Introduction
As total shoulder arthroplasty (TSA) becomes more prevalent, there is a trend toward shorter and stemless humeral components, potentially reducing operative time and preserving bone. This study compares clinical and functional outcomes of anatomic TSA using standard, short, and stemless components with ≥ 2 years of follow-up.
Methods
We retrospectively reviewed data from an IRB-approved, multi-center international database of patients who underwent primary anatomic TSA for osteoarthritis between 2018-2021 and had at least 2 years of follow-up, only including centers with all three stem types. Outcomes were assessed using patient-reported measures (ASES, Constant, SAS), VAS pain, global shoulder function, and range of motion. Post-operative shoulder ratings and radiographic findings for glenoid and humeral radiolucent lines were recorded, as well as complication and revision rates. Statistical comparisons were made using one-way ANOVA for continuous variables and Fisher Freeman-Halton test for count data, with significance at p < 0.05. Post-hoc analyses used Tukey’s test and Holm-Bonferroni adjustment.
Results
The study included 563 patients (121 with standard, 242 with short, and 200 with stemless components) with a mean follow-up of 36.5 ± 12.2 months. Stemless components were more common in younger males, but there were no significant differences in BMI, prior surgeries, or comorbidities. Forward elevation was similar across groups (157° for standard and stemless, 159° for short; p = 0.604). External rotation varied (59° for standard, 56° for short, 52° for stemless; p = 0.001). No significant differences were found in VAS pain, global shoulder function, Constant, ASES, UCLA, or SPADI scores. Complication rates were similar (standard = 0.8%, short = 3.3%, stemless = 4.0%; p = 0.254), as were revision rates (standard = 0.8%, short = 2.1%, stemless = 2.0%; p = 0.777). Radiolucent lines were more frequent with standard stems (8.8%) compared to short (1.9%) and stemless (0.0%; p = 0.001). Patient satisfaction was comparable (p = 0.119).
Conclusions
Clinical outcomes and patient satisfaction were similar across stem types, with fewer radiolucent lines in stemless components. Early findings suggest benefits for stemless and short stems in reducing operative time and preserving bone, but longer-term studies are needed.
Tables and Figures
| Characteristic |
|
Short (n = 242) |
Stemless (n = 200) |
p | p Adjusted | ||
|---|---|---|---|---|---|---|---|
Standar d-Short |
Standar d Stemles s |
Short Stemles s |
|||||
| Age | 67.1 ± 7.5 | 65.8 ± 7.5 | 63.2 ± 8.3 | 0.000 | 0.290 | <0.001 | 0.001 |
| Sex (Female) | 51.2% | 46.3% | 37.0% | 0.029 | 0.376 | 0.043 | 0.107 |
| BMI | 31.2 ± 6.8 | 30.4 ± 5.8 | 31.5 ± 6.9 | 0.185 | - | - | - |
| Previous Surgery? | 13.2% | 14.9% | 14.5% | 0.939 | - | - | - |
| Comorbidities | |||||||
|
29.8% | 34.3% | 25.5% | 0.136 | - | - | - |
Arthritis |
2.5% | 3.3% | 11.0% | 0.001 | 0.758 | 0.010 | 0.006 |
|
52.1% | 42.6% | 56.0% | 0.015 | 0.189 | 0.563 | 0.017 |
|
10.7% | 16.1% | 11.0% | 0.220 | - | - | - |
|
6.6% | 11.6% | 14.5% | 0.099 | - | - | - |
|
8.3% | 3.7% | 4.0% | 0.158 | - | - | - |
| Retroversion | 8.9 ± 7.7 | 10.6 ± 7.4 | 9.7 ± 7.4 | 0.124 | - | - | - |
| Walch Class | 0.793* | - | - | - | |||
|
46.8% | 52.4% | 41.6% | - | - | - | - |
|
10.1% | 6.2% | 13.7% | - | - | - | - |
|
7.3% | 10.6% | 8.4% | - | - | - | - |
|
28.4% | 23.3% | 31.6% | - | - | - | - |
|
6.4% | 4.8% | 3.7% | - | - | - | - |
|
0.0% | 2.2% | 1.1% | - | - | - | - |
|
0.9% | 0.4% | 0.0% | - | - | - | - |
| Augmented Glenoid | 38.8% | 38.0% | 48.0% | 0.085 | - | - | - |
| Follow-up | 33.8 ± 10.5 |
36.5 ± 12.2 |
33 ± 7.7 | 0.002 | 0.063 | 0.765 | 0.002 |
| *Percentage of A glenoids compared to other glenoid types was not significantly different between groups |
Table 1. Demographic, comorbidity, and pre-operative radiographic information for the three stem-type cohorts.
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