Stemmed versus stemless total shoulder arthroplasty: a preliminary report and short-term results Outcomes after shoulder replacement: comparison between reverse and anatomic total shoulder arthroplasty. Radiological changes do not influence clinical mid-term outcome in stemless humeral head replacements with hollow screw fixation: a prospective radiological and clinical evaluation Subscapularis-Sparing Total Shoulder Arthroplasty: A Prospective, Double-Blinded, Randomized Clinical Trial. Total shoulder arthroplasty using a subscapularis-sparing approach: a radiographic analysis. Impact of prosthetic design on clinical and radiologic outcomes of total shoulder arthroplasty: a prospective study. The effect of degenerative arthritis and prosthetic arthroplasty on shoulder proprioception. Nine-year outcome after anatomic stemless shoulder prosthesis: clinical and radiologic results. Functional midterm follow-up comparison of stemless total shoulder prostheses versus conventional stemmed anatomic shoulder prostheses using a 3D-motion-analysis Midterm results of stemless shoulder arthroplasty: a prospective study. Fatty infiltration and muscle atrophy of the rotator cuff in stemless total shoulder arthroplasty: a prospective cohort study. Revision surgery following total shoulder arthroplasty: analysis of 2588 shoulders over three decades (1976 to 2008). Higher preoperative sensitivity to pain and pain at rest are associated with worse functional outcome after stemless total shoulder arthroplasty: A PROSPECTIVE COHORT STUDY Hemiarthroplasty vs total shoulder replacement for rotator cuff intact osteoarthritis: how do they fare after a decade? Quality-of-life outcome following hemiarthroplasty or total shoulder arthroplasty in patients with osteoarthritis. A prospective, randomized trial. Shoulder Arthroplasty with or without Resurfacing of the Glenoid in Patients Who Have Osteoarthritis* Cemented versus uncemented fixation of humeral components in total shoulder arthroplasty for osteoarthritis of the shoulder: a prospective, randomized, double-blind clinical trial-A JOINTs Canada Project.
Abstract Background Although several studies have been performed on the use of various devices in total shoulder arthroplasty ( TSA ) , no data are available in order to establish whether to prefer stemmed or stemless humeral components . Thus , the purpose of our study was to evaluate the short-term functional outcome in a cohort of subjects treated with TSA r and omized to treatment with stemmed or stemless prosthesis .  Methods In this prospect i ve longitudinal study , we r and omized to treatment with stemmed ( group 1 ) or with stemless ( group 2 ) humeral component in nineteen subjects ( 2 M and 17 F ) diagnosed with humeral primary osteoarthritis with indication to TSA . We evaluated the range of movement of all the participants and the functional outcome using Constant score and simple shoulder test ( SST ) before and after 2 years from surgery . Results No differences were detected after 2 years from surgery in the two groups in terms of functional scores and range of motion ( p > 0.05 ) . ConclusionS temmed and stemless prostheses are comparable in terms of functional outcome . These data might be useful for the surgeon in order to choose more tissues-paring method ologies and less invasive procedures , such as stemless humeral implants BACKGROUND Anatomic total shoulder arthroplasty ( TSA ) and reverse total shoulder arthroplasty ( RTSA ) are increasingly common procedures employed to treat arthritic conditions . Although TSA is a widely accepted procedure for glenohumeral arthritis with intact rotator cuff , concerns about RTSA persist because of variable complication rates and outcomes . METHODS This is a prospect i ve , case-control study comparing outcomes and complications after TSA and RTSA . The study included 47 patients undergoing TSA for glenohumeral arthritis and 53 patients undergoing RTSA for rotator cuff tear arthropathy . Average clinical follow-up was more than 2 years in both groups . Major complications included infection , periprosthetic fracture , instability , glenoid loosening , and need for revision surgery . Patient outcome measures included the American Shoulder and Elbow Surgeons score , pain visual analog scale score , and goniometer-measured range of motion . Plain radiographs were review ed to assess for degree of glenoid lucency in TSA and scapular notching in RTSA . RESULTS At 2 years , there were no differences in rate of major complications  ( TSA , 15 % ; RTSA , 13 % ; P = .808 ) or revision surgeries  ( TSA , 11 % ; RTSA , 9 % ) . Outcomes assessed by the American Shoulder and Elbow Surgeons score and visual analog scale were also similar between the 2 groups . TSA patients had greater external rotation than RTSA patients did ( 53 ° vs 38 ° ; P = .001 ) . Otherwise , forward flexion , abduction , and internal rotation were comparable in range of motion . CONCLUSIONS TSA and RTSA  have similar complication rates , need for revision , patient-reported outcomes , and range of motion at 2 years of follow-up . The use of side-by-side cohorts in this study allows st and ardized comparison between these 2 shoulder arthroplasty procedures Background Stemless shoulder arthroplasty is a fairly new concept . Clinical and radiological follow-up is essential to prove implant safety and concept . This prospect i ve single-centre study was performed to evaluate the influence of radiological changes on clinical mid-term outcome following stemless humeral head replacement with hollow screw fixation . Methods Short- and mid-term radiological and clinical evaluations were performed in 73 consecutive shoulders treated mainly for idiopathic and posttraumatic osteoarthritis with stemless humeral head arthroplasty including 40 hemi- ( HSA ) and 33 total shoulder arthroplasties ( TSA ) . Operating times of stemless implantations were compared to  110 stemmed anatomical shoulder prostheses .  Appearances of humeral radiolucencies or radiological signs of osteolysis or stress shielding were assessed on st and ardized radiographs . Patients ’ clinical outcome was evaluated using the Constant score and patients ’ satisfaction was documented . Results Radiological changes , detected in 37.0 % , did not affect clinical outcome . Constant scores significantly improved from baseline to short and mid-term follow-up ( p < 0.001 ) . The majority of patients ( 96.2 % ) were satisfied with the procedure . No loosening of the humeral head component was detected during a mean follow-up of 58 months . Operating times were significantly shorter with stemless compared to stemmed implants ( p < 0.001 ) . Conclusions Clinical mid-term outcome after stemless humeral head replacement was not affected by radiological changes . Trial registration The institutional review board ( St. Vincent Hospital Vienna ; 201212_EK01 ; date of issue : 11.12.2012 ) approved the study . The trial was registered at Clinical Trials.gov ( NCT02754024 ) . Retrospective registration Although total shoulder arthroplasty ( TSA ) is generally associated with good to excellent outcomes in most patients , the integrity and function of the subscapularis tendon ( SSC ) is of paramount importance because SSC rupture after TSA can lead to inferior outcomes . Therefore , the efficacy of a SSC-sparing TSA procedure was evaluated through a prospect i ve , double-blinded , r and omized study . Patients with end-stage osteoarthritis of the shoulder were r and omized into 2 groups . Group 1 patients were treated with TSA in which the prosthesis was inserted entirely through the rotator interval without violating the SSC tendon ( SPARING ) . Group 2 patients were treated with TSA using the SSC tenotomy approach ( ST AND ARD ) . Both the patients and the evaluators remained blinded to the surgical approach throughout the study . Outcome data collected included the visual analog scale score for pain and the American Shoulder and Elbow Surgeons outcome score . Complete 2-year outcome data were collected from 32 SPARING and 38 ST AND ARD patients at a mean follow-up of 31.1 and 33.4 months , respectively . The American Shoulder and Elbow Surgeons and visual analog scale scores improved significantly for both groups . Differences between groups did not reach statistical significance . Complication profiles were similar for the 2 groups , with 3 patients in the SPARING group and 2 patients in the ST AND ARD group requiring revision surgery during the study . At short-term follow-up , the outcome of TSA  using the SSC-sparing surgical approach was similar to the outcome of TSA using the st and ard approach . Studies with longer follow-up are required to document the potential benefits of this surgical technique . [ Orthopedics . 2019 ; 42(1):e61-e67 . ] BACKGROUND Traditional total shoulder arthroplasty ( TSA ) involves releasing the subscapularis tendon for exposure . This can potentially lead to subscapularis insufficiency , compromised function , and dissatisfaction . A novel TSA technique preserves the subscapularis tendon by performing the procedure entirely through the rotator interval , allowing accelerated rehabilitation . However , early reports on this approach have noted malpositioning of the humeral component and residual osteophytes . In a r and omized trial , we examined the incidence of humeral head malpositioning , incorrect sizing , and residual osteophytes on postoperative radiographs after subscapularis-sparing TSA  compared with the traditional approach . METHODS Patients were prospect ively r and omized to undergo TSA performed through the traditional or subscapularis-sparing approach .  The operating surgeon was blinded to the r and omization until the day of surgery . Anatomic reconstruction measurements included humeral head height , humeral head centering , humeral head medial offset , humeral head diameter ( HHD ) , and head-neck angle . Two independent review ers analyzed the postoperative radiographs to determine anatomic restoration of the humeral head and the presence of residual osteophytes . RESULTS We r and omized 96 patients to undergo either the st and ard approach ( n = 50 ) or the subscapularis-sparing approach ( n = 46 ) . There were no significant differences in humeral head height , humeral head centering , humeral head medial offset , HHD , head-neck angle , and anatomic reconstruction index between the 2 groups . However , significantly more postoperative osteophytes ( P = .0001 ) were noted in the subscapularis-sparing TSA group . Although the overall mean was not statistically different , further analysis of HHD showed that more patients in the subscapularis-sparing TSA group were outliers ( mismatch > 4 mm ) than in the traditional TSA group . CONCLUSIONS Although anatomic restoration of the shoulder can be accomplished using subscapularis-sparing TSA , retained osteophytes and significant mismatch of the HHD raise concerns regarding long-term outcomes BACKGROUND This prospect i ve longitudinal study compared clinical and radiologic outcomes of  total shoulder arthroplasty ( TSA )  using 3 different prosthetic design s , the Neer II system , the Bigliani-Flatow ( BF ) , and a stemless prosthesis , the Total Evolutive Shoulder System ( TESS ) . MATERIAL S AND METHODS Patients with advanced osteoarthritis of the glenohumeral joint who underwent TSA  were followed up for 2 years . Four patient-oriented disability outcomes were used . The clinical data collected before surgery and at follow-up assessment s during a 2-year period included active range of motion ( ROM ) in 6 directions and strength . Radiographic signs of glenoid and humeral component loosening were recorded . The incidence of humeral head subluxation was documented . RESULTS Seventy-four patients completed the study . There was a significant improvement in the 4 disability measures , ROM , and strength at 2 years in all 3 groups ( P < .0001 ) . Active external rotation at 90 ° abduction was statistically significantly lower in the Neer II group ( P = .001 ) . The incidence of lucent lines around the glenoid component was higher in the Neer II group ( P = .0002 ) . No statistically significant relationship was seen between type of prosthesis and patient satisfaction ( P > 0.05 ) . CONCLUSIONS The 3 types of TSA prostheses used in this study all provided significant improvement in pain and function and were associated with high patient satisfaction . The Neer II was associated with less active external rotation and more lucent lines The effect of glenohumeral arthritis and subsequent  total shoulder arthroplasty ( TSA ) on shoulder proprioception has not been evaluated previously . A prospect i ve analysis of 20 consecutive patients with unilateral advanced glenohumeral arthritis who underwent TSA was undertaken .  Shoulder proprioception testing for passive position sense and detection of motion was performed 1 week before surgery and 6 months after TSA . The presence of glenohumeral arthritis had a significant effect on position sense for all 3 planes tested ( flexion , abduction , and external rotation ) . There were significant differences ( P < .05 ) compared with the uninvolved shoulder and with a group of 20 age- and gender-matched subjects without a history of shoulder problems . Six months after TSA , position sense was significantly improved ( P < .05 ) and was not significantly different from that in the contralateral shoulder or the comparison group . Detection of motion was also significantly worse in the arthritic group compared with that in the uninvolved contralateral side ( P < .05 ) . Six months after TSA , the sensitivity to detection of motion improved ( P < .01 ) and was not significantly different than that in the uninvolved contralateral shoulder . In addition , the postoperative values for the involved shoulder were not significantly different than those in the age- and gender-matched comparison group . This study demonstrates a significant decrease in proprioceptive function in patients with advanced glenohumeral arthritis . After TSA , there was a marked improvement in proprioception BACKGROUND Several stemless shoulder implants are available on the market , but only a few studies have presented results with sufficient mid- to long-term follow-up . The present study evaluated clinical and radiologic outcomes 9 years after anatomic stemless shoulder replacement . METHODS This is a prospect i ve cohort study evaluating the  stemless shoulder prosthesis since 2005 .  Anatomic stemless shoulder replacement using a single prosthesis was performed in 49 shoulders ; 17 underwent total shoulder replacement , and 32 underwent hemiarthroplasty . Forty-three patients were clinical ly and radiologically monitored after a mean of 9 years ( range , 90 - 127 months ; follow-up rate , 88 % ) . The indications for shoulder replacement were primary osteoarthritis in 7 shoulders , post-traumatic in 24 , instability in 7 , cuff tear arthropathy in 2 , postinfectious arthritis in 1 , and revision arthroplasty in 2 . RESULTS The Constant-Murley Score improved significantly from 52 % to 79 % ( P < .0001 ) . The active range of motion also increased significantly for flexion from 101 ° to 118 ° ( P = .022 ) , for abduction from 79 ° to 105 ° ( P = .02 ) , and for external rotation from 21 ° to 43 ° ( P < .0001 ) . Radiologic evaluation revealed incomplete radiolucency in 1 patient without clinical significance or further intervention . No revision caused by loosening or countersinking of the humeral implant was observed . CONCLUSIONS The 9-year outcome after stemless shoulder replacement is comparable to that of third- and fourth-generation st and ard shoulder arthroplasty Background The aim of this study is to compare the functional midterm outcome of stemless shoulder prostheses with st and ard anatomical stemmed shoulder prostheses and to show that the STEMLESS results are comparable to the STEMMED with respect to active maximum range of shoulder motion ( ROM ) and Constant score ( CS ) . Methods Seventeen patients underwent total shoulder arthroplasty ( TSA ) in 25 shoulder joints .  Stemless TSA was performed in 12 shoulder joints ( group STEMLESS ) , third-generation stemmed TSA in 13 shoulder joints ( group STEMMED ) . Functional results were documented using the CS . 3D-motion- analysis using the Heidelberg upper extremity model ( HUX ) was conducted to measure active maximum ( ROM ) . Results The group STEMLESS achieved a CS of 67.9 ( SD 12.0 ) points and the group STEMMED of 70.2 ( SD 5.8 points ) without significant difference between the groups ( p = 0.925 ) . The maximum ROM of the group STEMLESS , ascertained by 3-D-motion- analysis , was in forward flexion 125.5 ° ( SD 17.2 ° ) , in extension 49.4 ° ( SD 13.8 ° ) , in abduction 126.2 ° ( SD 28.5 ° ) and in external rotation 40.3 ° ( SD 13.9 ° ) . The maximum ROM of the group STEMMED , also ascertained by 3-D-motion analysis , was in forward flexion 135.0 ° ( SD 16.8 ° ) , in extension 47.2 ° ( SD 11.5 ° ) , in abduction 136.3 ° ( SD 24.2 ° ) and in external rotation 40.1 ° ( SD 12.2 ° ) . The maximum ROM of the STEMLESS group was lower in forward flexion and abduction , higher in extension and almost identical in external rotation . But there was no significant difference ( forward flexion p = 0.174 , extension p = 0.470 , abduction p = 0.345 , external rotation p = 0.978 ) . Conclusion Both types of shoulder prostheses achieve a similar and good active ROM and similar results in CS.Trial registration DRKS00013166 , retrospectively registered , BACKGROUND This study evaluated the functional and radiologic results of shoulder arthroplasty using a single type of stemless humeral head implant  with a minimum follow-up of 5 years . METHODS  Stemless shoulder arthroplasties in 78 patients at a mean age of 58 years were prospect ively evaluated at a mean clinical and radiologic follow-up of 72 months . Functional results were documented using the age- and sex-adjusted Constant score with st and ardized radiographic examination . RESULTS The Constant score improved significantly from 38.1 % to 75.3 % ( P < .0001 ) . Active range of motion improved significantly for flexion ( from 114 ° to 141 ° ) , abduction ( from 74 ° to 130 ° ) , and external rotation ( from 25 ° to 44 ° ; P < .0001 ) . Bone mineral density was reduced in 34.9 % of the older population , without an influence on shoulder function ( Constant score without lowering of bone density ; 73 % ; Constant score with lowering of bone density 80 % ; P = .404 ) . The overall complication rate was 12.8 % , with an overall revision rate of 9 % . None of the stemless implants were revised for loosening . CONCLUSION The functional and radiologic results of the stemless shoulder arthroplasty are comparable to the third and fourth generation of st and ard stem arthroplasty BACKGROUND The influence of preoperative rotator cuff fatty infiltration ( FI ) and muscle atrophy ( MA ) on the postoperative outcome of  total shoulder arthroplasty ( TSA ) has only rarely been investigated and reported in the literature . We hypothesized that more FI and MA would be associated with a worse postoperative functional outcome . METHODS This prospect i ve cohort study included 63 patients ( 31 female and 32 male patients ; mean age , 71 years [ range , 53 - 89 years ; st and ard deviation , 7 years ] ) with primary osteoarthritis of the shoulder operated on with anatomic stemless TSA .  Preoperatively and at 3 months and 1 year after the operation , the functional outcome ( QuickDASH [ short version of Disabilities of the Arm , Shoulder and H and question naire ] score ) and range of motion ( ROM ) ( goniometer ) and strength ( dynamometer ) for abduction at the scapular plane and for external rotation were measured . The degree of preoperative FI and MA was evaluated using computed tomography scans according to the Goutallier classification and Warner classification , respectively , for the supraspinatus and infraspinatus . RESULTS We found clinical ly and statistically significant improvements in functional outcome , strength , and ROM at both 3 months and 1 year of follow-up compared with those preoperatively . The Pearson correlation coefficient ( r ) showed significant correlations between preoperative supraspinatus and infraspinatus FI and MA and preoperative and 1-year postoperative shoulder abduction and external rotation strength but not ROM . However , we found no influence of the rotator cuff FI and MA on the functional outcome after TSA . CONCLUSION We demonstrated a significant correlation between rotator cuff FI and MA and strength but not ROM of the shoulder joint Our objective was to examine the rate of revision and its predictive factors in patients undergoing total shoulder arthroplasty ( TSA ) .  We used prospect ively collected data from the Mayo Clinic Total Joint Registry to examine five- , ten- and 20-year revision-free survival following TSA and the predictive factors . We examined patient characteristics ( age , gender , body mass index , comorbidity ) , implant fixation ( cemented versus uncemented ) , American Society of Anesthesiologists class and underlying diagnosis . Univariate and multivariable adjusted hazard rates were calculated using Cox regression analysis . A total of 2207 patients underwent 2588 TSAs . Their mean age was 65.0 years ( 19 to 91 ) and 1163 ( 53 % ) were women ; osteoarthritis was the underlying diagnosis in 1640 shoulders ( 63 % ) . In all , 212 TSAs ( 8.2 % ) were revised during the follow-up period . At five , ten and 20 years , survival rates were 94.2 % ( 95 % confidence interval ( CI ) 93.2 to 95.3 ) , 90.2 % ( 95 % CI 88.7 to 91.7 ) and 81.4 % ( 95 % CI 78.4 to 84.5 ) , respectively . In multivariable analyses men had a higher hazard ratio of revision of 1.72 ( 95 % CI 1.28 to 2.31 ) ( p < 0.01 ) compared with women , and those with rotator cuff disease had a hazard ratio of 4.71 ( 95 % CI 2.09 to 10.59 ) ( p < 0.001 ) compared with patients with rheumatoid arthritis . We concluded that male gender and rotator cuff disease are independent risk factors for revision after TSA . Future studies are needed to underst and the biological rationale for these differences Aims The aims of this study were to investigate any possible relationship between a preoperative sensitivity to pain and the degree of pain at rest and on exertion with postoperative function in patients who underwent stemless total shoulder arthroplasty ( TSA ) . Patients and Methods In this prospect i ve study , we included 63 patients who underwent stemless TSA and were available for evaluation one year postoperatively . There were 31 women and 32 men ; their mean age was 71 years ( 53 to 89 ) . The pain threshold , which was measured using a Pain Matcher ( PM ) unit , the  degree of pain ( visual analogue scale at rest and on exertion , and function using the short version of the Disabilities of the Arm , Shoulder and H and question naire ( QuickDASH ) , were recorded preoperatively , as well as three and 12 months postoperatively . Results We found an inverse relationship between both the preoperative PM threshold and pain ( VAS ) at rest and the 12‐month postoperative QuickDASH score ( Pearson correlation coefficient ( r ) ≥ 0.4 , p < 0.05 ) . A linear regression analysis showed that the preoperative PM threshold on the affected side and preoperative pain ( VAS ) at rest were the only factors associated with the QuickDASH score at 12 months . Conclusion These findings indicate the importance of central sensitization in the restoration of function after TSA . Further studies are required to investigate whether extra analgesia and rehabilitation could influence the outcome in at risk patients BACKGROUND We compared hemiarthroplasty ( HA ) and total shoulder replacement ( TSR ) for the treatment of  osteoarthritis at minimum of 10 years from primary arthroplasty . METHODS Thirty-three patients ( 13 HA and 20 TSR ) were intraoperatively r and omized to HA or TSR after glenoid exposure and were assessed to a minimum of 10 years postoperatively . Apart from those who died , no patients were lost to follow-up . RESULTS At 6 months and 1 year , the TSR patients had less pain than the HA patients ( P < .05 ) , and this became more apparent at 2 years postoperatively ( P < .02 ) . There were no statistically significant differences between the groups at 10 years with respect to pain , function , and daily activities . No patients in the HA group rated their shoulders as pain-free at 10 years ; however , 42 % of the surviving TSR patients rated their shoulders as pain-free at 10 years . Four HA patients were revised to TSR due to severe pain secondary to glenoid erosion . Two shoulders in the TSR group have been revised . Nine of the 13 HA patients ( 69 % ) and 18 of the 20 TSR patients ( 90 % ) remained in situ at death or at the 10-year review . CONCLUSION TSR has advantages over HA with respect to pain and function at 2 years , and there has not been a reversal of the outcomes on longer follow-up . This longer-term review does not support the contention that HA will avoid later TSR complications , and in particular , an unacceptable rate of glenoid component failure BACKGROUND Both total shoulder arthroplasty and hemiarthroplasty have been used commonly to treat severe osteoarthritis of the shoulder ; however , their effect on disease-specific quality -of-life outcome is unknown . The purpose of this study was to compare the quality -of-life outcome following hemiarthroplasty with that following total shoulder arthroplasty in patients with osteoarthritis of the shoulder . METHODS Forty-two patients with a diagnosis of osteoarthritis of the shoulder were r and omized to receive a hemiarthroplasty or a total shoulder arthroplasty .  One patient died , and all others were evaluated preoperatively and at six weeks and three , six , twelve , eighteen , and twenty-four months postoperatively with use of a st and ardized format including a disease-specific quality -of-life measurement tool ( Western Ontario Osteoarthritis of the Shoulder [ WOOS ] index ) , general shoulder rating scales ( University of California at Los Angeles [ UCLA ] shoulder scale , Constant score , and American Shoulder and Elbow Surgeons [ ASES ] evaluation form ) , general pain scales ( McGill pain score and visual analogue scale ) , and a global health measure ( Short Form-36 [ SF-36 ] ) . When a patient required revision of a hemiarthroplasty to a total shoulder arthroplasty , the last score before he or she " crossed over " was used for the analysis . RESULTS Significant improvements in disease-specific quality of life were seen two years after both the total shoulder arthroplasties and the hemiarthroplasties . There were no significant differences in quality of life ( WOOS score ) between the group treated with total shoulder arthroplasty and that treated with hemiarthroplasty ( 90.6 + /- 13.2 and 81.5 + /- 24.1 points , respectively ; p = 0.18 ) . The other outcome measures demonstrated similar findings . Two patients in the hemiarthroplasty group crossed over to the other group by undergoing a revision to a total shoulder arthroplasty because of glenoid arthrosis . CONCLUSIONS Both total shoulder arthroplasty and hemiarthroplasty improve disease-specific and general quality -of-life measurements . With the small number of patients in our study , we found no significant differences in these measurements between the two treatment groups . LEVEL OF EVIDENCE Therapeutic Level Background : The indications for resurfacing of the glenoid in patients who have osteoarthritis of the shoulder are not clearly defined ; some investigators routinely perform hemiarthroplasty whereas others perform total shoulder arthroplasty . Methods : Forty-seven patients ( fifty-one shoulders ) who were scheduled to have a shoulder arthroplasty for the treatment of degenerative osteoarthritis were r and omly assigned , according to a r and om-numbers table , to one of two groups : replacement of the humeral head with resurfacing of the glenoid with a polyethylene component with cement ( total shoulder arthroplasty [ twenty-seven shoulders ] ) or replacement of the humeral head without resurfacing of the glenoid ( hemiarthroplasty [ twenty-four shoulders ] ) . All patients received the same type of humeral component , and all operations were performed by or under the direct supervision of the same surgeon . The patients were followed for a mean of thirty-five months ( range , twenty-four to seventy-two months ) postoperatively . Evaluation was performed with use of the scoring systems of the University of California at Los Angeles and the American Shoulder and Elbow Surgeons . Results : No difference was observed between the preoperative scores for the two groups of patients . Postoperatively , the mean scores with use of the University of California at Los Angeles system and the American Shoulder and Elbow Surgeons system were 23.2 points ( range , 10 to 31 points ) and 65.2 points ( range , 15 to 94 points ) , respectively , after hemiarthroplasty and 27.4 points ( range , 9 to 34 points ) and 77.3 points ( range , 3 to 100 points ) , respectively , after total shoulder arthroplasty . With the numbers available for study , no significant difference was found between the two operative groups with respect to the postoperative score . ( Thirty-five subjects per group would be needed , assuming an effect size of 0.60 and a power of 0.80 . ) Total shoulder arthroplasty provided significantly greater pain relief ( p = 0.002 ) and internal rotation ( p = 0.003 ) than hemiarthroplasty did . Total shoulder arthroplasty also provided superior results in the specific areas of patient satisfaction , function , and strength , although none of these differences were found to be significant , with the numbers available . Total shoulder arthroplasty was associated with increased cost ( $ 1177 ) , operative time ( thirty-five minutes ) , and blood loss ( 150 milliliters ) per patient compared with hemiarthroplasty . To date , none of the total shoulder arthroplasties in the study group have been revised . Hemiarthroplasty yielded equivalent results for elevation and external rotation . Three of the twenty-five patients who had had a hemiarthroplasty needed a subsequent operation for resurfacing of the glenoid . The mean cost for the revision operations was $ 15,998 . Conclusions : Total shoulder arthroplasty provided superior pain relief compared with hemiarthroplasty in patients who had glenohumeral osteoarthritis , but it was associated with an increased cost of $ 1177 per patient BACKGROUND Although cemented humeral fixation is recognized as the st and ard of care in total shoulder arthroplasty ( TSA ) , uncemented fixation has the potential to provide stable fixation , decrease operative time , and simplify potential revision procedures . This prospect i ve , r and omized , double-blind clinical trial compared cemented and uncemented humeral fixation in TSA for primary shoulder osteoarthritis . METHODS Patients with primary shoulder osteoarthritis requiring replacement were screened for eligibility . After providing informed consent , subjects received baseline clinical and radiologic assessment s , computed tomography scans , and st and ardized TSA . After glenoid component insertion , patients were r and omized to either a cemented or uncemented humeral component . The primary outcome was the WOOS ( Western Ontario Arthritis of the Shoulder Index ) score at 2 years . Other outcomes included the Short Form 12 score , American Shoulder and Elbow Surgeons score , McMaster-Toronto Arthritis Patient Preference Disability Question naire , operative time , complications , and revisions . Patients were assessed by a blinded evaluator at 2 and 6 weeks and 3 , 6 , 12 , 18 , and 24 months postoperatively . RESULTS In total , 161 patients consented to be included and were r and omized : 80 in the  cemented  group and 81 in the  uncemented  group . There were no significant differences in demographics or baseline evaluations between groups , except for gender . The 12- , 18- , and 24-month WOOS scores showed a significant difference in favor of the cemented group . The cemented group also had better strength and forward flexion . As expected , the operative time was significantly less for the uncemented group . CONCLUSIONS These findings provide level I evidence that cemented fixation of the humeral component provides better quality of life , strength , and range of motion than uncemented fixation
Stemless anatomic TSA result ed in similar functional outcomes and complication rates to stemmed TSA with decreased operative time and lower blood loss .
BACKGROUND Stemless anatomic total shoulder arthroplasty ( TSA ) is used in the treatment of osteoarthritis of the shoulder joint and other degenerative shoulder diseases .
It has several proposed advantages over stemmed TSA including increased bone preservation , decreased operative time , and easier removal at revision .