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Review
. 2022 Aug;10(8):633-647.
doi: 10.22038/ABJS.2021.53555.2664.

Short Stems and Stemless Shoulder Arthroplasty: Current Concepts Review

Berta Buch  1   2 , María Vall  1   2 , Paolo Consigliere  3 , Josep Antón Guillén  1 , Enric Cruz  1 , Luis Natera  1
Affiliations
Review

Short Stems and Stemless Shoulder Arthroplasty: Current Concepts Review

Berta Buch et al. Arch Bone Jt Surg. 2022 Aug.

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.

Keywords: Bone preservation; Reverse total shoulder arthroplasty; Revision surgery; Short stems; Shoulder resurfacing; Stemless shoulder replacement; Total shoulder arthroplasty.

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Figures

Figure 1
Figure 1
1A. X-ray in the anteroposterior view of a right shoulder showing a Copeland resurfacing shoulder arthroplasty with 11 years of follow-up. It can be noticed that there is an important glenoid erosion, without clinical transcendence. See figure 2.
Figure 2
Figure 2
Clinical pictures showing the range of motion of an 83-year-old gentleman, that had a right Copeland resurfacing shoulder arthroplasty 11 years before.
Figure 3
Figure 3
Intraoperative perspective of a left shoulder in which a Copeland resurfacing shoulder arthroplasty was being performed.
Figure 4. 4A
Figure 4. 4A
X-ray in anteroposterior view of a right proximal humerus, in which the inlay design and the metaphyseal fixation of the Verso can be seen in the pre-op planification. Notice that the shell of the humeral component is flush with the humeral osteotomy, and that the tip of the humeral component does not reach the proximal third of the diaphysis.
Figure 5
Figure 5
X-rays of both shoulders of a 46 years-old gentleman with history of psoriatic arthritis, who had undergone bilateral stemless reverse total shoulder arthroplasty with the Verso. The left shoulder was operated when the patient was 45 years-old, and the right one was operated 15 months after.
Figure 6
Figure 6
Clinical pictures of the same patient presented in figure 4.
See this image and copyright information in PMC

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