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Stem length in anatomic total shoulder arthroplasty: long stem, short stem, and stemless

Biomechanical considerations, indications, and clinical performance

Schaftlänge bei anatomischen Schulterprothesen: Langschaft, Kurzschaft und schaftfrei

Biomechanische Überlegungen, Indikationen und klinische Ergebnisse

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Abstract

Background

Anatomic total shoulder arthroplasty (aTSA) has become a valuable option for patients with degenerative glenohumeral joint disease, and traditional cemented long stems have been the gold standard for many years. Over the past decade, there has been a trend towards uncemented metaphyseal fixed short stems and stemless prostheses with the proposed advantages of bone-stock preservation and easier revision. Short- and mid-term results are promising; however, regarding long-term stability, a valid comparison with standard long-stem aTSA cannot be made yet. Furthermore, little is known about the biomechanical properties of such designs.

Objectives

The aim of this review is to provide an overview of the current literature on biomechanical considerations, indications, and clinical performance for three different anchoring systems.

Methods

A narrative review of current original studies (evidence level I–IV), systematic reviews, and meta-analyses of clinical outcomes and biomechanical properties was performed using PubMed and Cochrane Central Register of Controlled Trials (non-systematic literature search).

Summery and practical conclusion

There is a paucity of mid- and long-term clinical data after short-stem and stemless aTSA. Studies evaluating the influence of implant design on the biomechanical stability of humeral anatomical shoulder joint replacements are insufficient. Clinical long-term outcomes are needed to evaluate whether one anchoring concept is superior to another.

Zusammenfassung

Hintergrund

Für Patienten mit degenerativen Schultergelenkerkrankungen stellt die anatomische Schulterprothese eine wertvolle Option dar. Als Goldstandard haben sich über viele Jahre zementierte Langschaftprothesen etabliert. Neuerdings ist ein Trend zu zementfreien, metaphysär verankerten Kurzschaftprothesen und schaftfreien Prothesen zu beobachten, welche den Vorteil einer knochensparenden Implantation mit sich bringen sollen. Trotz vielversprechender kurz- und mittelfristiger Ergebnisse können Vergleiche hinsichtlich der langfristigen Stabilität aufgrund noch ausstehender Langzeitdaten nicht gezogen werden. Ob das Verankerungsprinzip der Kurzschaftprothesen oder schaftfreien Prothesen Einfluss auf die biomechanischen Eigenschaften hat, ist bisher wenig untersucht.

Ziel der Arbeit

Ziel dieser Arbeit ist es, einen Überblick über die aktuelle Literatur zu biomechanischen Überlegungen, Indikationen und klinischen Ergebnissen für 3 verschiedene Verankerungssysteme zu geben.

Methoden

Zur Erstellung der vorliegenden Übersichtsarbeit erfolgte eine nichtsystematische Literaturrecherche über die Datenbank PubMed und das Cochrane-Zentralregister für kontrollierte Studien. Analysiert wurden aktuelle Originalstudien (Evidenzlevel I–IV), systematische Übersichtsarbeiten und Metaanalysen zu klinischen Ergebnissen und biomechanischen Eigenschaften.

Schlussfolgerung

Trotz guter kurz- und mittelfristiger Ergebnisse bleiben die langfristigen Daten nach der Implantation von anatomischen Kurzschaftprothesen oder schaftfreien Prothesen abzuwarten. Die Datenlage hinsichtlich biomechanischer Untersuchungen zum Einfluss des Implantatdesigns auf das Verankerungsverhalten der unterschiedlichen Prothesendesigns ist unzureichend. Es werden klinische Langzeitergebnisse benötigt, um beurteilen zu können, ob ein Verankerungskonzept dem anderen überlegen ist.

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Authors and Affiliations

  1. Clinic for Orthopaedic Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200A, 69118, Heidelberg, Germany

    Anna-K. Tross, Matthias Bülhoff, Tobias Renkawitz & Jan Philippe Kretzer

  2. Laboratory of Biomechanics and Implant Research, Clinic for Orthopaedic Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200A, 69118, Heidelberg, Germany

    Jan Philippe Kretzer

  3. Heidelberg, Germany

    Anna-K. Tross

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  1. Anna-K. Tross
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  2. Matthias Bülhoff
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Correspondence to Anna-K. Tross.

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Conflict of interest

A.-K. Tross, M. Bülhoff, and J. P. Kretzer, their immediate family, and any research foundation 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. T. Renkawitz reports research funding/travel expenses and/or paid speaking engagements by the German Federal Ministry of Education and Research (BMBF), The German Federal Ministry for Economic Cooperation and Development (BMZ), Otto Bock Foundation, Stiftung Oskar-Helene-Heim Berlin, DePuy Int, Zimmer, Aesculap/B. Braun, AE, the Vielberth Foundation, German Society of Orthopaedics and Traumatology (DGOU), the German Association of Orthopaedics and Orthopaedic Surgery (DGOOC) and the Professional association for orthopedics and trauma surgery (BVOU). TR is associate editor of Der Orthopäde and Der Unfallchirurg (Springer Heidelberg, Berlin, New York) and member of the International Advisory Board of the Journal of the American Academy of Orthopaedic Surgeons (AAOS).

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Tross, AK., Bülhoff, M., Renkawitz, T. et al. Stem length in anatomic total shoulder arthroplasty: long stem, short stem, and stemless. Obere Extremität 17, 84–91 (2022). https://doi.org/10.1007/s11678-022-00687-8

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