Shoulder
The short-term survival of total stemless shoulder arthroplasty for osteoarthritis is comparable to that of total stemmed shoulder arthroplasty: a Nordic Arthroplasty Register Association study

https://doi.org/10.1016/j.jse.2019.01.010Get rights and content

Background

The purpose of this study was to compare the short-term survival rate of total stemless, metaphyseal fixated, shoulder arthroplasty with that of total stemmed shoulder arthroplasty in the treatment of osteoarthritis.

Methods

Data were collected by the national arthroplasty registries in Denmark, Finland, Norway, and Sweden and merged into 1 dataset under the umbrella of the Nordic Arthroplasty Register Association. For the present study, we included all patients with osteoarthritis treated with either stemless (n = 761) or stemmed (n = 4398) shoulder arthroplasty from 2011 to 2016.

Results

A total of 21 (2.8%) stemless and 116 (2.6%) stemmed shoulder arthroplasties were revised. The 6-year unadjusted cumulative survival rates were 0.953 for stemless shoulder arthroplasty and 0.958 for stemmed shoulder arthroplasty, P = .77. The most common indication for revision of both arthroplasty types was infection. Five (0.7%) stemless and 16 (0.4%) stemmed shoulder arthroplasties were revised because of loosening of either the glenoid or the humeral component. In the multivariate cox regression model, which included age, category, gender, year of surgery, previous surgery, and arthroplasty type, the hazard ratio (HR) for revision of the stemless shoulder arthroplasty was 1.00 (95% confidence interval [CI], 0.63-1.61), P = .99, with the stemmed shoulder arthroplasty as reference. Male gender (HR = 1.50 [95% CI, 1.06-2.13], P = .02) and previous surgery (HR = 2.70 [95% CI, 1.82-4.01], P < .001) were associated with increased risk of revision.

Conclusion

The short-term survival of total stemless shoulder arthroplasty appears comparable with total stemmed shoulder arthroplasty, but longer observation time is needed to confirm whether they continue to perform equally.

Section snippets

Sources of data

The Finnish arthroplasty registry was established in 1980 and has included shoulder arthroplasties from the beginning, which makes it the oldest national registry collecting data on shoulder arthroplasties. The arthroplasty registry in Norway was established in 1994 and has included shoulder arthroplasties since 1997. The Swedish and the Danish shoulder arthroplasty registries were established in 1999 and in 2004, respectively.18

All private and public hospitals in the 4 countries report to the

Study population

The number of stemmed and stemless total shoulder arthroplasties for OA increased toward the end of the study period (Fig. 1). The mean age was 64 years (range, 31-89 years) for the total stemless shoulder arthroplasty and 68 years (range, 20-96 years) for the total stemmed shoulder arthroplasty. The proportion of women was 49% for the total stemless shoulder arthroplasty and 59% for the total stemmed shoulder arthroplasty. Previous surgery was recorded in 87 patients (11%) treated with a total

Discussion

The number of both total stemless shoulder arthroplasties and total stemmed arthroplasties is increasing. With a mean follow-up of approximately 30 months, the survival of the total stemless shoulder arthroplasty was comparable with that of the total stemmed shoulder arthroplasty. Loosening of either the humeral or glenoid component was a rare indication for revision for both arthroplasty types. The Eclipse system had a high risk of revision compared with the Simpliciti system.

Conclusion

The short-term survival of the total stemless shoulder arthroplasty appears comparable with that of the total stemmed shoulder arthroplasty, but longer observation time is needed to confirm if they continue to perform equally. Loosening was a rare indication for revision for both arthroplasty types.

Acknowledgments

The authors thank the orthopedic surgeons in Denmark, Norway, and Sweden for data reporting.

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

References (25)

Cited by (27)

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    Similar to other comparative studies, no differences were found in the patient-determined outcome between stemmed and stemless prostheses.9,39,41,54,57,64,71,74 The Norwegian Registry determined that the survival rate was comparable between all stemmed and stemless arthroplasties.52 This registry database did demonstrate that the Simpliciti system (n = 213) had a lower rate of revision than the Eclipse system.

  • Outcomes of different stem sizes in shoulder arthroplasty

    2023, Journal of Orthopaedics
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    By promoting enhanced prosthesis positioning on the proximal humerus, they re-established the centre of rotation (CoR) with enhanced glenohumeral kinematics.28,29 With stemless implants, revision surgeries are relatively easy while preserving bone quality.30 Their indications are identical to those of anatomical stemmed implants, the benefits include preserving humeral bone stock, restoring patient anatomy (humeral head diameter, humeral shaft angle and lateralisation) and less complications during component removal for revision SA.28,31,32

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No institutional review board approval was required for this retrospective study.

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