Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Does humeral fixation technique affect long-term outcomes of total shoulder arthroplasty?

  • Troy Li (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Kenneth H. Levy (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Akiro H. Duey (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Akshar V. Patel (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Christopher A. White (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Carl M. Cirino (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Alexis Williams (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Kathryn Whitelaw (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Dave Shukla (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Bradford O. Parsons (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Evan L. Flatow (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai) ;
  • Paul J. Cagle (Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai)
  • Received : 2023.03.09
  • Accepted : 2023.05.12
  • Published : 2023.09.01
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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.

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