Page 45 - ISAKOS 2018 Newsletter Volume 2

CURRENT CONCEPTS
In nearly all series, the clinical outcomes associated with short-stem and stemless implants have been equivalent to those associated with traditional stemmed implants. Malpositioning of the implant secondary to loss of constraint remains the most common complication2. Intraoperative fractures generally have been more common in association with short-stem and stemless implants than with standard stems, and improvement in the rate of postoperative fractures to date has not be established. Despite the purported advantage of the lack of diaphyseal constraint, the restoration of humeral-sided anatomical parameters has been reported to occur significantly less frequently in association with stemless implants as compared with short-stem and standard-stem implants2. The clinical importance of this malalignment remains unclear.
Conclusion
The early published results associated with short-stem and stemless components have been encouraging. The rates of loosening and revision have been consistent with the long- term results associated with traditional stemmed components. We agree with the conclusion of Keener et al.4, who stated that “Longer-term follow-up will be necessary before the potential clinical advantages and disadvantages of stemless and short-stemmed implants are fully understood. Stemmed implants continue to have the best available evidence and thus remain the preferred design.”
Reference
1. Razfar N, Reeves JM, Langohr DG, Willing R, Athwal GS, Johnson JA. Comparison of proximal humeral bone stresses between stemless, short stem, and standard stem length: a finite element analysis. J Shoulder Elbow Surg. 2016;25(7):1076-83. 2. Sholder D HJ, Abboud JA, Cox RM, Lazarus MD, Ramsey ML, Stoll LE, Williams GR. Humeral Head Anatomic Restoration after Total Shoulder Arthroplasty: Does the Stem make a Difference? Proceedings of the American Academy of Orthopedic Surgeons. 2018. 3. Hawi N, Tauber M, Messina MJ, Habermeyer P, Martetschlager F. Anatomic stemless shoulder arthroplasty and related outcomes: a systematic review. BMC Musculoskelet Disord. 2016;17(1):376. 4. Keener JD, Chalmers PN, Yamaguchi K. The Humeral Implant in Shoulder Arthroplasty. J Am Acad Orthop Surg. 2017;25(6):427-38. 5. Budeyri A, Garofalo R, Krishnan SG. Glenohumeral osteoarthritis in young patients: Stemless total shoulder arthroplasty trumps resurfacing arthroplasty–Affirms. Seminars in Arthroplasty. 2017;28(3):113-20.
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02 Diagram illustrating stemless, short-stem, and standard humeral components. (Reprinted, with permission, from: Razfar et al.1
03 Radiograph showing a loose short stem at the site of a malunited proximal humeral fracture.
ISAKOS NEWSLETTER 2018: VOLUME II 43