1
|
Zbeda R, Asaid R, Warby SA, Cassidy JT, Hoy G. Medium-Term Clinical Outcomes of the Global Icon Stemless Shoulder System: Results of a 2-Year Follow-Up. J Clin Med 2023; 12:6745. [PMID: 37959211 PMCID: PMC10648431 DOI: 10.3390/jcm12216745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/21/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
The primary aim of this study was to assess the medium-term outcomes of the Global Icon stemless shoulder replacement in patients who have undergone primary total shoulder arthroplasty (TSA) for glenohumeral joint osteoarthritis. A retrospective review of patients who had undergone a TSA using the Global Icon stemless shoulder system was performed. The Western Ontario Osteoarthritis Shoulder (WOOS) Index and Oxford Shoulder Score (OSS) were evaluated pre-operatively and at 12 to 24 months post-operatively. Radiological outcomes, operation time, and post-operative complications were reported. Primary analysis for the WOOS Index and OSS focused on detecting within-group treatment effects at 24 months using a repeated measures ANOVA. Thirty patients were included in the study. Post-surgery, there was a significant improvement at 24 months on the OSS (ES = 0.932, CI: 41.7 to 47.7, p < 0.001) and the WOOS Index (ES = 0.906, CI: 71.9 to 99.8, p < 0.001). Radiographs revealed that no component loosened, migrated, or subsided. The median operative time was 75.5 (IQR: 12.25, range: 18 to 105) min. No implant-related complications were reported. The Global Icon stemless replacements have excellent clinical outcomes in this cohort at 12- and 24-month follow-up with no implant-related complications.
Collapse
Affiliation(s)
- Robert Zbeda
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, VIC 3181, Australia; (R.Z.); (R.A.); (J.T.C.); (G.H.)
| | - Raf Asaid
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, VIC 3181, Australia; (R.Z.); (R.A.); (J.T.C.); (G.H.)
| | - Sarah A. Warby
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Corner of Kingsbury Drive and Plenty Road, Bundoora, VIC 3080, Australia
| | - John Tristan Cassidy
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, VIC 3181, Australia; (R.Z.); (R.A.); (J.T.C.); (G.H.)
| | - Gregory Hoy
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, VIC 3181, Australia; (R.Z.); (R.A.); (J.T.C.); (G.H.)
- Department of Surgery, Monash Medical Centre, Monash University, Level 5, Block E·246 Clayton Road, Clayton, VIC 3168, Australia
| |
Collapse
|
2
|
Zhou Y, Frampton C, Hirner M. Medium-term results of stemless, short, and conventional stem humeral components in anatomic total shoulder arthroplasty: a New Zealand Joint Registry study. J Shoulder Elbow Surg 2022; 32:1001-1008. [PMID: 36473693 DOI: 10.1016/j.jse.2022.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of this study was to compare the medium-term results for anatomic total shoulder arthroplasty by humeral component stem length. We hypothesize that the newer stemless implants may have comparable results to short-stem and conventional stemmed implants. METHODS The 12 most used anatomic total shoulder arthroplasty implants on the New Zealand Joint Registry were included in the study. Implants were categorized by stem length-conventional, short, and stemless. The primary outcome was revision up to 7 years postsurgery. Secondary outcomes included revision cause, implant survival, and early functional outcomes as evaluated by the Oxford Shoulder Score. Analysis was stratified by age and surgeon volume to control for potential confounding. RESULTS A total of 3952 patients (conventional, 3114; short, 360; stemless, 478) were included in the study. No significant difference in revision rate per 100 component-years was found between stemless, short-stem, and conventional stemmed implants (revision rate per 100 component-years: conventional, 1.01 [95% confidence interval (CI) 0.89-1.14]; short, 0.54 [95% CI 0.25-1.03]; stemless, 0.99 [95% CI 0.51-1.74]). This finding was irrespective of patient age or surgeon volume. There were no cases of humeral loosening up to 7 years' follow-up and no cases of intraoperative humeral fracture in the stemless group. Functional outcomes at 6 months postsurgery suggested better outcomes in the stemless group compared with the conventional stem group (mean Oxford Shoulder Score: conventional, 39.4; stemless, 40.7; P value = .023). CONCLUSION The medium-term survival of stemless implants for anatomic total shoulder arthroplasty appears comparable to short-stem and conventional stemmed implants. Further follow-up is required to understand the long-term survivorship and functional outcomes between these groups.
Collapse
Affiliation(s)
- Yushy Zhou
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia; Department of Orthopaedic Surgery, Whangarei Hospital, Whangarei, New Zealand.
| | - Chris Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marc Hirner
- Department of Orthopaedic Surgery, Whangarei Hospital, Whangarei, New Zealand
| |
Collapse
|
3
|
Outcomes Between Stemmed and Stemless Total Shoulder Arthroplasty: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202211000-00004. [PMID: 36322637 PMCID: PMC9633087 DOI: 10.5435/jaaosglobal-d-22-00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/20/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Both stemmed and stemless designs for total shoulder arthroplasty (TSA) have demonstrated efficacious outcomes for the surgical treatment of primary glenohumeral joint osteoarthritis. The purpose of this systematic review and meta-analysis was to compare the clinical outcomes of stemmed versus stemless TSA in randomized controlled trials. We hypothesized that there would be no differences in Constant Score (CS), range of motion, or adverse events, such as periprosthetic fracture and/or revision surgery. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the literature was done using MEDLINE, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Registry of Controlled Trials, Embase, and Web of Science databases. Outcomes of interest included CS, range of motion, and adverse events (periprosthetic fracture and revision). Summary effect estimates of the mean difference between stemmed and stemless TSA for each outcome were estimated in random effects models. RESULTS The search yielded 301 articles with 4 appropriate for qualitative analysis, including the results of 229 stemmed and 358 stemless TSAs. No significant difference was observed in postoperative CS (P = 0.36), forward flexion (P = 0.93), abduction (P = 0.30), or external rotation (P = 0.34) between stemmed and stemless TSA. No significant difference was observed in change in CS (P = 0.27), forward flexion (P = 0.25), or external rotation (P = 0.74). A change in abduction was significantly different between stemmed and stemless TSA (standardized mean difference = -0.64; 95% confidence interval, -1.20 to -0.08) in favor of stemmed TSA (P = 0.02), attributed to preoperative differences. No significant difference was observed in periprosthetic fractures (P = 0.07) or revision (P = 0.90). CONCLUSION TSA with stemless versus stemmed humeral components was not associated with notable differences in functional and clinical outcomes. No difference was observed between stemmed and stemless designs in postoperative forward flexion, abduction, or external rotation. Similarly, there was no difference in change in forward flexion or external rotation. A markedly greater improvement in abduction was observed with stemmed TSA, likely due to the lower preoperative motion in the stemmed cohort in one of the studies. No differences were observed between stemmed and stemless designs in the rate of humeral fracture or risk of revision. LEVEL OF EVIDENCE Level II; systematic review and meta-analysis of prospective randomized controlled trials.
Collapse
|
4
|
Smith T, Horstmann H, Karkosch R, Tsamassiotis S, Bowsher N, Ellwein A, Pastor MF. Short-term results of a new anatomic stemless shoulder arthroplasty - A prospective multicentre study. Orthop Rev (Pavia) 2022; 14:37042. [PMID: 35910546 DOI: 10.52965/001c.37042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/05/2022] [Indexed: 11/06/2022] Open
Abstract
Background Anatomic total shoulder arthroplasty (TSA) has been continuously developed and current designs include stemless or canal-sparing humeral components. In the literature stemless and canal sparing TSA showed good clinical and radiographic results, which were comparable to stemmed TSA. Objective The aim of this study was to determine the short-term clinical and radiological outcomes of a new stemless TSA design. Methods A prospective multicentre study including 154 total shoulder arthroplasty patients with a follow up of 12 months was performed. At the time of follow up 129 patients were available for review. The adjusted Constant Murley score,1 Oxford Shoulder Score, EQ-5D-5L score and radiographs were examined preoperatively, 3 and 12 months after the implantation of the new stemless TSA implant GLOBAL ICON™ (DePuy Synthes, Warsaw, IN, USA). Complications were documented. Results Implant Kaplan-Meier survivorship was 98.7% at 12 months. From baseline to 12 months follow-up, all scores showed a progressive significant mean improvement. The mean adjusted Constant score increased from 42.3 to 96.1 points (p<0.001). The Oxford Shoulder Score showed an increase of 21.6 points (p<0.001). The postoperative radiographs showed no continuous radiolucent lines, subsidence, aseptic loosening or progressive radiolucency, but one osteolytic lesion was observed. Only 2 prostheses were revised. Conclusion The new GLOBAL ICON stemless TSA showed good clinical and radiographic results at short-term follow up which were comparable to early results of other stemless TSA. Further studies with longer follow up are needed in the future.
Collapse
Affiliation(s)
- Tomas Smith
- Department of orthopaedic surgery, Medical School Hannover, Anna-von-Borries Str. 1, 30625 Hannover, Germany
| | - Hauke Horstmann
- Department of orthopaedic surgery, Medical School Hannover, Anna-von-Borries Str. 1, 30625 Hannover, Germany
| | - Roman Karkosch
- Department of orthopaedic surgery, Medical School Hannover, Anna-von-Borries Str. 1, 30625 Hannover, Germany
| | - Spiros Tsamassiotis
- Department of orthopaedic surgery, Medical School Hannover, Anna-von-Borries Str. 1, 30625 Hannover, Germany
| | - Nina Bowsher
- DePuy Synthes, 700 Orthopaedic Drive,Warsaw, IN 46581, United States
| | - Alexander Ellwein
- Department of orthopaedic and trauma surgery, Friederikensift Hannover, Humboldtstraße 5, 30169 Hannover, Germany
| | - Marc-Frederic Pastor
- Department of orthopaedic surgery, Medical School Hannover, Anna-von-Borries Str. 1, 30625 Hannover, Germany
| |
Collapse
|
5
|
Okafor C, Anastasio AT, Christian RA, Klifto CS, Lassiter T, Anakwenze O. Subscapularis management in stemmed and stemless total shoulder arthroplasty: a surgeon decision-making analysis study. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:353-356. [PMID: 37588702 PMCID: PMC10426477 DOI: 10.1016/j.xrrt.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Stemless total shoulder arthroplasty (TSA) continues to grow in popularity as an evolution of stemmed humeral implants. Proposed advantages include bone preservation and ease of potential revision. However, absence of a stem may necessitate a change in subscapularis takedown approach. Specifically, there is theoretical concern about violation of supportive bone with lesser tuberosity osteotomy when using a stemless device. Therefore, the goal of this study was to identify if surgeons change their subscapularis takedown preference when performing stemless vs. stemmed TSA. Methods and materials Data from a consecutive series of patients who underwent stemmed and stemless TSA at an academic institution were collected. The subscapularis management technique was documented. Subscapularis takedown techniques were divided into 2 groups: soft-tissue approach (subscapularis tenotomy or peel) and bony approach (lesser tuberosity osteotomy). Historical preference for each surgeon was determined by evaluating techniques employed using stemmed TSA. A Cramers V analysis was run to determine the strength of association between this historical preference and subscapularis management technique used for stemless TSA. Results One hundred and fifty-four patients were included in this analysis. There were 72 and 82 stemmed and stemless arthroplasty cases performed, respectively. Of the 154 patients, 50.6% were women. The average age of patients was 64.2 years. Four surgeons were included in this study. In all, there were 79 and 75 bony and soft-tissue subscapularis techniques, respectively. The historical preference for 3 of the surgeons was a subscapularis bony approach, and the historical preference for one of the surgeons was a soft-tissue approach. A Cramer's V analysis was used to measure the relative strength of association between patient factors, historical subscapularis management preference, and subscapularis takedown approach in stemless TSA. Our analysis yielded a value of 0.65 (P < .01), indicating a redundant association between subscapularis management approach used between stemmed and stemless implant per surgeon. Conclusion In determining subscapularis tendon management strategy, in surgeons who performed stemmed TSA before stemless TSA, the subscapularis takedown approach used for stemless TSA is strongly associated with surgeon's historical preference for stemmed TSA. Future research will be needed to determine the clinical ramifications of this finding.
Collapse
Affiliation(s)
| | - Albert T. Anastasio
- Duke University School of Medicine, Department of Orthopedic Surgery, Durham, NC, USA
| | - Robert A. Christian
- Duke University School of Medicine, Department of Orthopedic Surgery, Durham, NC, USA
| | - Christopher S. Klifto
- Duke University School of Medicine, Department of Orthopedic Surgery, Durham, NC, USA
| | - Tally Lassiter
- Duke University School of Medicine, Department of Orthopedic Surgery, Durham, NC, USA
| | - Oke Anakwenze
- Duke University School of Medicine, Department of Orthopedic Surgery, Durham, NC, USA
| |
Collapse
|
6
|
Shin YS, Lee WS, Won JS. Comparison of stemless and conventional stemmed shoulder arthroplasties in shoulder arthropathy: A meta-analysis. Medicine (Baltimore) 2021; 100:e23989. [PMID: 33578516 PMCID: PMC7886414 DOI: 10.1097/md.0000000000023989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/29/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND It is unclear whether stemless shoulder prosthesis lead to better clinical outcomes than conventional stemmed shoulder prosthesis. The purpose is to compare clinical outcomes and complication rates after surgery in patients with shoulder arthropathy treated with stemless or conventional stemmed shoulder prosthesis. METHOD All studies comparing the constant score (CS), range of motion (ROM), and complication rates after surgery in patients with shoulder arthropathy treated with stemless or conventional stemmed shoulder prosthesis were included. The major databases MEDLINE, EMBASE, the Cochrane Library, Web of Science, and SCOPUS were searched for appropriate studies from the earliest available date of indexing through March 31, 2019. No restrictions were placed on language of publication. RESULTS A total of 6 studies met the inclusion criteria and were analyzed in detail. Overall postoperative ROM (95% CI: 3.27 to 11.92; P < .01) was significantly greater for stemless prosthesis compared to conventional stemmed prosthesis. However, postoperative CS (95% CI: -2.98 to 7.13; P = .42) and complication rates (OR 1.22, 95% CI: 0.48-3.08; P = .68) were did not differ significantly between the 2 groups. CONCLUSION This meta-analysis revealed that postoperative CS and complication rates did not differ significantly between the 2 treatment methods, stemless shoulder prosthesis and conventional stemmed shoulder prosthesis, for shoulder arthropathy. However, stemless shoulder prosthesis resulted in better outcomes than conventional stemmed shoulder prosthesis in terms of postoperative ROM. LEVEL OF EVIDENCE Level III, Therapeutic study.
Collapse
Affiliation(s)
- Young-Soo Shin
- Department of Orthopedic Surgery, Hallym University School of Medicine, Chucheon, Republic of Korea
| | - Woo-Seung Lee
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul
| | - Jun-Sung Won
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul
| |
Collapse
|
7
|
Karssiens TJ, Gill JR, Sunil Kumar KH, Sjolin SU. Clinical results and survivorship of the Mathys Affinis Short, Short Stem Total Shoulder Prosthesis. Bone Jt Open 2021; 2:58-65. [PMID: 33537677 PMCID: PMC7842163 DOI: 10.1302/2633-1462.21.bjo-2020-0184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS The Mathys Affinis Short is the most frequently used stemless total shoulder prosthesis in the UK. The purpose of this prospective cohort study is to report the survivorship, clinical, and radiological outcomes of the first independent series of the Affinis Short prosthesis. METHODS From January 2011 to January 2019, a total of 141 Affinis Short prostheses were implanted in 127 patients by a single surgeon. Mean age at time of surgery was 68 (44 to 89). Minimum one year and maximum eight year follow-up (mean 3.7 years) was analyzed using the Oxford Shoulder Score (OSS) at latest follow-up. Kaplan-Meier survivorship analysis was performed with implant revision as the endpoint. Most recently performed radiographs were reviewed for component radiolucent lines (RLLs) and proximal humeral migration. RESULTS Five shoulders underwent revision surgery (3.5%); three for rotator cuff failure, one for infection, and one for component malposition. Survivorship of the implant was 95.4% (95% confidence interval 90.1% to 97.9%) at five and nine years. Mean OSS improved significantly compared to preoperative values from 19.0 (1 to 35) to 43.3 (7 to 48) (p < 0.001). Radiological analysis was undertaken for 99 shoulders. This revealed humeral RLLs in one case (1%), glenoid RLLs in 15 cases (15.2%), and radiological rotator cuff failure in 22 cases (22.2%). CONCLUSION This prospective cohort study shows encouraging short- to mid-term survivorship and clinical and radiological results for the Mathys Affinis Short, Short Stem Total Shoulder Prosthesis.Level of Evidence: IVCite this article: Bone Jt Open 2021;2(1):58-65.
Collapse
Affiliation(s)
- Timothy James Karssiens
- Department of Trauma and Orthopaedics, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
| | - James Ritchie Gill
- Department of Trauma and Orthopaedics, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
| | - Karadi Hari Sunil Kumar
- Department of Trauma and Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Søren Upton Sjolin
- Department of Trauma and Orthopaedics, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
| |
Collapse
|
8
|
Liu EY, Kord D, Horner NS, Leroux T, Alolabi B, Khan M. Stemless anatomic total shoulder arthroplasty: a systematic review and meta-analysis. J Shoulder Elbow Surg 2020; 29:1928-1937. [PMID: 32220527 DOI: 10.1016/j.jse.2019.12.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/12/2019] [Accepted: 12/21/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stemless anatomic total shoulder arthroplasty (TSA) is used in the treatment of osteoarthritis of the shoulder joint and other degenerative shoulder diseases. It has several proposed advantages over stemmed TSA including increased bone preservation, decreased operative time, and easier removal at revision. METHODS A systematic search was conducted using MEDLINE, Embase, PubMed, and CENTRAL (Cochrane Central Register of Controlled Trials) to retrieve all relevant studies. RESULTS The literature search yielded 1417 studies, of which 22 were included in this review, with 962 patients undergoing stemless TSA. Stemless TSA led to significant improvements in range of motion and functional scores in all included studies. Meta-analysis of comparative studies between stemless and stemmed TSA identified no significant differences in postoperative Constant scores (mean difference [MD], 1.26; 95% confidence interval [CI], -3.29 to 5.81 points; P = .59) or complication rates (odds ratio, 1.79; 95% CI, 0.71-4.54; P = .22). Stemless TSA resulted in a significantly shorter operative time compared with stemmed TSA (MD, -15.03 minutes; 95% CI, -23.79 to -6.26 minutes; P = .0008). Stemless TSA also resulted in significantly decreased intraoperative blood loss compared with stemmed TSA (MD, -96.95 mL; 95% CI, -148.53 to -45.36 mL; P = .0002). CONCLUSION Stemless anatomic TSA resulted in similar functional outcomes and complication rates to stemmed TSA with decreased operative time and lower blood loss. Further research is required to investigate the long-term durability of the stemless implant.
Collapse
Affiliation(s)
- Eva Y Liu
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Dorsa Kord
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Nolan S Horner
- Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada
| | | | - Bashar Alolabi
- Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Moin Khan
- Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada.
| |
Collapse
|
9
|
Craig RS, Goodier H, Singh JA, Hopewell S, Rees JL. Shoulder replacement surgery for osteoarthritis and rotator cuff tear arthropathy. Cochrane Database Syst Rev 2020; 4:CD012879. [PMID: 32315453 PMCID: PMC7173708 DOI: 10.1002/14651858.cd012879.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Shoulder replacement surgery is an established treatment for patients with end-stage glenohumeral osteoarthritis or rotator cuff tear arthropathy who have not improved with non-operative treatment. Different types of shoulder replacement are commonly used, but their relative benefits and risks compared versus one another and versus other treatments are uncertain. This expanded scope review is an update of a Cochrane Review first published in 2010. OBJECTIVES To determine the benefits and harms of shoulder replacement surgery in adults with osteoarthritis (OA) of the shoulder, including rotator cuff tear arthropathy (RCTA). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, SportDiscus, and Web of Science up to January 2019. We also searched clinical trial registers, conference proceedings, and reference lists from previous systematic reviews and included studies. SELECTION CRITERIA We included randomised studies comparing any type of shoulder replacement surgery versus any other surgical or non-surgical treatment, no treatment, or placebo. We also included randomised studies comparing any type of shoulder replacement or technique versus another. Study participants were adults with osteoarthritis of the glenohumeral joint or rotator cuff tear arthropathy. We assessed the following major outcomes: pain, function, participant-rated global assessment of treatment success, quality of life, adverse events, serious adverse events, and risk of revision or re-operation or treatment failure. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. We collected trial data on benefits and harms. MAIN RESULTS We included 20 studies involving 1083 participants (1105 shoulders). We found five studies comparing one type of shoulder replacement surgery to another type of shoulder replacement surgery, including three studies comparing conventional stemmed total shoulder replacement (TSR) surgery to stemmed humeral hemiarthroplasty. The remaining 15 studies compared one type of shoulder replacement to the same type of replacement performed with a technical modification or a different prosthetic component. We found no studies comparing shoulder replacement surgery to any other type of surgical treatment or to any type of non-surgical treatment. We found no studies comparing reverse total shoulder replacement surgery to any other type of treatment or to any type of replacement. Trial size varied from 16 to 161 participants. Participant mean age ranged from 63 to 81 years. 47% of participants were male. Sixteen trials reported participants with a diagnosis of osteoarthritis and intact rotator cuff tendons. Four trials reported patients with osteoarthritis and a rotator cuff tear or rotator cuff tear arthropathy. All studies were at unclear or high risk of bias for at least two domains, and only one study was free from high risk of bias (included in the main comparison). The most common sources of bias were lack of blinding of participants and assessors, attrition, and major baseline imbalance. Three studies allowed a comparison of conventional stemmed TSR surgery versus stemmed humeral hemiarthroplasty in people with osteoarthritis. At two years, low-quality evidence from two trials (downgraded for bias and imprecision) suggested there may be a small but clinically uncertain improvement in pain and function. On a scale of 0 to 10 (0 is no pain), mean pain was 2.78 points after stemmed humeral hemiarthroplasty and 1.49 points lower (0.1 lower to 2.88 lower) after conventional stemmed TSR. On a scale of 0 to 100 (100 = normal function), the mean function score was 72.8 points after stemmed humeral hemiarthroplasty and 10.57 points higher (2.11 higher to 19.02 higher) after conventional stemmed TSR. There may be no difference in quality of life based on low-quality evidence, downgraded for risk of bias and imprecision. On a scale of 0 to 100 (100 = normal), mean mental quality of life was rated as 57.4 points after stemmed humeral hemiarthroplasty and 1.0 point higher (5.1 lower to 7.1 higher) after conventional stemmed TSR. We are uncertain whether there is any difference in the rate of adverse events or the rate of revision, re-operation, or treatment failure based on very low-quality evidence (downgraded three levels for risk of bias and serious imprecision). The rate of any adverse event following stemmed humeral hemiarthroplasty was 286 per 1000, and following conventional stemmed TSR 143 per 1000, for an absolute difference of 14% fewer events (25% fewer to 21% more). Adverse events included fractures, dislocations, infections, and rotator cuff failure. The rate of revision, re-operation, or treatment failure was 103 per 1000, and following conventional stemmed TSR 77 per 1000, for an absolute difference of 2.6% fewer events (8% fewer to 15% more). Participant-rated global assessment of treatment success was not reported. AUTHORS' CONCLUSIONS Although it is an established procedure, no high-quality randomised trials have been conducted to determine whether shoulder replacement might be more effective than other treatments for osteoarthritis or rotator cuff tear arthropathy of the shoulder. We remain uncertain about which type or technique of shoulder replacement surgery is most effective in different situations. When humeral hemiarthroplasty was compared to TSR surgery for osteoarthritis, low-quality evidence led to uncertainty about whether there is a clinically important benefit for patient-reported pain or function and suggested there may be little or no difference in quality of life. Evidence is insufficient to show whether TSR is associated with greater or less risk of harm than humeral hemiarthroplasty. Available randomised studies did not provide sufficient data to reliably inform conclusions about adverse events and harm. Although reverse TSR is now the most commonly performed type of shoulder replacement, we found no studies comparing reverse TSR to any other type of treatment.
Collapse
Affiliation(s)
- Richard S Craig
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Botnar Research CentreOld RoadOxfordUKOX3 7LD
| | - Henry Goodier
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Botnar Research CentreOld RoadOxfordUKOX3 7LD
| | - Jasvinder A Singh
- Birmingham VA Medical CenterDepartment of MedicineFaculty Office Tower 805B510 20th Street SouthBirminghamALUSA35294
| | - Sally Hopewell
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Botnar Research CentreOld RoadOxfordUKOX3 7LD
| | - Jonathan L Rees
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Botnar Research CentreOld RoadOxfordUKOX3 7LD
| | | |
Collapse
|
10
|
Abstract
Through an iteration of various advancements, both short stem and stemless options for humeral fixation have been proposed and have shown clinical promise. The proposed benefits of a stemless humeral implant include greater bone preservation, less stress shielding, less risk of a diaphyseal stress riser, decreased surgical time, and less intraoperative blood loss. Potential downsides include the dependence on proximal bone quality for fixation, increased cost, the dependence on the strength of subscapularis fixation, and pending FDA approval for multiple implants. The purpose of this article is to review the evidence behind stemless implants including the biomechanical advantages and disadvantages, surgical technique, and clinical outcomes.
Collapse
|
11
|
Peng W, Ou Y, Wang C, Wei J, Mu X, He Z. The short- to midterm effectiveness of stemless prostheses compared to stemmed prostheses for patients who underwent total shoulder arthroplasty: a meta-analysis. J Orthop Surg Res 2019; 14:469. [PMID: 31884957 PMCID: PMC6936155 DOI: 10.1186/s13018-019-1515-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/11/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To systematically compare the short- to midterm effectiveness of stemless prostheses to that of stemmed prostheses for patients who underwent total shoulder arthroplasty (TSA) and to provide a guideline for clinical decision-making. METHODS PubMed, the Cochrane Library, and Web of Science were searched with the given search terms until July 2019 to identify published articles evaluating the clinical outcomes for stemless prostheses compared with stemmed prostheses for patients who underwent TSA. Data extraction and the quality assessment of the included studies were independently performed by two authors. Stata software 14.0 was used to analyze and synthesize the data. RESULTS Two randomized controlled trials and six case-controlled studies with a total of 347 shoulders were included in this meta-analysis. The results of this meta-analysis showed that there were no significant differences between the stemless and stemmed prostheses in terms of the Constant score, pain score, strength, activities of daily living, postoperative range of motion (ROM), and postoperative maximum active ROM. CONCLUSIONS This is the first meta-analysis reporting the clinical results of stemless TSA in the short- to midterm follow-up period. Both types of shoulder prostheses were similar in achieving satisfactory clinical outcomes.
Collapse
Affiliation(s)
- Wei Peng
- Department of Anatomy and Cell Biology, Justus-Liebig University, 35392, Giessen, Germany
| | - Yufu Ou
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Chenglong Wang
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Jianxun Wei
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Xiaoping Mu
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Zhian He
- Department of Orthopaedics, The Affiliated Chencun Hospital of Shunde Hospital, Southern Medical University, Foshan, 528300, China
| |
Collapse
|
12
|
Abstract
Background The number of anatomic total shoulder (TSA), hemiarthroplasty (HA), and reverse total shoulder arthroplasties (RTSA) is rapidly increasing in the United States. Stemless shoulder arthroplasty has numerous theoretical advantages, including preserved bone stock, decreased operating time, reduced rate of intraoperative humerus fracture, and flexibility of anatomic reconstruction. Only recently studies with more than 5 years of mean follow-up have become available. Methods The MEDLINE database was systematically queried to identify all studies reporting outcomes regarding anatomic or reverse stemless shoulder arthroplasty. Studies were categorized according to mean reported follow-up. Outcome scores and range of motion measurements were compiled. Complication and revision rates due to failure of the humeral or glenoid components were summarized. Results Nineteen TSA and HA studies with a total of 1115 patients were identified, with 4 studies and 162 patients with a mean follow-up between 60 and 120 months. Six RTSA studies with a total of 346 patients were identified, all with a mean follow-up between 18 and 60 months. There was a reliable improvement in outcomes compared with preoperative scores across studies. A cumulative 0.7% (8 of 1115) humeral component complication rate was found for TSA and HA components. There was a cumulative 1.7% (6 of 346) humeral complication rate for RTSA prostheses. Conclusions In the studies reporting similar outcome measures, there were reliable improvements on par with stemmed counterparts. Aggregate complication rates appear similar to those published in the literature for stemmed components. Evidence supporting the utility and safety of stemless designs would be strengthened by longer-term follow-up and additional prospective comparative studies.
Collapse
|
13
|
Pinto MC, Archie AT, Mosher ZA, Ransom EF, McGwin G, Fehringer EV, Brabston EW, Ponce BA. Radiographic restoration of native anatomy: a comparison between stemmed and stemless shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28:1595-1600. [PMID: 30982698 DOI: 10.1016/j.jse.2019.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 01/23/2019] [Accepted: 01/27/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder arthroplasty is a reliable procedure for patients with degenerative glenohumeral disease, and reproduction of native shoulder anatomy leads to superior outcomes. The aim of this study was to compare the ability of stemmed and stemless implants to radiographically restore native glenohumeral anatomy. METHODS Shoulder arthroplasties were performed in 79 patients, with 58 receiving a stemless implant and 21 receiving a stemmed implant. Preoperative and postoperative radiographs were assessed for humeral head height, humeral head centering, humeral head medial offset, humeral head diameter, humeral neck angle, and lateral humeral offset by 2 independent viewers. Measurements were scored and summed to identify the anatomic reconstruction index (ARI). Radiographic measurements were compared using the Student t test, and significance was set at P < .05 for all statistical analyses. Interobserver agreement of radiographic analyses was assessed using the intraclass correlation coefficient, finding excellent reliability (intraclass correlation coefficient, 0.92). RESULTS Five of six radiographic measurements along with the calculated ARI demonstrated no differences between stemmed and stemless shoulder implants (humeral head diameter, P = .651; humeral head height, P = .813; humeral head medial offset, P = .592; lateral humeral offset, P = .311; humeral head centering, P = .414; and ARI, P = .862). Stemless implants showed improved restoration of the native humeral neck angle (0° for stemless vs. -3° for stemmed, P = .017). CONCLUSION Radiographic restoration of anatomy is similar for stemmed and stemless shoulder arthroplasty implants.
Collapse
Affiliation(s)
- Martim C Pinto
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adam T Archie
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zachary A Mosher
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erin F Ransom
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Geral McGwin
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward V Fehringer
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eugene W Brabston
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brent A Ponce
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| |
Collapse
|
14
|
Primary shoulder replacement using stemless inlay arthroplasty as a joint preservation alternative. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Spranz DM, Bruttel H, Wolf SI, Zeifang F, Maier MW. Functional midterm follow-up comparison of stemless total shoulder prostheses versus conventional stemmed anatomic shoulder prostheses using a 3D-motion-analysis. BMC Musculoskelet Disord 2017; 18:478. [PMID: 29162072 PMCID: PMC5697353 DOI: 10.1186/s12891-017-1835-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 11/13/2017] [Indexed: 12/29/2022] Open
Abstract
Background The aim of this study is to compare the functional midterm outcome of stemless shoulder prostheses with standard anatomical stemmed shoulder prostheses and to show that the STEMLESS results are comparable to the STEMMED with respect to active maximum range of shoulder motion (ROM) and Constant score (CS). Methods Seventeen patients underwent total shoulder arthroplasty (TSA) in 25 shoulder joints. Stemless TSA was performed in 12 shoulder joints (group STEMLESS), third-generation stemmed TSA in 13 shoulder joints (group STEMMED). Functional results were documented using the CS. 3D-motion-analysis using the Heidelberg upper extremity model (HUX) was conducted to measure active maximum (ROM). Results The group STEMLESS achieved a CS of 67.9 (SD 12.0) points and the group STEMMED of 70.2 (SD 5.8 points) without significant difference between the groups (p = 0.925). The maximum ROM of the group STEMLESS, ascertained by 3-D-motion-analysis, was in forward flexion 125.5° (SD 17.2°), in extension 49.4° (SD 13.8°), in abduction 126.2° (SD 28.5°) and in external rotation 40.3° (SD 13.9°). The maximum ROM of the group STEMMED, also ascertained by 3-D-motion analysis, was in forward flexion 135.0° (SD 16.8°), in extension 47.2° (SD 11.5°), in abduction 136.3° (SD 24.2°) and in external rotation 40.1° (SD 12.2°). The maximum ROM of the STEMLESS group was lower in forward flexion and abduction, higher in extension and almost identical in external rotation. But there was no significant difference (forward flexion p = 0.174, extension p = 0.470, abduction p = 0.345, external rotation p = 0.978). Conclusion Both types of shoulder prostheses achieve a similar and good active ROM and similar results in CS. Trial registration DRKS00013166, retrospectively registered, 11.10.2017
Collapse
Affiliation(s)
- David M Spranz
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, D-69118, Heidelberg, Germany
| | - Hendrik Bruttel
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, D-69118, Heidelberg, Germany
| | - Sebastian I Wolf
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, D-69118, Heidelberg, Germany
| | - Felix Zeifang
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, D-69118, Heidelberg, Germany
| | - Michael W Maier
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, D-69118, Heidelberg, Germany.
| |
Collapse
|
16
|
Petrillo S, Longo UG, Gulotta LV, Berton A, Kontaxis A, Wright T, Denaro V. Reverse total shoulder arthroplasty: research models. JOINTS 2017; 4:236-246. [PMID: 28217660 DOI: 10.11138/jts/2016.4.4.236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE the past decade has seen a considerable increase in the use of research models to study reverse total shoulder arthroplasty (RTSA). Nevertheless, none of these models has been shown to completely reflect real in vivo conditions. METHODS we performed a systematic review of the literature matching the following key words: "reverse total shoulder arthroplasty" or "reverse total shoulder replacement" or "reverse total shoulder prosthesis" and "research models" or "biomechanical models" or "physical simulators" or "virtual simulators". The following databases were screened: Medline, Google Scholar, EMBASE, CINAHIL and Ovid. We identified and included all articles reporting research models of any kind, such as physical or virtual simulators, in which RTSA and the glenohumeral joint were reproduced. RESULTS computer models and cadaveric models are the most commonly used, and they were shown to be reliable in simulating in vivo conditions. Bone substitute models have been used in a few studies. Mechanical testing machines provided useful information on stability factors in RTSA. CONCLUSION because of the limitations of each individual model, additional research is required to develop a research model of RTSA that may reduce the limitations of those presently available, and increase the reproducibility of this technique in the clinical setting.
Collapse
Affiliation(s)
- Stefano Petrillo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy; Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy; Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Lawrence V Gulotta
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, USA
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy; Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Trigoria, Rome, Italy
| | | | - Timothy Wright
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, USA
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy; Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Trigoria, Rome, Italy
| |
Collapse
|
17
|
Holschen M, Franetzki B, Witt KA, Liem D, Steinbeck J. Is reverse total shoulder arthroplasty a feasible treatment option for failed shoulder arthroplasty? A retrospective study of 44 cases with special regards to stemless and stemmed primary implants. Musculoskelet Surg 2017; 101:173-180. [PMID: 28205145 DOI: 10.1007/s12306-017-0467-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 02/07/2017] [Indexed: 12/31/2022]
Abstract
Is reverse total shoulder arthroplasty a feasible treatment option for failed shoulder arthroplasty? A retrospective study of 44 cases with special regards to stemless and stemmed primary implants. BACKGROUND Due to humeral or glenoid bone-loss and rotator cuff insufficiency reverse total shoulder arthroplasty often means the only remaining treatment option in revision shoulder arthroplasty. This study investigates the clinical outcome of patients treated with a reverse total shoulder in revision cases with special regard to stemless and stemmed primary implants. MATERIALS AND METHODS From 2010 to 2012 60 failed shoulder arthroplasties were converted to reverse total shoulder arthroplasty. Forty-four patients were available for follow-up after a mean of 24 months. Patients were assessed with X-rays, Constant- and ASES Score and a questionnaire about their subjective satisfaction. RESULTS The total number of observed complications was seven (16%). Ninety-eight percent of the patients were satisfied with their clinical result. Patients achieved a mean normalized constant score of 70.2% and a mean ASES Score of 65.3. Patients with stemless primary implants achieved a higher normalized constant score than patients with stemmed primary implants (82 vs. 61.8%; p = 0009). CONCLUSION Reverse total shoulder arthroplasty provides satisfactory clinical results and a high patient satisfaction in revision shoulder arthroplasty. The complication rate needs to be considered and discussed with the patient prior to surgery. Presence or absence of a stem of revised shoulder arthroplasties interferes with the outcome. LEVEL OF EVIDENCE IV: (Retrospective study).
Collapse
Affiliation(s)
- M Holschen
- Orthopedic Practice Clinic (OPPK), Von-Vincke-Str. 14, 48143, Münster, Germany.
| | - B Franetzki
- Orthopedic Practice Clinic (OPPK), Von-Vincke-Str. 14, 48143, Münster, Germany
| | - K-A Witt
- Orthopedic Practice Clinic (OPPK), Von-Vincke-Str. 14, 48143, Münster, Germany
| | - D Liem
- Orthopedic Department of the University of Münster, Münster, Germany
| | - J Steinbeck
- Orthopedic Practice Clinic (OPPK), Von-Vincke-Str. 14, 48143, Münster, Germany
| |
Collapse
|
18
|
Uschok S, Magosch P, Moe M, Lichtenberg S, Habermeyer P. Is the stemless humeral head replacement clinically and radiographically a secure equivalent to standard stem humeral head replacement in the long-term follow-up? A prospective randomized trial. J Shoulder Elbow Surg 2017; 26:225-232. [PMID: 27856267 DOI: 10.1016/j.jse.2016.09.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 08/01/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stemless humeral head replacement represents a young generation of shoulder arthroplasty. This study evaluated the differences of this new stemless design compared with the fourth-generation standard stemmed design. METHODS Total shoulder arthroplasty was performed in 20 patients with a stemless shoulder prosthesis (group 1) and in 20 patients with a standard stem humeral head replacement (group 2). Twenty-nine patients were examined clinically and radiographically at a minimum follow-up of 2 years and a minimum follow-up of 5 years. Functional results were assessed using the age- and gender-related Constant Score (CS). The radiographic analysis used native x-rays in 3 planes. RESULTS The postoperative CS improved significantly in both groups, with no significant difference between the minimum of 2-year and 5-year follow-up. The difference in the CS, its subcategories, and active range of motion between the implant groups was not significant. A significant difference was observed in the radiographic analysis for the zone adjacent to the humeral calcar, with a lower bone mineral density in 41% of group 2 and in 0% in group 1. Radiolucent lines were statistically more frequent in group 2. No statistical differences were observed between the implant groups for the change of the inclination angle, the medial offset, and the lateral offset. CONCLUSION Both implants showed consistently good functional and radiologic results without a significant difference and achieved an anatomic reconstruction of the humeral head geometry in the coronal plane.
Collapse
Affiliation(s)
| | - Petra Magosch
- ATOS Clinic Heidelberg, Heidelberg, Germany; Orthopaedic and Trauma Surgery Center, University Medical Centre Mannheim, University of Heidelberg, Germany.
| | | | | | | |
Collapse
|
19
|
Affiliation(s)
- Kamal I Bohsali
- 1Jacksonville Orthopaedic Institute, Jacksonville Beach, Florida 2Section of Orthopaedic Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada 3Department of Orthopaedics, University of Texas HSC-San Antonio, San Antonio, Texas
| | | | | |
Collapse
|
20
|
Ho AG, Gowda AL, Wiater JM. WITHDRAWN: Stemless humeral component in total shoulder arthroplasty: 2-year age-related clinical outcomes. J Shoulder Elbow Surg 2016:S1058-2746(16)00131-2. [PMID: 27090008 DOI: 10.1016/j.jse.2016.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/31/2016] [Accepted: 02/12/2016] [Indexed: 02/01/2023]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
Collapse
Affiliation(s)
- Anthony G Ho
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - Ashok L Gowda
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA.
| |
Collapse
|