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Improvement in component design allowing for press-fit
fixation can help reduce humeral-sided failure and radiographic slackening in
reverse shoulder arthroplasty.
As per a study published in ‘Journal of Shoulder and Elbow Surgery’, the first-generation cemented modular and the second-generation monolithic humeral stem implant were found to have comparable clinical outcomes in reverse total shoulder arthroplasty (RSA). Also, there was a noteworthy decrease in the occurrence of radiographic loosening and requirement for revision with monolithic stem primarily utilizing press fit fixation than cemented stem.
The outcomes, revisions, and complications between a first-generation cemented and a second-generation monolithic, chiefly uncemented humeral implant in RSA with 135-degree neck-shaft angle and changing degrees of metallic glenosphere offsets were examined in this study by R. Allen Gorman et al.
The patients undergoing RSA from 2004-2014 were
retrospectively evaluated with a first-generation cemented modular humeral
implant (comprising of 400 patients, Group 1) or second-generation monolithic
humeral stem (comprising of 231 patients, Group 2), with minimum 2-year
clinical and radiographic follow-up.
As found (Table 1 A and B), both groups
had similar improvement of clinical outcomes (ASES +30 points versus +34
points) with improvements in all planes of motion.
Table 1 A and B: Pre- and postoperative patient-reported outcome measures and range of motion measurements at 2+ years in Group 1 and Group 2; p value <0.0001
The occurrence of humeral loosening for the cemented group
was 3.6%, then 0.4% in the uncemented group. All in all, the revision was
observed in 28 shoulders treated with cementing method (4.0%) and 6 patients
treated by press-fit method (1.5%). Rate of postoperative acromial fractures
within the first year was 3.4% in the cemented group and 1.8% in the uncemented
group.
Journal of Shoulder and Elbow Surgery
A cohort comparison of humeral implant designs in reverse shoulder arthroplasty: does implant design lead to lower rates of complications and revision?
R. AllenGormanII et al.
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