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. 2021 Apr 17;5(4):656-662.
doi: 10.1016/j.jseint.2021.02.014. eCollection 2021 Jul.

Short-stem uncemented anatomical shoulder replacement for osteoarthritis in patients older than 70 years: is it appropriate?

Hugo Barret  1 , Nicolas Bonnevialle  1 , Vadim Azoulay  1 , Thomas Baron-Trocellier  1 , Pierre Mansat  1
Affiliations

Short-stem uncemented anatomical shoulder replacement for osteoarthritis in patients older than 70 years: is it appropriate?

Hugo Barret et al. JSES Int. .

Abstract

Background: Despite a new trend to systematically use reverse shoulder arthroplasty (RSA) in elderly population regardless of the indication, total anatomical shoulder arthroplasty can get good functional results in this population. The purpose of this study was to evaluate clinical and radiological outcomes of uncemented short-stem anatomic total shoulder arthroplasty (TSA) for primary glenohumeral osteoarthritis in patients older than 70 years and to compare these results to a matched population with an uncemented short-stem RSA.

Methods: In this retrospective monocentric study, clinical outcomes were based on constant score (Cst), subjective shoulder value (SSV) score, and range of motion. The aim of radiographic analysis was to identify glenoid component loosening and humeral bone remodeling around the uncemented short stem.

Results: At an average follow-up of 44 ± 12.5 months, 32 uncemented short-stem TSA in 31 patients with a minimum of 2 years of follow-up were included and were compared to 32 uncemented RSA. Fifty three percent of the patients had "a forgotten prosthesis". ROM was significantly improved in all cases. Cst reached 73 ± 9 pts and SSV 90 ± 10.8% (P < .001). In 8 patients with repairable supraspinatus tendon tears, clinical outcomes were not statistically different from patients with an intact rotator cuff: Cst (77 ± 6.2 points vs 72 ± 9.6 points, P = .3) and SSV (88 ± 11.5% vs. 91 ± 10.5%; P = .59). The type of glenoid wear (A vs B) did not influence the constant score: 73 ± 9 points versus 74 ± 11 points respectively; P = .81. Despite a complication rate of 6% (n = 2), no prosthesis revision was performed. At last follow-up, range of motion was better in the TSA group compared to the RSA group for internal (7.8 ± 1.3 vs 6.25 ± 2; P = .001) and external (47 ± 14 vs 24 ± 21; P < .001) rotations. The postoperative SSV score was also better in the TSA group (91.3 ± 10% vs 82.2 ± 13%; P = .002).

Conclusions: At medium-term, uncemented short-stem anatomic TSA in patients older than 70 years provided satisfactory clinical results. Patients have forgotten their prosthesis in over 50% of cases. This prosthetic design is still indicated in this patient population in case of primary osteoarthritis with a functional rotator cuff with an almost normal rotator cuff muscle trophicity.

Keywords: Patients older than 70 years; Total anatomical shoulder arthroplasty; Uncemented short stem.

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Figures

Figure 1
Figure 1
Postoperative “ideal” X-rays of TSA with some measurements. Anteroposterior and lateral X-rays of TSA with so-called ideal placement and a low-filling stem centered in the humeral shaft. The formula image reprsent the lines for measuring the height of the humeral stem: straight line drawn between the lateral edge of the greater tuberosity and the upper edge of the glenoid and parallel to this line passing through the most proximal and lateral point of the stem. The formula image corresponds to the distance between the 2 formula image: potential subsidence of the stem. formula image = size of the humeral head. formula image and formula image = metaphyseal and diaphyseal filing ratio. The angle alpha in violet corresponds to the angle between the line passing through the center of the humeral head and the distal end of the stem and the line representing the axis of the humeral shaft.
Figure 2
Figure 2
Most frequent feature for each zone at last follow-up. CNO, cortical bone narrowing osteopenia; SW, spot welds.
Figure 3
Figure 3
Radiological results according to Molà with RLL score at last follow-up. RLLs, radiolucent lines.
Figure 4
Figure 4
Intraoperative complication: intraoperative metaphyso-humeral fracture requiring cemented humeral short stem (anteroposterior view [A] and Bernageau profil view [B]).
See this image and copyright information in PMC

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