title: Reverse shoulder arthroplasty with a cementless short metaphyseal humeral implant without a stem: clinical and radiologic outcomes in prospective 2- to 7-year follow-up study.
abstract: BACKGROUND
  Reverse shoulder prostheses are increasingly used in recent years for treatment of glenohumeral arthropathy with deficient rotator cuff. Bone preservation is becoming a major goal in shoulder replacement surgery. Metaphyseal humeral components without a stem were developed to minimize bone resection and preserve bone. This study evaluated the clinical and radiologic outcomes at 2 to 7 years using a novel short metaphyseal reverse total shoulder arthroplasty (rTSA) prosthesis without a diaphyseal stem.
  
  
  METHODS
  Between 2005 and 2010, 102 consecutive patients underwent rTSA with this implant, and 98 (20 men, 78 women) were available for follow-up. Mean age was 74.4 years (range, 38-93 years). Indications were cuff tear arthropathy, 65; fracture sequelae, 12; rheumatoid arthritis, 13; failed rotator cuff repair, 3; cuff deficiency with loosening of anatomic prosthesis, 3; and acute trauma, 2; with 17 of these as revisions.
  
  
  RESULTS
  Patients' satisfaction (Subjective Shoulder Value) improved from 8 of 100 to 85 of 100. The Constant score improved from 14 to 59 (age- and sex-adjusted, 86; P < .0001). Range of motion improved from 47° to 129° in elevation, 10° to 51° in external rotation, and 21° to 65° in internal rotation. Radiographic analysis showed no lucencies, subsidence, or stress shielding around the humeral or glenoid components. Glenoid notching was found in 21 patients (18 grade 1-2; 3 grade 3).
  
  
  CONCLUSIONS
  The short metaphyseal rTSA design without a diaphyseal stem shows encouraging short- to midterm results, with excellent pain relief and shoulder function, restoration of good active range of motion, and high patient satisfaction scores. The design of this implant seems to result in improved rotational movements, low incidence of glenoid notching, and no implant loosening, subsidence, or stress shielding.
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK. Electronic address: oferlevy@readingshoulderunit.com.
authors.forename: Ofer
authors.initials: O
authors.lastname: Levy
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK.
authors.forename: Ali
authors.initials: A
authors.lastname: Narvani
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK.
authors.forename: Nir
authors.initials: N
authors.lastname: Hous
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK.
authors.forename: Ruben
authors.initials: R
authors.lastname: Abraham
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK.
authors.forename: Jai
authors.initials: J
authors.lastname: Relwani
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK.
authors.forename: Riten
authors.initials: R
authors.lastname: Pradhan
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK.
authors.forename: Juan
authors.initials: J
authors.lastname: Bruguera
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sforza
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK.
authors.forename: Ehud
authors.initials: E
authors.lastname: Atoun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011474:Prosthesis Design; D011859:Radiography; D016059:Range of Motion, Articular; D012785:Shoulder Joint; D000072227:Shoulder Prosthesis; D016896:Treatment Outcome
keywords: Shoulder; arthroplasty; bone graft impaction; cementless; glenoid notching; metaphyseal; replacement; reverse TSA; rotation