Stemless shoulder arthroplasty: what are the benefits?

TL;DR

Stemless shoulder arthroplasty offers benefits like bone preservation and easier revisions, with outcomes comparable to traditional methods, but requires careful patient selection.

Contribution

This paper reviews the biomechanical and clinical advantages of stemless shoulder arthroplasty, emphasizing its potential as a paradigm shift in shoulder surgery.

Findings

Stemless implants show comparable clinical outcomes to stemmed implants with improved bone preservation.

They offer biomechanical advantages and easier handling in periprosthetic fractures and revisions.

Mid-term results are promising, but patient suitability based on bone quality is critical.

Abstract

The emergence of stemless shoulder arthroplasty marks a significant advancement, dignified to surpass traditional stemmed approaches. Stemless reverse total shoulder arthroplasty (slrTSA) shares benefits with its anatomic counterpart, including reduced complications, bone preservation, and simplified revision. In addition, it offers potential long-term osteological advantages, minimizing stress shielding and, in case of periprosthetic fractures, easier revision. Early data suggest comparable outcomes between slrTSA and stemmed implants, with future benefits. Understanding its advantages, design variations, and clinical outcomes is paramount for its seamless integration into shoulder surgery. A narrative review focused on stemless shoulder arthroplasty was conducted, retrieving recent articles spanning the last decade. Studies examining biomechanics, implantation techniques, and clinical outcomes were critically analyzed by long-term users of stemless implants. Stemless implants exhibit biomechanical advantages, adaptability to patient anatomy, bone preservation, simplified surgical techniques, and less invasive approaches. Notably, they facilitate easier handling of periprosthetic fractures and easier revisions. Clinical outcomes reveal significant improvements in functional scores and pain improvement postoperatively and are comparable to stemmed rTSA. Challenges include patient suitability concerning bone quality. Stemless shoulder arthroplasty represents a paradigm shift in shoulder surgery, with promising mid-term outcomes. However, careful patient selection based on bone quality is crucial. Stemless implants offer significant advantages, particularly for younger adults, warranting continued research and clinical evaluation to optimize patient outcomes.