Long-Term Radiographic Changes in Stemless Press-Fit Total Shoulder Arthroplasty

Abstract

Introduction Stemmed humeral implants have represented the gold standard in total shoulder arthroplasty (TSA) for decades. Like many other joints, the latest trends in TSA designs aim at bone preservation. Current studies have demonstrated that native proximal humeral bone stresses are most closely mimicked by stemless implants. Nevertheless, there are concerns about the long-term performance of stemless designs. The aim of the present study was to evaluate the long-term radiographic changes at the proximal humerus in anatomical stemless press-fit TSA.

Materials and Methods Between 2008 and 2010, 48 shoulders in 43 patients were resurfaced using an anatomic stemless shoulder prosthesis (TESS, Biomet). Thirty shoulders in twenty-five patients who were aged 65.7 ± 9.9 (34 to 82) years were available for clinical and radiographic review at a mean follow-up of 94.0 ± 8.9 (78 to 110) months.

Results Radiographic changes of the proximal humerus due to stress shielding were found in 38.4% of the stemless TESS implants. Mild stress shielding accounted for 80% of the observed radiographic changes. Radiographs exhibited stable fixation of the stemless humeral press-fit implant at early and late follow-up. In contrast, radiolucent lines at the glenoid implant were found in 96.1% of the cases. Irrespective of the degree of radiographic changes, clinical scores (VAS, Quick-DASH, Constant score) significantly improved at follow-up.

Conclusions The anatomic stemless press-fit implant seems to be favorable in terms of implant-related stress shielding. Clinical outcome was not affected by radiographic changes, demonstrating an 8-year clinical performance that seems to be comparable to conventional stemmed TSA.

Zusammenfassung

Einleitung Schaftprothesen stellten bei der Endoprothetik des Schultergelenkes über Jahrzehnte den Goldstandard dar. In den letzten Jahren wurden für das Schultergelenk knochensparende Endprothesendesigns entwickelt. Aktuelle Studien konnten zeigen, dass die native Krafteinleitung auf den proximalen Humerus am besten durch schaftfreie Implantate imitiert werden kann. Es bestehen jedoch Bedenken bezüglich der Langzeit-Performance solcher schaftfreier Schulterprothesendesigns. Diese Studie hatte zum Ziel, die im Langzeitverlauf entstehenden knöchernen Veränderungen des proximalen Humerus nach schaftfreier anatomischer Schultertotalendoprothesenversorgung zu untersuchen.

Material und Methoden Zwischen 2008 und 2010 wurden 48 Schultern bei 43 Patienten mit einer anatomischen schaftfreien press-fit Schultertotalendoprothese (TESS, Biomet) versorgt. 30 Schultern bei 25 Patienten mit einem Durchschnittsalter von 65,7 ± 9,9 (34 bis 82) Jahren standen für eine klinische und radiologische Auswertung nach einem mittleren Follow-up von 94,0 ± 8,9 (78 bis 110) Monaten zur Verfügung.

Ergebnisse Der proximale Humerus wies bei 38,4% der schaftfreien Endoprothesen radiologisch sichtbare knöcherne Veränderungen auf. 80% dieser radiologischen Veränderungen waren auf mildes Stress-shielding zurückzuführen. Abgesehen von diesen Veränderungen zeigte sich die humerale Press-fit-Verankerung über den Verlauf stabil und wies keine Lockerungsanzeichen auf. Im Gegensatz dazu konnten bei 96,1% der zementierten PE-Glenoide Radiolucencies nachgewiesen werden. Ein Zusammenhang der durch die endoprothetische Versorgung signifikant verbesserten klinischen Scores (VAS, Quick-DASH und Constant Score) zu den sichtbaren radiologischen Veränderungen konnte nicht hergestellt werden.

Zusammenfassung Die anatomische schaftfreie Press-fit-Schultertotalendoprothese scheint in punkto Stress-shielding Vorteile zu bieten. Überwiegend konnten nur milde Implantat-assoziierte knöcherne Veränderungen nachgewiesen werden, die keinen Einfluss auf das klinische Ergebnis hatten. Das schaftfreie Press-fit-Prothesendesign wies eine 8-Jahres-Performance auf, die mit jener konventioneller Schaftprothesen vergleichbar ist.

Key words

stemless - press-fit - shoulder arthroplasty - stress shielding - radiographic changes - long-term follow-up

Schlüsselwörter

schaftfrei - Schulterprothese - Stress-Shielding - radiologische Veränderungen - Knochenumbau

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