty in severe primary osteoarthritis (Walch type B glenoids). Shoulder Elbow 2023; 15:28-36. [PMID: 36895605 PMCID: PMC9990115 DOI: 10.1177/17585732211048120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/19/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
Background: We report the radiological and functional outcomes at five years in patients with severe osteoarthritis of the glenohumeral joint and a Walch type B glenoid who have undergone stemless anatomic total shoulder replacement. Methods: A retrospective analysis of case notes, computed tomography scans and plain radiographs of patients undergoing anatomic total shoulder replacement for primary glenohumeral osteoarthritis were performed. Patients were grouped by the severity of their osteoarthritis using the modified Walch classification, glenoid retroversion and posterior humeral head subluxation. An evaluation was made using modern planning software. Functional outcomes were assessed using the American shoulder and elbow surgeons score, shoulder pain and disability index and visual analogue scale. Annual Lazarus scores were reviewed as regard to glenoid loosening. Results: Thirty patients were reviewed at 5 years. Analysis of all patient-reported outcome measures demonstrated significant improvement at 5-year review, American shoulder and elbow surgeons (p = <0.0001), shoulder pain and disability index (p = 0.0001), visual analogue scale (p = 0.0001). Radiological associations between Walch scores and Lazarus scores were not statistically significant (p = 0.1251) at 5 years. There were no associations between features of glenohumeral osteoarthritis and patient-reported outcome measures. Discussion: The severity of osteoarthritis did not show any association with glenoid component survivorship or with patient-reported outcome measures at 5 years review. Level of evidence: IV.
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Affiliation(s)
| | - Jennifer Coghlan
- Melbourne Shoulder and Elbow Centre, Melbourne, Australia
- Department of Surgery (School of Clinical Sciences at Monash
Health), Monash University, Melbourne, Australia
| | - Jeff Hughes
- North Shore Private
Hospital, Chatswood, Sydney, Australia
| | | | | | - A/Prof Simon Nicolas Bell
- Melbourne Shoulder and Elbow Centre, Melbourne, Australia
- Department of Surgery (School of Clinical Sciences at Monash
Health), Monash University, Melbourne, Australia
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18
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Baumgarten KM. Is stemless total shoulder arthroplasty indicated in elderly patients? J Shoulder Elbow Surg 2023; 32:260-268. [PMID: 36162630 DOI: 10.1016/j.jse.2022.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/24/2022] [Accepted: 08/03/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Stemmed anatomic total shoulder arthroplasty has represented the gold standard for the treatment of glenohumeral osteoarthritis with an intact rotator cuff for decades. To the author's knowledge, no study has specifically examined the outcomes of stemless, modular total shoulder arthroplasty in elderly patients. The hypothesis of this study was that stemless anatomic total shoulder arthroplasty in elderly patients (age ≥70 years) would have equivalent clinical and radiographic outcomes compared with a younger population (age <70 years). MATERIALS AND METHODS A prospectively collected database of patients undergoing primary, modular, stemless anatomic total shoulder arthroplasty for osteoarthritis was retrospectively reviewed. Patient-determined outcomes including the Western Ontario Osteoarthritis Index (WOOS) score, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, Simple Shoulder Test score, and Shoulder Activity Level score were recorded preoperatively and postoperatively at 1 year and 2 years. Preoperative and 1-year postoperative range of motion was recorded. Postoperative radiographs were examined to assess for radiographic evidence of complications. RESULTS Stemless arthroplasty was planned in 116 patients. Seven patients underwent conversion intraoperatively to a stemmed prosthesis. There was no difference between patients aged <70 yr and those aged ≥70 years who required intraoperative deviation from the preoperative plan to a stemmed prosthesis (5.8% vs 6.4%, P = .90). At the time of stemless arthroplasty, 64 patients were aged <70 yr and 44 patients were aged ≥70 years. Between the 2 groups, there were no clinically or statistically significant differences in WOOS, ASES, and SANE scores at baseline, 1-year follow-up, or 2-year follow-up. The changes in all scores from baseline to 2 years were similar between the group aged <70 yr and the group aged ≥70 years. There was no difference in the percentage of patients achieving the minimal clinically important difference or substantial clinical benefit in either group after shoulder arthroplasty at 2-year follow-up. There was no difference between the 2 groups in terms of final postoperative range of motion or change in range of motion for any metric examined. There was no evidence of radiographic complications in either group. CONCLUSIONS Age ≥70 years does not appear to be a contraindication to stemless anatomic total shoulder arthroplasty. Postoperative improvements in patient-determined outcome scores, the percentage of patients achieving clinically important outcomes for the ASES, SANE, and WOOS scores, and postoperative range of motion were similar between patients aged <70 yr and those aged ≥70 years. There was no difference between the groups regarding the patients who required intraoperative deviation from the preoperatively planned stemless prosthesis to a stemmed prosthesis. Neither age group demonstrated a radiographically apparent complication.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
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19
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Sears BW, Creighton RA, Denard PJ, Griffin JW, Lichtenberg S, Lederman ES, Werner BC. Stemless components lead to improved radiographic restoration of humeral head anatomy compared with short-stemmed components in total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:240-246. [PMID: 36115615 DOI: 10.1016/j.jse.2022.07.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/16/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Restoring the native center of rotation (COR) in total shoulder arthroplasty (TSA) has been shown to improve postsurgical function, subjective outcomes, and implant longevity. The primary purpose of this study was to compare postoperative radiographic restoration of the humeral COR between short-stem and stemless humeral implants by evaluating the mean COR shift between the 2 techniques. Secondary outcomes evaluated were comparisons of COR shift outliers, humeral head implant thickness and diameter, direction of COR shift, and neck-shaft angle (NSA). METHODS This study was a multicenter retrospective comparative study using a consecutive series of primary anatomic TSA patients who received either a short-stem or stemless humeral implant. Radiographically, COR and NSA were measured by 2 fellowship-trained surgeons using the best-fit circle technique on immediate postoperative Grashey radiographs. RESULTS A total of 229 patients formed the final cohort for analysis that included 89 short stems and 140 stemless components. The mean COR shift for short stems was 2.7 mm (±1.4 mm) compared with 2.1 mm (±0.9 mm) for stemless implants (P < .001). The percentage of short-stem implant patients with a >2 mm COR difference from native was 66.0% (n = 62) compared with 47.4% (n = 64) for stemless (P = .006). The percentage of short-stem patients with a >4 mm COR difference from native was 17.0% (n = 16) compared with 3.0% (n = 4) for stemless (P < .001). The mean humeral implant head thickness for short stems was 18.7 ± 2.2 mm compared with 17.2 ± 1.3 mm for stemless implants (P < .001). The mean humeral head diameter for short stems was 48.7 ± 4.4 mm compared with 45.5 ± 3.5 mm for stemless implants (P < .001). The NSA for the short-stem cohort was 136.7° (±3.6°) compared with 133.5° (±6.0°) for stemless (P < .001). CONCLUSIONS Stemless prostheses placed during TSA achieved improved restoration of humeral head COR and were less likely to have significant COR outliers compared with short-stem implants.
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Affiliation(s)
| | - Robert A Creighton
- Orthopaedics and Sports Medicine, UNC Orthopaedics, Chapel Hill, NC, USA
| | | | - Justin W Griffin
- Shoulder Surgery/Sports Medicine, Jordan-Young Institute, Virginia Beach, VA, USA
| | | | - Evan S Lederman
- Orthopedic Sports Medicine, Orthopedic Surgery, Shoulder Orthopedic Surgery, Sports Medicine, Banner Health, Phoenix, AZ, USA
| | - Brian C Werner
- Orthopaedic Surgery, Department of Sports Medicine, UVA Health, Charlottesville, VA, USA
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20
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Guareschi AS, Eichinger JK, Friedman RJ. Patient outcomes after revision total shoulder arthroplasty in an inpatient vs. outpatient setting. J Shoulder Elbow Surg 2023; 32:82-88. [PMID: 35961496 DOI: 10.1016/j.jse.2022.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/03/2022] [Accepted: 06/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) is becoming an increasingly common surgical procedure for numerous shoulder conditions. The incidence of revision TSA is increasing because of the increase in primary TSA and the increased utilization of TSA in younger patients. Conducting revision TSA as an outpatient procedure would be beneficial in limiting expenditure and resource allocation but must show a similar complication profile compared to inpatient revision TSA in order to justify its clinical value. The purpose of this study is to compare the outcomes of outpatient revision TSA to inpatient revision TSA and outpatient primary TSA. METHODS The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2010-2019 to identify all patients who underwent revision TSA (n = 1456) in either an inpatient or outpatient setting, as well as patients who underwent primary TSA in an outpatient setting (n = 2630). Relevant demographic characteristics were compared between the outpatient revision group and both the inpatient revision and outpatient primary groups. Postoperative complications, readmission, and reoperation rates were also compared between the groups. RESULTS Patients undergoing inpatient revision TSA exhibited increased rates of preoperative hypertension (P = .013) and had increased prevalence of severe American Society of Anesthesiologists classification (P = .021) compared to patients undergoing outpatient revision TSA. Patients undergoing outpatient revision TSA were significantly more likely to experience complications (P < .001), have longer surgical times (P < .001), and undergo readmission (P = .006) and reoperation (P = .049) compared to patients undergoing outpatient primary TSA. There was no significant increase in rates of overall complication, readmission, or reoperation between patients undergoing revision TSA in an outpatient vs. an inpatient setting. CONCLUSION Outpatient revision TSA has higher complication rates, readmission, and reoperation rates compared to outpatient primary TSA, similar to previous findings when comparing revision and primary TSA done as an inpatient. However, there was no increased risk of complications, readmission, or reoperation for outpatient revision TSA compared to inpatient revision TSA. Outpatient revision TSA should be considered by orthopedic surgeons in patients who are medically healthy to undergo the procedure as an outpatient surgery.
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Bidwai R, Kumar K. Outcomes of different stem sizes in shoulder arthroplasty. J Orthop 2023; 35:37-42. [PMID: 36387763 PMCID: PMC9647328 DOI: 10.1016/j.jor.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/20/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022] Open
Abstract
Background The successive refinement in implant design and operative technique alongwith improved understanding has resulted in increased incidence of total shoulder arthroplasty (TSA). Simultaneously, the indications of TSA have widened and include a range of shoulder pathologies. Methods Using the keywords and relevant literature, we have described an overview of the different stem sizes used in shoulder arthroplasty. Relevant description of clinical and radiological outcome is done with regards to different stem sizes. Discussion There are plethora of shoulder replacement systems, based on unique philosophy and having their own advantages and disadvantages. Additionally, the rise in ageing population had increased the need for revision TSA, thereby necessitating the judicious choice of implant at primary TSA. We further present the role of cemented and uncemented humeral stems and discuss the findings of finite element analysis. The choice of humeral stem size and use of cemented or uncemented stems have been reported to affect the clinical and radiological outcomes.
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Affiliation(s)
- Rohan Bidwai
- Aberdeen Upper Limb Unit, Department of Trauma and Orthopaedics, Woodend Hospital, NHS Grampian , Aberdeen, UK
| | - Kapil Kumar
- Aberdeen Upper Limb Unit, Department of Trauma and Orthopaedics, Woodend Hospital, NHS Grampian , Aberdeen, UK
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22
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Zhou Y, Frampton C, Hirner M. Medium-term results of stemless, short, and conventional stem humeral components in anatomic total shoulder arthroplasty: a New Zealand Joint Registry study. J Shoulder Elbow Surg 2022; 32:1001-1008. [PMID: 36473693 DOI: 10.1016/j.jse.2022.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of this study was to compare the medium-term results for anatomic total shoulder arthroplasty by humeral component stem length. We hypothesize that the newer stemless implants may have comparable results to short-stem and conventional stemmed implants. METHODS The 12 most used anatomic total shoulder arthroplasty implants on the New Zealand Joint Registry were included in the study. Implants were categorized by stem length-conventional, short, and stemless. The primary outcome was revision up to 7 years postsurgery. Secondary outcomes included revision cause, implant survival, and early functional outcomes as evaluated by the Oxford Shoulder Score. Analysis was stratified by age and surgeon volume to control for potential confounding. RESULTS A total of 3952 patients (conventional, 3114; short, 360; stemless, 478) were included in the study. No significant difference in revision rate per 100 component-years was found between stemless, short-stem, and conventional stemmed implants (revision rate per 100 component-years: conventional, 1.01 [95% confidence interval (CI) 0.89-1.14]; short, 0.54 [95% CI 0.25-1.03]; stemless, 0.99 [95% CI 0.51-1.74]). This finding was irrespective of patient age or surgeon volume. There were no cases of humeral loosening up to 7 years' follow-up and no cases of intraoperative humeral fracture in the stemless group. Functional outcomes at 6 months postsurgery suggested better outcomes in the stemless group compared with the conventional stem group (mean Oxford Shoulder Score: conventional, 39.4; stemless, 40.7; P value = .023). CONCLUSION The medium-term survival of stemless implants for anatomic total shoulder arthroplasty appears comparable to short-stem and conventional stemmed implants. Further follow-up is required to understand the long-term survivorship and functional outcomes between these groups.
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Affiliation(s)
- Yushy Zhou
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia; Department of Orthopaedic Surgery, Whangarei Hospital, Whangarei, New Zealand.
| | - Chris Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marc Hirner
- Department of Orthopaedic Surgery, Whangarei Hospital, Whangarei, New Zealand
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23
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Kelly PJ, Twomey-Kozak JN, Goltz DE, Wickman JR, Levin JM, Hinton Z, Lassiter TE, Klifto CS, Anakwenze OA. Perioperative pain control represents the primary concern for patients considering outpatient shoulder arthroplasty: a survey-based study. J Shoulder Elbow Surg 2022; 31:e628-e633. [PMID: 35998781 DOI: 10.1016/j.jse.2022.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/27/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Outpatient (OP) total shoulder arthroplasty (TSA) with same-day discharge can now be performed safely in appropriately selected patients. Patient knowledge and perspectives regarding OP TSA are yet unknown and such information may inform surgeon decision-making and provide a framework for addressing patient concerns. The goal of this study was to understand and quantify patient knowledge of and concerns for OP TSA, with a working hypothesis that majority of patients are unaware of OP TSA as a realistic option and that their primary concern would be postoperative pain control. METHODS This was a retrospective cohort study at a tertiary care academic medical center including patients who underwent anatomic or reverse shoulder arthroplasty and completed an OP TSA expectations questionnaire/survey. This survey was provided preoperatively and included demographic factors, self-rated health evaluation, and perioperative expectations. Surveys evaluated whether patients undergoing TSA had any prior awareness of OP TSA and evaluated their primary concern with same-day discharge. Secondary questions included an assessment of patient expectations of outcomes of outpatient vs. inpatient surgery as well as their expected length of inpatient stay. RESULTS A total of 122 patients who underwent anatomic and reverse shoulder arthroplasty completed the questionnaire and comprised the study cohort. Fifty-two (42.6%) of the patients were unaware that OP TSA was an option, and 26 (50%) of these were comfortable with the idea of OP TSA. Comfort with OP TSA was significantly associated with higher subjective patient-reported health status. Fifty-eight patients (47.5%) expected that following TSA they would require <24 hours of in-hospital postoperative care. The primary concern for patients considering OP TSA was postoperative pain control, endorsed by 44.3% of patients, compared with 13.1% of patients stating this would be their primary concern if admitted as an inpatient postoperatively. Pain control being a primary concern was significantly different between those considering outpatient vs. inpatient TSA. Most patients anticipated that OP shoulder arthroplasty would lead to a better (36%) or comparable (53%) outcome, whereas only 11% had concerns that it would lead to a worse outcome. CONCLUSION Expanding OP TSA crucially depends on awareness and education. Perceived ability to control pain is an important concern. Patients may benefit from preoperative counseling, including emphasizing a comprehensive postoperative pain management strategy.
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Affiliation(s)
- Patrick J Kelly
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
| | | | - Daniel E Goltz
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - John R Wickman
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Jay M Levin
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Zoe Hinton
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Tally E Lassiter
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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24
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Looney AM, Day J, Johnson JL, Johnston PS. Outcomes Between Stemmed and Stemless Total Shoulder Arthroplasty: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202211000-00004. [PMID: 36322637 PMCID: PMC9633087 DOI: 10.5435/jaaosglobal-d-22-00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/20/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Both stemmed and stemless designs for total shoulder arthroplasty (TSA) have demonstrated efficacious outcomes for the surgical treatment of primary glenohumeral joint osteoarthritis. The purpose of this systematic review and meta-analysis was to compare the clinical outcomes of stemmed versus stemless TSA in randomized controlled trials. We hypothesized that there would be no differences in Constant Score (CS), range of motion, or adverse events, such as periprosthetic fracture and/or revision surgery. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the literature was done using MEDLINE, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Registry of Controlled Trials, Embase, and Web of Science databases. Outcomes of interest included CS, range of motion, and adverse events (periprosthetic fracture and revision). Summary effect estimates of the mean difference between stemmed and stemless TSA for each outcome were estimated in random effects models. RESULTS The search yielded 301 articles with 4 appropriate for qualitative analysis, including the results of 229 stemmed and 358 stemless TSAs. No significant difference was observed in postoperative CS (P = 0.36), forward flexion (P = 0.93), abduction (P = 0.30), or external rotation (P = 0.34) between stemmed and stemless TSA. No significant difference was observed in change in CS (P = 0.27), forward flexion (P = 0.25), or external rotation (P = 0.74). A change in abduction was significantly different between stemmed and stemless TSA (standardized mean difference = -0.64; 95% confidence interval, -1.20 to -0.08) in favor of stemmed TSA (P = 0.02), attributed to preoperative differences. No significant difference was observed in periprosthetic fractures (P = 0.07) or revision (P = 0.90). CONCLUSION TSA with stemless versus stemmed humeral components was not associated with notable differences in functional and clinical outcomes. No difference was observed between stemmed and stemless designs in postoperative forward flexion, abduction, or external rotation. Similarly, there was no difference in change in forward flexion or external rotation. A markedly greater improvement in abduction was observed with stemmed TSA, likely due to the lower preoperative motion in the stemmed cohort in one of the studies. No differences were observed between stemmed and stemless designs in the rate of humeral fracture or risk of revision. LEVEL OF EVIDENCE Level II; systematic review and meta-analysis of prospective randomized controlled trials.
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Affiliation(s)
- Austin M Looney
- From the Department of Orthopaedic Surgery, Georgetown University Hospital, Washington, DC (Dr. Looney, Dr. Day, and Dr. Johnson), and the Southern Maryland Orthopaedic & Sports Medicine Center, Centers for Advanced Orthopaedics, Leonardtown, MD (Dr. Johnston)
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25
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Marigi EM, Elahi MA, Cancio-Bello AM, Duquin TR, Sperling JW. Stemless anatomic total shoulder arthroplasty: surgical technique and review of the literature. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:442-450. [PMID: 37588463 PMCID: PMC10426651 DOI: 10.1016/j.xrrt.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Stemless anatomic total shoulder arthroplasty (aTSA) is a promising option for the treatment of degenerative disease in patients. This novel technique avoids the stem-related complications associated with the traditional stemmed aTSA. Stemless aTSA offers additional benefits such as decreased operative time, preservation of bone stock, improved radiographic outcomes, and easier revision. Moreover, loading of the metaphyseal region rather than the diaphysial region with traditional stemmed implants can decrease stress shielding. When compared to stemmed-implants, stemless aTSA has demonstrated similar outcomes and complication rates. The purpose of this article is to analyze published outcomes and complications following the utilization of stemless aTSA. Additionally, key aspects of the surgical technique that may promote optimal results in stemless aTSA implantation are presented.
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Affiliation(s)
- Erick M. Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Muhammad Ali Elahi
- Mayo Clinic Alix School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | | | - Thomas R. Duquin
- Department of Orthopaedics, State University of New York, Buffalo, NY, USA
| | - John W. Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Imiolczyk JP, Krukenberg A, Mansat P, Bartsch S, McBirnie J, Gotterbarm T, Wiedemann E, Soderi S, Scheibel M. Midterm results of stemless impaction shoulder arthroplasty for primary osteoarthritis: a prospective, multicenter study. JSES Int 2022; 7:1-9. [PMID: 36820431 PMCID: PMC9937825 DOI: 10.1016/j.jseint.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background 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. Methods 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. Results 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%. Conclusion 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.
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Affiliation(s)
| | - Anna Krukenberg
- Center for Musculoskeletal Surgery, Charité – Universitaetsmedizin Berlin, Germany
| | - Pierre Mansat
- Centre Hospitalier Universitaire Toulouse, Hôpital Purpan, Toulouse, France
| | | | - Julie McBirnie
- Department of Orthopaedics, New Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Austria
| | | | - Stefano Soderi
- Orthopedic Clinic, Department of NeuroMuscoloSkeletal and Sense Organs, Azienda Ospedaliero Universitaria Careggi, Centro Traumatologico Ortopedico, Florence, Italy
| | - Markus Scheibel
- Center for Musculoskeletal Surgery, Charité – Universitaetsmedizin Berlin, Germany,Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland,Corresponding author: Markus Scheibel, MD, Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité – Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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27
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Smith T, Horstmann H, Karkosch R, Tsamassiotis S, Bowsher N, Ellwein A, Pastor MF. Short-term results of a new anatomic stemless shoulder arthroplasty - A prospective multicentre study. Orthop Rev (Pavia) 2022; 14:37042. [PMID: 35910546 DOI: 10.52965/001c.37042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/05/2022] [Indexed: 11/06/2022] Open
Abstract
Background 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. Objective The aim of this study was to determine the short-term clinical and radiological outcomes of a new stemless TSA design. Methods 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. Results 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. Conclusion 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.
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Affiliation(s)
- Tomas Smith
- Department of orthopaedic surgery, Medical School Hannover, Anna-von-Borries Str. 1, 30625 Hannover, Germany
| | - Hauke Horstmann
- Department of orthopaedic surgery, Medical School Hannover, Anna-von-Borries Str. 1, 30625 Hannover, Germany
| | - Roman Karkosch
- Department of orthopaedic surgery, Medical School Hannover, Anna-von-Borries Str. 1, 30625 Hannover, Germany
| | - Spiros Tsamassiotis
- Department of orthopaedic surgery, Medical School Hannover, Anna-von-Borries Str. 1, 30625 Hannover, Germany
| | - Nina Bowsher
- DePuy Synthes, 700 Orthopaedic Drive,Warsaw, IN 46581, United States
| | - Alexander Ellwein
- Department of orthopaedic and trauma surgery, Friederikensift Hannover, Humboldtstraße 5, 30169 Hannover, Germany
| | - Marc-Frederic Pastor
- Department of orthopaedic surgery, Medical School Hannover, Anna-von-Borries Str. 1, 30625 Hannover, Germany
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Buch B, Vall M, Consigliere P, Guillén JA, Cruz E, Natera L. Short Stems and Stemless Shoulder Arthroplasty: Current Concepts Review. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:633-647. [PMID: 36258746 PMCID: PMC9569137 DOI: 10.22038/abjs.2021.53555.2664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
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.
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Affiliation(s)
- Berta Buch
- Hospital General de Granollers, Avinguda Francesc Ribas s/n, postcode: 08402, Granollers, Barcelona, Spain, Universitat Autònoma de Barcelona, Campus Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - María Vall
- Hospital General de Granollers, Avinguda Francesc Ribas s/n, postcode: 08402, Granollers, Barcelona, Spain, Universitat Autònoma de Barcelona, Campus Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - Paolo Consigliere
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, United Kingdom
| | - Josep Antón Guillén
- Hospital General de Granollers, Avinguda Francesc Ribas s/n, postcode: 08402, Granollers, Barcelona, Spain
| | - Enric Cruz
- Hospital General de Granollers, Avinguda Francesc Ribas s/n, postcode: 08402, Granollers, Barcelona, Spain
| | - Luis Natera
- Hospital General de Granollers, Avinguda Francesc Ribas s/n, postcode: 08402, Granollers, Barcelona, Spain
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A Comparison of Operative Time and Intraoperative Blood Volume Loss Between Stemless and Short‐stem Anatomic Total Shoulder Arthroplasty: A Single Institution's Experience. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202207000-00015. [PMID: 35858250 PMCID: PMC9302242 DOI: 10.5435/jaaosglobal-d-22-00141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/19/2022] [Indexed: 11/24/2022]
Abstract
There has been increasing interest in the use of stemless humeral implants for total shoulder arthroplasty when compared with both short-stem (SS) and standard-length implants. Although evidence for decreased surgical time and blood loss exists for stemless versus standard-length stems, far less literature exists comparing these clinical parameters for stemless versus SS implants.
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30
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Nixon RA, Dang KH, Haberli JE, O'Donnell EA. Surgical time and outcomes of stemmed versus stemless total shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:S83-S89. [PMID: 35172208 DOI: 10.1016/j.jse.2022.01.129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stemless total shoulder arthroplasty (TSA) was approved for use in the United States in 2015, and there remains a paucity of data on its performance in this market. Decreased operative time without compromise of clinical outcomes is a theoretical advantage of stemless TSA, but no studies have evaluated this in a comparative study to date. Herein, the operative times and clinical outcomes of stemless vs. conventional stemmed TSA are investigated. METHODS This is a retrospective cohort study, evaluating all consecutive TSAs performed by a single surgeon between 2015 and 2018. Data were collected from 59 patients who underwent TSA with conventional, stemmed humeral implants and 115 patients in whom a stemless humeral implant was used. Operative times and demographic data were collected retrospectively from the anesthesia record, and prospectively collected patient-reported outcome measures were collected from the Surgical Outcomes System database. For patient-reported outcome measure, visual analog scale, American Shoulder and Elbow Surgeons, and Single Assessment Numerical Evaluation scores were recorded serially until a minimum 2-year follow-up. RESULTS The average operative time was 24 minutes less in the stemless cohort compared with the stemmed cohort (104 minutes vs. 128 minutes, P < .001). Cost analysis showed a decreased personnel cost of 15.9% that correlates to a 3.1% overall reduction in operating room-associated cost. Patient-reported outcome scores significantly improved postoperatively in both cohorts across all time points. There was no difference found in visual analog scale, American Shoulder and Elbow Surgeons, and Single Assessment Numerical Evaluation scores between the cohorts at the 2-year follow-up. CONCLUSIONS Stemless TSA significantly reduces operative time with equivalent functional outcomes at a minimum 2-year follow-up.
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Affiliation(s)
- Ryan A Nixon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Khang H Dang
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jillian E Haberli
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Evan A O'Donnell
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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31
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Innovations in Shoulder Arthroplasty. J Clin Med 2022; 11:jcm11102799. [PMID: 35628933 PMCID: PMC9144112 DOI: 10.3390/jcm11102799] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/07/2022] [Accepted: 05/12/2022] [Indexed: 11/22/2022] Open
Abstract
Innovations currently available with anatomic total shoulder arthroplasty include shorter stem designs and augmented/inset/inlay glenoid components. Regarding reverse shoulder arthroplasty (RSA), metal augmentation, including custom augments, on both the glenoid and humeral side have expanded indications in cases of bone loss. In the setting of revision arthroplasty, humeral options include convertible stems and newer tools to improve humeral implant removal. New strategies for treatment and surgical techniques have been developed for recalcitrant shoulder instability, acromial fractures, and infections after RSA. Finally, computer planning, navigation, PSI, and augmented reality are imaging options now available that have redefined preoperative planning and indications as well intraoperative component placement. This review covers many of the innovations in the realm of shoulder arthroplasty.
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Ajibade DA, Yin CX, Hamid HS, Wiater BP, Martusiewicz A, Wiater JM. Stemless reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2022; 31:1083-1095. [PMID: 35051541 DOI: 10.1016/j.jse.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/27/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The use of reverse total shoulder arthroplasty and stemless anatomic total shoulder replacement has been increasing in the United States every year. Stemless humeral components in reverse total shoulder arthroplasty are only approved for clinical trials in the United States with an investigational device exception with limited data. METHODS A systematic review on stemless reverse total shoulder arthroplasty was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A search was conducted on November 25, 2020, using the MEDLINE/PubMed, Cochrane, and Embase databases. All articles were reviewed by 2 independent evaluators, with any conflicts or issues resolved by consensus or a final decision by the senior author. The primary outcomes extracted were complications, radiographic results, and outcome scores. RESULTS We evaluated 10 studies that used either the Total Evolutive Shoulder System (TESS) or Verso implant. There were 430 total patients and 437 total procedures; 266 patients in the TESS group underwent a total of 272 procedures, and 164 patients in the Verso group underwent a total of 165 procedures. The mean age at the time of surgery was 73.8 years (range, 38-93 years). The mean follow-up period ranged from 6.4 to 101.6 months per study. There was an overall trend of improved clinical outcome scores, a 0.2% humeral component loosening rate, and an 11.2% complication rate. CONCLUSIONS This review shows that the clinical and functional outcomes following stemless or metaphyseal reverse total shoulder arthroplasty are quite promising, especially with the low rate of humeral-sided complications. There continues to be a need for additional long-term studies and randomized clinical trials.
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Affiliation(s)
- David A Ajibade
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - Clark X Yin
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - Hussein S Hamid
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - Brett P Wiater
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - Alexander Martusiewicz
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA
| | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Health System, Oakland University School of Medicine, Royal Oak, MI, USA.
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McClelland D, Blackwell JR, O'Beirne S, Grocott NE, Ogrodnik PJ. Determining the ideal osteotomy for stemless total shoulder replacement: a cadaveric study. J Shoulder Elbow Surg 2022; 31:413-419. [PMID: 34560290 DOI: 10.1016/j.jse.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS We sought to determine the angle of osteotomy that produces a circular humeral cut surface. METHODS A total of 49 cadaveric shoulders, from 25 cadavers, underwent sequential humeral head osteotomy from 180° (vertical, in line with the humeral diaphyseal shaft), in 10° increments, until the rotator cuff insertion was encountered. At each stage, the anteroposterior (AP) and superoinferior (SI) distances were recorded. The data were analyzed for normality and then assessed to determine the optimum cut angle. RESULTS The AP/SI ratio is an indication of roundness. Plotting values of 1 - AP/SI (ie, error) vs. cut angle allowed us to plot the likelihood of producing a circular cut surface using a third-order curve that created the best fit to the data set (R2 = 0.99). The results from this study suggest that the optimum osteotomy angle that produces a circular cut surface is 23° from the vertical. The cohort data illustrated that at this angle, the average roundness error was 1% with a 95% confidence limit of <1%. There was no significant difference (P > .05) between sexes. CONCLUSION The humeral head shape changes from oval to circular and then to an oval cut surface as the osteotomy angle increases from the vertical toward the horizontal. The range of angles within which the cut surface is circular, within a 10% error margin, is 18°-27° from the vertical, which is much less than the traditional osteotomy angle of 45°.
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Galhoum MS, Elsheikh AA, Wood A, Yin Q, Frostick SP. Anatomic and Reverse Stemless Shoulder Arthroplasty: Functional and Radiological Evaluation. J Shoulder Elb Arthroplast 2022; 6:24715492221118765. [PMID: 36035594 PMCID: PMC9411739 DOI: 10.1177/24715492221118765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/29/2022] [Accepted: 07/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background Stemless 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 methods This 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). Results The 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. Conclusion Anatomic Stemless total shoulder arthroplasty offers acceptable results and improvement of overall functional outcomes.
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Affiliation(s)
| | - Ahmed A. Elsheikh
- Department of Orthopaedic Surgery, Faculty of Medicine, Benha University, Benha, Egypt
| | - Amanda Wood
- Musculoskeletal Science Research Group, Department of Molecular and Clinical Cancer, University of Liverpool, Liverpool, UK
| | - Qi Yin
- Consultant Orthopedic surgery, Royal Liverpool University Hospitals, Liverpool, UK
| | - Simon P. Frostick
- Professor of Orthopaedics, Department of Molecular and Clinical Cancer Medicine, Cancer Research Centre, University of Liverpool, Liverpool, UK
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McMillan TE, Neilly DW, Khan LAK, Cairns D, Barker SL, Kumar K. Midterm clinical and radiologic survivorship of a stemless total shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:2795-2803. [PMID: 33984521 DOI: 10.1016/j.jse.2021.04.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/18/2021] [Accepted: 04/25/2021] [Indexed: 02/01/2023]
Abstract
AIM The aim of this study was to evaluate the clinical and radiologic outcomes of stemless total shoulder arthroplasty (TSA) in patients with glenohumeral arthritis. PATIENTS AND METHODS This is a retrospective case series of all patients who underwent a TSA with Affinis Short prosthesis during the period 2010-2017. Seventy-two TSAs were performed within our unit, in 62 patients (45 females and 17 males), with 10 patients having bilateral TSAs with this prosthesis. The mean follow-up was 3.9 years (2-8.7 years). Patients were evaluated clinically with the Oxford Shoulder Score, range of movement assessment, and a numerical patient satisfaction score. Follow-up radiographs were evaluated by 2 reviewers assessing for lucency and assigned a Lazarus grade. RESULTS Six patients were lost to follow-up prior to their 2-year review. At last follow-up, the mean forward elevation was 157° (80°-180°), abduction was 150° (60°-180°), and external rotation was 39° (20°-60°). The mode internal rotation was to the lumbar spine, with 95% of patients achieving internal rotation to L5 or higher. The mean Oxford Shoulder Score was 45 (18-48). The mean patient satisfaction score was 4.93/5. No humeral lucencies were observed. Sixty-four percent (n=47) of the glenoids were Lazarus grade 0, showing no evidence of radiolucency. The remaining patients were Lazarus grade 1-3, although none were progressive and all patients were asymptomatic. No patients were revised for aseptic loosening. Four patients underwent revision: 1 for infection, 1 for heterotrophic ossification and stiffness, and 2 for rotator cuff failure. CONCLUSION Midterm follow-up results indicate good clinical and radiologic survivorship for this stemless TSA. Our findings suggest good patient function and satisfaction, and no patients have required revision for aseptic loosening. Further follow-up is required to determine long-term survivorship.
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Affiliation(s)
- Tristan E McMillan
- Department of Trauma and Orthopaedics, Aberdeen Upper Limb Unit, Woodend Hospital, Aberdeen, UK.
| | - David W Neilly
- Department of Trauma and Orthopaedics, Aberdeen Upper Limb Unit, Woodend Hospital, Aberdeen, UK
| | - L A Kash Khan
- Department of Trauma and Orthopaedics, Aberdeen Upper Limb Unit, Woodend Hospital, Aberdeen, UK
| | - David Cairns
- Department of Trauma and Orthopaedics, Aberdeen Upper Limb Unit, Woodend Hospital, Aberdeen, UK
| | - Scott L Barker
- Department of Trauma and Orthopaedics, Aberdeen Upper Limb Unit, Woodend Hospital, Aberdeen, UK
| | - Kapil Kumar
- Department of Trauma and Orthopaedics, Aberdeen Upper Limb Unit, Woodend Hospital, Aberdeen, UK
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Abstract
The etiology of avascular necrosis (AVN) of the proximal humerus can be classified as idiopathic or posttraumatic, the latter being mainly due to proximal humerus fractures. Evidence suggests that posttraumatic AVN may require surgical intervention more often than idiopathic AVN of the proximal humerus. This article provides a comprehensive review of the management of posttraumatic AVN of the proximal humerus. Early stage AVN (stages 1 to 3) is commonly treated with nonoperative intervention or core decompression of the humeral head, whereas later stage disease (stages 4 and 5) may require hemiarthroplasty or total shoulder arthroplasty to restore function. [Orthopedics. 2021;44(6):367-375.].
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Goldberg SS, Baranek ES, Korbel KC, Blaine TA, Levine WN. Anatomic total shoulder arthroplasty using a stem-free ellipsoid humeral implant in patients of all ages. J Shoulder Elbow Surg 2021; 30:e572-e582. [PMID: 33486059 DOI: 10.1016/j.jse.2020.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stem-free shoulder arthroplasty has recently been shown to have comparable results to stemmed arthroplasty, though stemless designs are typically used in a younger patient population. Additionally, although the native humeral head is elliptical in shape, clinical results with ellipsoid implants in shoulder arthroplasty have not been reported on previously. This case series reports on the outcomes of a recently introduced anatomic total shoulder arthroplasty with an ellipsoid-shaped articular surface and unique multiplanar platform type of stemless fixation. METHODS This retrospective case series examines the initial cohort of patients who received an anatomic total shoulder arthroplasty using an ellipsoid stem-free humeral prosthesis and an all-polyethylene glenoid component from the Catalyst CSR Total Shoulder System (Catalyst OrthoScience) over a 1-year period. Inclusion criteria were patients with a diagnosis of advanced glenohumeral joint arthritis with an intact rotator cuff, regardless of patient age. Clinical outcomes including shoulder range of motion and patient-reported outcome measures, as well as radiographs, were evaluated at multiple time points postoperatively, with minimum 2-year follow-up. RESULTS Sixty-three shoulders in 57 patients with a mean age of 73.0 years (range 60-85 years) were included in the study with a mean follow-up period of 30.5 months (range 24-41 months). Forward elevation improved from 121° to 150° (P < .0001), external rotation improved from 28° to 48° (P < .0001), and internal rotation improved from L3 to L1 (P < .001). There were statistically significant improvements exceeding the minimal clinically important difference (MCID) in the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score (37 to 94, P < .001), Single Assessment Numeric Evaluation (SANE) (40 to 93, P < .001), visual analog scale (6.3 to 0.4, P < .001), and Patient-Reported Outcomes Measurement Information System physical domain T score (44 to 57, P < .001). The improvement in the ASES score also exceeded the threshold for the substantial clinical benefit. Age, sex, and preoperative glenoid morphology did not appear to have an effect on the clinical outcome scores. There were no implant failures or evidence of radiographic loosening of the humerus component in any patients. CONCLUSION At 2-year minimum follow-up, this stem-free ellipsoid humerus total shoulder arthroplasty provides very good results with high patient satisfaction, clinical improvement in all outcome measures studied, and no signs of loosening.
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Affiliation(s)
- Steven S Goldberg
- Division of Orthopedic Surgery, Physicians Regional Medical Center, Naples, FL, USA.
| | - Eric S Baranek
- Department of Orthopedic Surgery, New York Presbyterian-Columbia University Medical Center, New York, NY, USA
| | - Kayla C Korbel
- Division of Orthopedic Surgery, Physicians Regional Medical Center, Naples, FL, USA
| | - Theodore A Blaine
- Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - William N Levine
- Department of Orthopedic Surgery, New York Presbyterian-Columbia University Medical Center, New York, NY, USA
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Ambros L, Schoch C, Merz C, Huth J, Mauch F. Clinical and radiologic results after anatomic stemless shoulder prosthesis: a minimum 4-year follow-up. J Shoulder Elbow Surg 2021; 30:2082-2089. [PMID: 33588054 DOI: 10.1016/j.jse.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Since the introduction of stemless anatomic shoulder arthroplasty, few midterm functional and radiographic results have been published. This article presents results of the Arthrex Eclipse prosthesis with a mean follow-up of 70 months. METHODS We prospectively evaluated the outcome of 53 arthroplasties in 51 patients with a mean age of 65 years at the time of implantation with a minimum follow-up of 48 months. All patients were physically and radiologically examined, and the results documented by Constant-Murley and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. RESULTS Significant improvements from preoperative to last follow-up were documented in the Constant-Murley score (53.8%-83.5%, P < .001) and active range of motion (abduction 84°-108°, flexion 98°-125°, and external rotation 19°-41°). There was no significant difference between total and hemiarthroplasty. The mean DASH score was 28.3 points (95% confidence interval 20.1-35.2). Lowering of bone mineral density was observed in anteroposterior radiographs at the humeral component in 24.5% and at the glenoid component in 33.3%. The rate of complications was 15.7%. CONCLUSION This study finds improvements in functional, radiographic, and subjective midterm results comparable to other accessible data for stemless and stemmed arthroplasty.
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Affiliation(s)
| | | | | | - Jochen Huth
- Sportklinik Stuttgart GmbH, Stuttgart, Germany.
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Märtens N, Heinze M, Awiszus F, Bertrand J, Lohmann CH, Berth A. Long-term survival and failure analysis of anatomical stemmed and stemless shoulder arthroplasties. Bone Joint J 2021; 103-B:1292-1300. [PMID: 34192923 DOI: 10.1302/0301-620x.103b7.bjj-2020-0915.r3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS 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. METHODS 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. RESULTS 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. CONCLUSION 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 J 2021;103-B(7):1292-1300.
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Affiliation(s)
- Nicole Märtens
- Department of Orthopaedic Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Maximilian Heinze
- Department of Orthopaedic Surgery, Asklepios Harzkliniken Fritz-König-Stift Bad Harzburg, Bad Harzburg, Germany
| | - Friedemann Awiszus
- Department of Orthopaedic Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Jessica Bertrand
- Department of Orthopaedic Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Alexander Berth
- Department of Orthopaedic Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
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Posterior approach shoulder arthroplasty: a cadaveric study assessing access. J Shoulder Elbow Surg 2021; 30:1471-1476. [PMID: 33221523 DOI: 10.1016/j.jse.2020.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Posterior shoulder arthroplasty is an approach to shoulder replacement. The goal of this cadaveric study was to determine anatomic feasibility for posterior approach shoulder arthroplasty by evaluating access to the glenoid, humerus, and canal. METHODS Twelve fresh frozen shoulders (10 males; 2 females) (mean age, 76 [range, 55-92 years]; weight, 79 kg [range, 34-125 kg]) were used. Traditional exposure techniques and retractors were used to evaluate direct access. Exposure to the glenoid and humerus was evaluated using digital imaging software. Successful placement from stemmed arthroplasty was evaluated using digital radiographs and imaging software. RESULTS The posterior approach permitted direct access to 88.8% ± 8.1% of the glenoid. There was access to the center of the humeral head cut surface in 12 of 12 specimens. In 10 specimens, there was 100% access to the entire cut surface of the humerus and peripheral edges. The average access to the humerus was 95.3% ± 13.4%. Average angulation with stem placement was 0.73° of varus (range, 4.4° of varus to 3.5° of valgus). Regarding lateral plane angulation, there was an average of 0.33° of posterior angulation (range, 3.3° of posterior angulation to 2.5° of anterior angulation). CONCLUSION Access to the center of the glenoid and humerus was achieved in all cases. More research is needed to evaluate the clinical efficacy of posterior shoulder arthroplasty, including mid- and long-term outcome and safety studies.
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Does computerized CT-based 3D planning of the humeral head cut help to restore the anatomy of the proximal humerus after stemless total shoulder arthroplasty? J Shoulder Elbow Surg 2021; 30:e309-e316. [PMID: 32950671 DOI: 10.1016/j.jse.2020.08.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Restoration of proximal humeral anatomy (RPHA) after total shoulder arthroplasty (TSA) has been shown to result in better clinical outcomes than is the case in nonanatomic humeral reconstruction. Preoperative virtual planning has mainly focused on glenoid component placement. Such planning also has the potential to improve anatomic positioning of the humeral head by more accurately guiding the humeral head cut and aid in the selection of anatomic humeral component sizing. It was hypothesized that the use of preoperative 3-dimensional (3D) planning helps to reliably achieve RPHA after stemless TSA. METHODS One hundred consecutive stemless TSA (67 males, 51 right shoulder, mean age of 62 ±9.4 years) were radiographically assessed using pre- and postoperative standardized anteroposterior radiographs. The RPHA was measured with the so-called circle method described by Youderian et al. We measured deviation from the premorbid center of rotation (COR), and more than 3 mm was considered as minimal clinically important difference. Additionally, pre- and postoperative humeral head diameter (HHD), head-neck angle (HNA), and humeral head height (HHH) were measured to assess additional geometrical risk factors for poor RPHA. RESULTS The mean distance from of the premorbid to the implanted head COR was 4.3 ± 3.1 mm. Thirty-five shoulders (35%) showed a deviation of less than 3 mm (mean 1.9 ±1.1) and 65 shoulders (65%) a deviation of ≥3 mm (mean 8.0 ± 3.7). Overstuffing was the main reason for poor RPHA (88%). The level of the humeral head cut was responsible for overstuffing in 46 of the 57 overstuffed cases. The preoperative HHD, HHH, and HNA were significantly larger, higher, and more in valgus angulation in the group with accurate RPHA compared with the group with poor RPHA (HHD of 61.1 mm ± 4.4 vs. 55.9 ± 6.6, P < .001; HHH 8.6±2.2 vs. 7.6±2.6, P = .026; and varus angulation of 134.7° ±6.4° vs. 131.0° ±7.91, P = .010). CONCLUSION Restoration of proximal humeral anatomy after stemless TSA using computed tomography (CT)-based 3D planning was not precise. A poorly performed humeral head cut was the main reason for overstuffing, which was seen in 88% of the cases with inaccurate RPHA. Preoperative small HHD, low HHH, and varus-angulated HNA are risk factors for poor RPHA after stemless TSA.
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Walters JD, Brockmeier SF. Anatomic Total Shoulder Arthroplasty With a Stemless Humeral Component. VIDEO JOURNAL OF SPORTS MEDICINE 2021; 1:2635025421997126. [PMID: 40308257 PMCID: PMC11883407 DOI: 10.1177/2635025421997126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/29/2020] [Indexed: 05/02/2025]
Abstract
Background This technique video reviews anatomic total shoulder arthroplasty (TSA) with a stemless humeral component using a representative case example. Indications Stemless TSA is indicated for patients with symptomatic glenohumeral arthritis typically younger than 65 years of age. Stemless TSA may be used for other glenohumeral degenerative conditions such as avascular necrosis or posttraumatic arthropathy, provided acceptable humeral bone quality is confirmed intraoperatively using a thumb-press test. Poor bone quality is the primary contraindication. Technique Description Preoperatively, computed tomography is typically used for planning, and intraoperative navigation through magnetic resonance imaging is also useful. The procedure's critical elements include beach chair positioning, standard deltopectoral approach with lesser tuberosity osteotomy (LTO), freehand proximal humeral osteotomy, perpendicular proximal humeral exposure and subsequent preparation over a central guidewire, stemless implant and humeral head sizing, perpendicular glenoid exposure and implant placement, and final humeral implantation with LTO repair/fixation. A phased rehabilitation protocol includes 6-week sling immobilization to protect the subscapularis/LTO repair and return to normal activities between 3 and 6 months postoperatively. Discussion/Conclusion Stemless TSA shows promising early and mid-term outcomes with complication rates, including humeral loosening rates, similar to standard stemmed components. Potential complications include neurovascular injury, infection, glenoid or humeral component loosening, and rotator cuff failure.
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Wodarek J, Shields E. Stemless Total Shoulder: A Review of Biomechanical Fixation and Recent Results. J Shoulder Elb Arthroplast 2021; 5:24715492211008408. [PMID: 34993377 PMCID: PMC8492026 DOI: 10.1177/24715492211008408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/02/2021] [Accepted: 03/14/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: Anatomic total shoulder arthroplasty is the replacement of the humeral head and glenoid surfaces with the goal of replicating normal anatomy. It is commonly utilized for patients with osteoarthritis, rheumatoid arthritis, and osteonecrosis, who have decreased range of motion (ROM), persistent pain, and loss of strength. Total shoulder Arthroplasty (TSA) is the third most common joint replacement in the United States. The incidence of TSA has been increasing, some data suggest that by the year 2025, TSA incidence may rise to 439,206 operations per year. In recent years, stemless total shoulder implants have become available. Results: These implants preserve bone stock while decreasing complications such as osteolysis, stress shielding and periprosthetic fracture. Stemless implants improve anatomic reconstruction and biomechanical function of the shoulder joint. Conclusion: Increasing amounts of data suggest stemless TSA to be a safe and effective technology that will become more common in the coming year.
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Affiliation(s)
- Jeremy Wodarek
- Central Michigan University College of Medicine, Mount Pleasant, Michigan
| | - Edward Shields
- Central Michigan University College of Medicine, Mount Pleasant, Michigan
- Orthopedic Associates of Muskegon, Muskegon, Michigan
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Park H, Haskoor J, Domingo-Johnson EL, Srikumaran U. Stemless Total Shoulder Arthroplasty for a 4-Part Proximal Humerus Malunion and Post-traumatic Arthritis: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00049. [PMID: 33886518 DOI: 10.2106/jbjs.cc.20.00902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CASE We present a 62-year-old left-hand-dominant woman with history of renal failure, osteoporosis, and 4-part proximal humerus fracture malunion with subsequent post-traumatic arthritis of the left glenohumeral joint. After conservative treatments failed to relieve her symptoms, the patient underwent stemless total shoulder arthroplasty (TSA) because of concerns that her proximal humerus could not accommodate a stemmed implant. At 2 and a half-years postoperative, the patient demonstrated significant improvement of symptoms without signs of radiographic loosening. CONCLUSION In the setting of proximal humerus malunion with post-traumatic arthritis, clinical improvement without implant loosening can be achieved with stemless TSA, even in the setting of compromised bone quality.
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Affiliation(s)
- Hannah Park
- University of New England College of Osteopathic Medicine, Biddeford, Maine
| | - John Haskoor
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | | | - Uma Srikumaran
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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Kozak T, Bauer S, Walch G, Al-Karawi S, Blakeney W. An update on reverse total shoulder arthroplasty: current indications, new designs, same old problems. EFORT Open Rev 2021; 6:189-201. [PMID: 33841918 PMCID: PMC8025709 DOI: 10.1302/2058-5241.6.200085] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Reverse total shoulder arthroplasty (RTSA) was originally developed because of unsatisfactory results with anatomic shoulder arthroplasty options for the majority of degenerative shoulder conditions and fractures. After initial concerns about RTSA longevity, indications were extended to primary osteoarthritis with glenoid deficiency, massive cuff tears in younger patients, fracture, tumour and failed anatomic total shoulder replacement. Traditional RTSA by Grammont has undergone a number of iterations such as glenoid lateralization, reduced neck-shaft angle, modular, stemless components and onlay systems. The incidence of complications such as dislocation, notching and acromial fractures has also evolved. Computer navigation, 3D planning and patient-specific implantation have been in use for several years and mixed-reality guided implantation is currently being trialled. Controversies in RTSA include lateralization, stemless humeral components, subscapularis repair and treatment of acromial fractures. Cite this article: EFORT Open Rev 2021;6:189-201. DOI: 10.1302/2058-5241.6.200085
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Affiliation(s)
- Thomas Kozak
- Albany Health Campus, Albany, Australia.,Royal Perth Hospital, Perth, Australia
| | - Stefan Bauer
- Ensemble Hospitalier de la Côte, Morges, Switzerland
| | - Gilles Walch
- Hôpital Privé Jean-Mermoz, Centre Orthopédique Santy, Lyon, France
| | | | - William Blakeney
- Albany Health Campus, Albany, Australia.,Royal Perth Hospital, Perth, Australia
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Shin YS, Lee WS, Won JS. Comparison of stemless and conventional stemmed shoulder arthroplasties in shoulder arthropathy: A meta-analysis. Medicine (Baltimore) 2021; 100:e23989. [PMID: 33578516 PMCID: PMC7886414 DOI: 10.1097/md.0000000000023989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/29/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND It is unclear whether stemless shoulder prosthesis lead to better clinical outcomes than conventional stemmed shoulder prosthesis. The purpose is to compare clinical outcomes and complication rates after surgery in patients with shoulder arthropathy treated with stemless or conventional stemmed shoulder prosthesis. METHOD All studies comparing the constant score (CS), range of motion (ROM), and complication rates after surgery in patients with shoulder arthropathy treated with stemless or conventional stemmed shoulder prosthesis were included. The major databases MEDLINE, EMBASE, the Cochrane Library, Web of Science, and SCOPUS were searched for appropriate studies from the earliest available date of indexing through March 31, 2019. No restrictions were placed on language of publication. RESULTS A total of 6 studies met the inclusion criteria and were analyzed in detail. Overall postoperative ROM (95% CI: 3.27 to 11.92; P < .01) was significantly greater for stemless prosthesis compared to conventional stemmed prosthesis. However, postoperative CS (95% CI: -2.98 to 7.13; P = .42) and complication rates (OR 1.22, 95% CI: 0.48-3.08; P = .68) were did not differ significantly between the 2 groups. CONCLUSION This meta-analysis revealed that postoperative CS and complication rates did not differ significantly between the 2 treatment methods, stemless shoulder prosthesis and conventional stemmed shoulder prosthesis, for shoulder arthropathy. However, stemless shoulder prosthesis resulted in better outcomes than conventional stemmed shoulder prosthesis in terms of postoperative ROM. LEVEL OF EVIDENCE Level III, Therapeutic study.
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Affiliation(s)
- Young-Soo Shin
- Department of Orthopedic Surgery, Hallym University School of Medicine, Chucheon, Republic of Korea
| | - Woo-Seung Lee
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul
| | - Jun-Sung Won
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul
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[Shoulder arthroplasty]. DER ORTHOPADE 2021; 50:245-256. [PMID: 33543309 DOI: 10.1007/s00132-020-04065-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
Arthroplasty of the shoulder joint leads to excellent clinical results if the indications are valid and the implantation is technically correct. Taking anatomical requirements and mechanical functions as well as material properties and developments in surgical techniques into account, articulations and anchoring systems have been developed which, as modular systems enable successful restoration of the biomechanics and consider the importance of the surrounding soft tissues. Scientific data show promising medium-term and long-term results in terms of functionality and pain reduction. Nevertheless, due to the limited bone stock for implant anchoring, especially loosening of the prosthesis or instability of the glenoid joint component, revision arthroplasty remains challenging. This review article summarizes the relevant aspects of shoulder arthroplasty.
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Jordan RW, Kelly CP, Pap G, Joudet T, Nyffeler RW, Reuther F, Irlenbusch U. Mid-term results of a stemless ceramic on polyethylene shoulder prosthesis - A prospective multicentre study. Shoulder Elbow 2021; 13:67-77. [PMID: 33717220 PMCID: PMC7905519 DOI: 10.1177/1758573219866431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/09/2019] [Accepted: 07/05/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Early reports of stemless shoulder arthroplasty have shown promising clinical and radiological outcomes. The purpose of this study was to report on the mid-term results of an implant that utilises a ceramic humeral head. METHODS A prospective, consecutive, multicentre study of stemless shoulder prosthesis with a minimum of four years of follow-up was conducted between August 2009 and May 2012. The adjusted Constant-Murley Score (CMS), revision rate and presence of radiolucent lines were recorded at intervals. RESULTS A total of 207 patients were eligible for study inclusion; 62.8% were female and mean age was 64.8 years (range 30-86). Mean follow-up was 70.7 months (range 48-100), 73% underwent TSA and 27% hemiarthroplasty. The mean CMS improvement was 42.6 (p < 0.0001) at 48 months. Radiolucencies were present in 2.7% of humeral zones and 14% of glenoid zones at 48-month follow-up. The revision rate was 6.3% with rotator cuff failure (2.9%) the most common indication. CONCLUSIONS Mid-term results demonstrate that the studied stemless implant with a ceramic humeral head had clinical and radiological outcomes that are comparable to other reported studies.
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Affiliation(s)
- RW Jordan
- Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, England,RW Jordan, Robert Jones & Agnes Hunt Orthopaedic Hospital Gobowen, Oswestry SY10 7AG, England.
| | - CP Kelly
- Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, England
| | - G Pap
- Helios Park-Hospital Leipzig, Leipzig, Germany
| | - T Joudet
- Clinique du Libournais, Libourne, France
| | | | - F Reuther
- DRK Clinic Berlin Koepenick, Berlin, Germany
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Schoch C, Dittrich M, Ambros L, Geyer M. Revision of a Stemless Anatomic Implant into a Stemless Reverse Implant. Case Rep Orthop 2021; 2021:6667871. [PMID: 33505748 PMCID: PMC7815383 DOI: 10.1155/2021/6667871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Stemless anatomic implants are the growing standard for solving osteoarthritis of the shoulder. If there are secondary rotator cuff insufficiency and the need to revise the implant into a reverse total shoulder, there is usually the option to revise it into a stemmed implant with losing the benefits of stemless implants. There are only a few stemless reverse implants available on the market. Usually, they are recommended as primary implants, but not for revision surgery. Case Report. A 61-year-old male with an indwelling anatomic stemless TESS (Total Evolutive Shoulder System, Zimmer Biomet, Warsaw, USA) implant presented in our clinic with growing pain and loss of range of motion. The TESS was implanted in 2007 as a hemishoulder arthroplasty. The X-ray was showing a stable implanted corolla with clearly growing protrusion of the glenoid. Because of the clinical presentation and the ultrasound investigation that showed only remnants of the supraspinatus and infraspinatus left, we decided that it is necessary to revise the stable implant in a reverse total shoulder arthroplasty. As the TESS was not designed to be convertible, it was clear that it has to be explanted. Due to the young age of the patient, we proposed an "off-label" change to a stemless reverse implant, e.g., the LIMA SMR stemless reverse prosthesis. A revision was possible without much bone loss, so the stemless reverse implant could be used. The clinical and radiological 2-year follow-up showed a good result. CONCLUSION Stemless implants are well known for anatomic implants, rarely for reverse implants, and seldom used for revision into reverse stemless. This case report shows that it is possible to revise a stemless anatomic implant with a stemless reverse, as long as the rules for implantation are applicable.
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Affiliation(s)
- Christian Schoch
- St. Vinzenz Klinik Pfronten, Department for Shoulder and Elbow Surgery, Kirchweg 15, 87459 Pfronten, Germany
| | - Michael Dittrich
- St. Vinzenz Klinik Pfronten, Department for Shoulder and Elbow Surgery, Kirchweg 15, 87459 Pfronten, Germany
| | - Leander Ambros
- St. Vinzenz Klinik Pfronten, Department for Shoulder and Elbow Surgery, Kirchweg 15, 87459 Pfronten, Germany
| | - Michael Geyer
- St. Vinzenz Klinik Pfronten, Department for Shoulder and Elbow Surgery, Kirchweg 15, 87459 Pfronten, Germany
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Willems JIP, Hoffmann J, Sierevelt IN, van den Bekerom MPJ, Alta TDW, van Noort A. Results of stemless shoulder arthroplasty: a systematic review and meta-analysis. EFORT Open Rev 2021; 6:35-49. [PMID: 33532085 PMCID: PMC7845565 DOI: 10.1302/2058-5241.6.200067] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Stemless shoulder arthroplasty relies solely on cementless metaphyseal fixation and is designed to avoid stem-related problem such as intraoperative fractures, loosening, stress shielding or stress-risers for periprosthetic fractures. Many designs are currently on the market, although only six anatomic and two reverse arthroplasty designs have results published with a minimum of two-year follow-up. Compared to stemmed designs, clinical outcome is equally good using stemless designs in the short and medium-term follow-up, which is also the case for overall complication and revision rates. Intraoperative fracture rate is lower in stemless compared to stemmed designs, most likely due to the absence of intramedullary preparation and of the implantation of a stem. Radiologic abnormalities around the humeral implant are less frequent compared to stemmed implants, possibly related to the closer resemblance to native anatomy. Between stemless implants, several significant differences were found in terms of clinical outcome, complication and revision rates, although the level of evidence is low with high study heterogeneity; therefore, firm conclusions could not be drawn. There is a need for well-designed long-term randomized trials with sufficient power in order to assess the superiority of stemless over conventional arthroplasty, and of one design over another. Cite this article: EFORT Open Rev 2021;6:35-49. DOI: 10.1302/2058-5241.6.200067
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Affiliation(s)
| | | | - Inger N Sierevelt
- Spaarne Gasthuis, Hoofddorp, The Netherlands.,Xpert Orthopedics, Amsterdam, The Netherlands
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