Document Type : CURRENT CONCEPTS REVIEW
Orthopaedics Department, Hospital General Granollers, Barcelona, Spain.
Hospital General de Granollers, Avinguda Francesc Ribas s/n, postcode: 08402, Granollers, Barcelona, Spain.
Reading Shoulder Unit, Berkshire Independent Hospital & Spire Dunedin Hospital, Reading, United Kingdom
Orthopaedics Department, Shoulder and Elbow Unit, Hospital General Granollers, Barcelona, Spain.
Historically, the total shoulder arthroplasty humeral component was designed for the treatment of infections, tumours or fractures. In all these cases the stem was needed as a scaffold. Original humeral components were not developed for use in shoulder arthritis, so these designs and derivates had a long stem. The newest humeral implants innovations consist in shortening of the component, or even eliminating the stem entirely, to rely on stemless fixation at the humeral metaphysis. This offers theoretical advantages of preserved bone stock, less stress shielding, eliminating the diaphyseal stress riser, easier stem removal at revision, and humeral component placement independent from the humeral shaft axis. Nowadays, surgeons are trying to balance the need for a stable fixation of the humeral component with the potential need for revision surgery. Complications of revision shoulder arthroplasty are related to the need to remove a well-fixed humeral stem, the length of the procedure, and the need to deal with severe bone loss.
In this narrative review, the most important aspects of short stems and stemless shoulder arthroplasty are highlighted.