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. 2023 Sep;26(3):245-251.
doi: 10.5397/cise.2023.00199. Epub 2023 Aug 17.

Does humeral fixation technique affect long-term outcomes of total shoulder arthroplasty?

Troy Li  1 , Kenneth H Levy  1 , Akiro H Duey  1 , Akshar V Patel  1 , Christopher A White  1 , Carl M Cirino  1 , Alexis Williams  1 , Kathryn Whitelaw  1 , Dave Shukla  1 , Bradford O Parsons  1 , Evan L Flatow  1 , Paul J Cagle  1
Affiliations

Does humeral fixation technique affect long-term outcomes of total shoulder arthroplasty?

Troy Li et al. Clin Shoulder Elb. 2023 Sep.

Abstract

Background: For anatomic total arthroscopic repair, cementless humeral fixation has recently gained popularity. However, few studies have compared clinical, radiographic, and patient-reported outcomes between cemented and press-fit humeral fixation, and none have performed follow-up for longer than 5 years. In this study, we compared long-term postoperative outcomes in patients receiving a cemented versus press-fit humeral stem anatomic arthroscopic repair.

Methods: This study retrospectively analyzed 169 shoulders that required primary anatomic total shoulder arthroplasty (aTSA). Shoulders were stratified by humeral stem fixation technique: cementation or press-fit. Data were collected pre- and postoperatively. Primary outcome measures included range of motion, patient reported outcomes, and radiographic measures.

Results: One hundred thirty-eight cemented humeral stems and 31 press-fit stems were included. Significant improvements in range of motion were seen in all aTSA patients with no significant differences between final cemented and press-fit stems (forward elevation: P=0.12, external rotation: P=0.60, and internal rotation: P=0.77). Patient reported outcome metrics also exhibited sustained improvement through final follow-up. However, at final follow-up, the press-fit stem cohort had significantly better overall scores when compared to the cemented cohort (visual analog score: P=0.04, American Shoulder and Elbow Surgeon Score: P<0.01, Simple Shoulder Test score: P=0.03). Humeral radiolucency was noted in two cemented implants and one press-fit implant. No significant differences in implant survival were observed between the two cohorts (P=0.75).

Conclusions: In this series, we found that irrespective of humeral fixation technique, aTSA significantly improves shoulder function. However, within this cohort, press-fit stems provided significantly better outcomes than cemented stems in terms of patient reported outcome scores. Level of evidence: III.

Keywords: Cemented; Long-term outcomes; Press-fit; Shoulder; Replacement arthroplasty.

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Conflict of interest statement

Conflict of interest

Dave Shukla is a consultant for Stryker, Tornier, and Wright Medical Technology; Bradford O. Parsons: consultant for Arthrex; Evan L. Flatow: Board and/or Committee Member of American Shoulder and Elbow Surgeons and Health Association of New York, and IP royalties from Innomed, Publishing royalties and financial and/or material support from Springer; Paul J. Cagle: consultant for Stryker, Johnson & Johnson, and Arthrex. No other potential conflicts of interest relevant to this article were reported.

Figures

Fig. 1.
Fig. 1.
Radiograph depicting the eight Humerus-Implant zones utilized in the evaluation of humeral radiolucency in implants. Credit to Sanchez-Sotelo et al. [6,15] for describing this technique.
Fig. 2.
Fig. 2.
Kaplan-Meier survival curve for both cemented and press-fit cohorts. Shaded regions represent the 95% confidence interval of survival.
See this image and copyright information in PMC

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