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Review Question - QID 218111

QID 218111 (Type "218111" in App Search)
A 62-year-old male presents to the office with ongoing shoulder pain. Radiographs reveal end-stage glenohumeral arthritis. The decision is made to proceed with an anatomic total shoulder arthroplasty. When comparing that implant in Figure A with that in Figure B, which of the following is true?
  • A
  • B

Figure A is better indicated in 3 or 4 part proximal humerus fractures

1%

8/647

Figure A has a lower incidence of subscapularis failure

15%

99/647

Figure A is less likely to require an osteotomy for a proximal humerus malunion

58%

377/647

Figure B relies more heavily on metaphyseal fixation

21%

139/647

Figure B allows for greater bone preservation

3%

18/647

  • A
  • B

Select Answer to see Preferred Response

Stemless replacement does have the unique advantage of allowing placement of a prosthesis in the setting of a proximal humerus malunion without the need for an osteotomy, as the prosthesis is not constrained by the position of the stem.

Anatomic total shoulder arthroplasty (TSA) involves replacement of the humeral head and glenoid. Both stemmed and stemless TSA have been used to treat patients with glenohumeral arthritis with functioning rotator cuff tendons. In patients with prior proximal humerus fractures with malunion, a stemless TSA offer the advantage over a stemmed TSA to accomplish the goal of joint replacement surgery without requiring further intervention such as an osteotomy, as the stemless prosthesis is not constrained by the position of the stem.

Kadum et al. reviewed the function and quality of life after the Total Evolutive Shoulder System (TESS) reverse shoulder arthroplasty (RSA), to evaluate the radiological stability of the stemless version and to address the effect of arm lengthening and scapular notching (SN) on the outcome. They reported a significant improvement in functional outcome and reduction of pain in both stemmed and stemless groups.

Brolin et al. reviewed stemless anatomic total shoulder arthroplasty (TSA) and RSA designs. They reported that radiographic results in the short-term follow-up period show a low prevalence of component loosening, stress shielding, or osteolysis. They concluded that stemless arthroplasty requires an accurate humeral-head osteotomy to properly restore humeral anatomy because of the lack of a stem as a guide.

Churchill et al. reviewed stemless shoulder arthroplasty. They reported that these implants are designed for metaphyseal fixation to minimize humeral bone removal, avoid intraoperative and postoperative humeral fracture complications, and to decrease morbidity associated with revision operations. They concluded that convertible implants may allow for the use in either anatomic or reverse arthroplasty configuration.

Figure A is a radiograph of a shoulder with a stemless anatomic total shoulder arthroplasty. Figure B is a radiograph of a shoulder with a stemmed anatomic total shoulder arthroplasty.

Incorrect Answers:
Answer 1: 3 or 4 part proximal humerus fractures are often treated with a stemmed RSA in elderly patients.
Answer 2: Subscapularis failure is thought to be independent of implant design with TSA.
Answer 4: The stemless TSA relies completely on biological fixation of metaphyseal bone.
Answer 5: Stemless TSA is believed to be more bone preserving that stemmed TSA.

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