Clin Should Elbow.  2023 Sep;26(3):245-251. 10.5397/cise.2023.00199.

Does humeral fixation technique affect long-term outcomes of total shoulder arthroplasty?

• Li T
• Levy KH
• Duey AH
• Patel AV
• White CA
• Cirino CM
• Williams A
• Whitelaw K
• Shukla D
• Parsons BO
• Flatow EL
• Cagle PJ

• KMID: 2547050
• DOI: http://doi.org/10.5397/cise.2023.00199

Abstract

Background
For anatomic total arthroscopic repair, cementless humeral fixation has recently gained popularity. However, few studies have compared clinical, radiographic, and patient-reported outcomes between cemented and press-fit humeral fixation, and none have performed follow-up for longer than 5 years. In this study, we compared long-term postoperative outcomes in patients receiving a cemented versus press-fit humeral stem anatomic arthroscopic repair.
Methods
This study retrospectively analyzed 169 shoulders that required primary anatomic total shoulder arthroplasty (aTSA). Shoulders were stratified by humeral stem fixation technique: cementation or press-fit. Data were collected pre- and postoperatively. Primary outcome measures included range of motion, patient reported outcomes, and radiographic measures.
Results
One hundred thirty-eight cemented humeral stems and 31 press-fit stems were included. Significant improvements in range of motion were seen in all aTSA patients with no significant differences between final cemented and press-fit stems (forward elevation: P=0.12, external rotation: P=0.60, and internal rotation: P=0.77). Patient reported outcome metrics also exhibited sustained improvement through final follow-up. However, at final follow-up, the press-fit stem cohort had significantly better overall scores when compared to the cemented cohort (visual analog score: P=0.04, American Shoulder and Elbow Surgeon Score: P<0.01, Simple Shoulder Test score: P=0.03). Humeral radiolucency was noted in two cemented implants and one press-fit implant. No significant differences in implant survival were observed between the two cohorts (P=0.75).
Conclusions
In this series, we found that irrespective of humeral fixation technique, aTSA significantly improves shoulder function. However, within this cohort, press-fit stems provided significantly better outcomes than cemented stems in terms of patient reported outcome scores. Level of evidence: III.

Keyword

Replacement arthroplasty; Shoulder; Fixation technique; Press-fit; Cemented; Humeral stem; Long-term outcomes