title: Is the humeral stem useful in anatomic total shoulder arthroplasty?
abstract: Traditionally and since Neer, the humeral side of shoulder arthroplasty consisted of a stemmed component but the real need for stem fixation in total shoulder arthroplasty (TSA) has barely been investigated. The current study evaluated the clinical and radiological outcomes with a stemless TSA.
  
  
  
  Forty-seven patients, 20 female and 27 male patients with an average age of 63, were selected in four orthopaedic centres during a four year period, and implanted with a humeral head prosthesis with a three-fin design and titanium coating. Aetiologies were: primary osteoarthritis (29), fracture sequelae (12) and avascular osteonecrosis (6). Minimum follow-up was two years (range 24-51 months). The patients were evaluated with the Constant score (CS) and radiological exams.
  
  
  
  Two patients had revision of the implants, one for persistent pain and one for secondary massive rotator cuff tear. At the final follow-up, the mean CS was 69, with an average gain of 36. All parameters improved with a foremost in pain relief. Mean satisfaction rate was 87%. Average anterior active elevation was 131° with a gain of 48. Radiologic evaluations showed stable implants in all cases. However, 17 cases demonstrated radiolucent areas, particularly superior and lateral to the implant, which neither decreased nor increased with time. No revisions were related to humeral component loosening.
  
  
  
  Stemless TSA provides the same results as compared to TSA with a humeral stem. We are still unsure as to the nature of the lucent zones and we are continuing our investigation to better understand this radiological phenomenon.
authors.affiliation: Institut Locomoteur de l'Ouest CHP Saint Grégoire (vivalto Santé), 6 Boulevard de la Boutière, 35740, Saint Grégoire, France. collin.ph@wanadoo.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Collin
authors.affiliation: Institut Locomoteur de l'Ouest CHP Saint Grégoire (vivalto Santé), 6 Boulevard de la Boutière, 35740, Saint Grégoire, France.|Department of Orthopedic Surgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Matsukawa
authors.affiliation: Service de Chirurgie Orthopédique et Chirurgie du Sport, Institut Universitaire Locomoteur et du Sport, CHU de Nice Hôpital Pasteur, 2 30 Voie Romaine, 06000, Nice, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Boileau
authors.affiliation: Krankenhaus Agatharied GmbH, Norbert-Kerkel-Platz, 83734, Hausham, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Brunner
authors.affiliation: Hopital Privé J Mermoz (Générale de Santé), Centre orthopédique Santy, 24 avenue P Santy, 69008, Lyon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Walch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006811:Humerus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D010020:Osteonecrosis / Q000601:surgery*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000601:surgery; D000072227:Shoulder Prosthesis; D016896:Treatment Outcome
keywords: Arthritis; Stem less; Total shoulder arthroplasty