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KMID : 1036220230260030245
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Clinics in Shoulder and Elbow
2023 Volume.26 No. 3 p.245 ~ p.251
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Does humeral fixation technique affect long-term outcomes of total shoulder arthroplasty?
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Troy Li
Kenneth H. Levy
Akiro H. Duey
Akshar V. Patel
Christopher A. White
Carl M. Cirino
Alexis Williams
Kazunari Misawa
Dave Shukla
Bradford O. Parsons
Evan L. Flatow
Paul J. Cagle
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Abstract
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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.
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KEYWORD
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Replacement arthroplasty, Shoulder, Press-fit, Cemented, Long-term outcomes
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