DECEMBER 20218In My OpinionAnand Murthi, Chief, Shoulder and Elbow Surgery, MedStar Union Memorial HospitalByThe ideal humeral component for shoulder arthroplasty provides long-term fixation while preserving proximal bone stock for revision surgery. Traditional stemmed humeral prostheses achieve fixation through either cementation or a press-fit coating. However, humeral component loosening has been reported in 7-15 percent of patients, and periprosthetic fractures occur in up to 3 percent of patients.TSA implant design is constantly evolving, and stems of humeral components have become shorter. Stemless implants were first released in 2004 in Europe, and eight stemless shoulder arthroplasty systems are currently available. Stemless humeral implants have the potential to mitigate some humeral-sided complications. These implants preserve proximal bone stock because the humeral canal is not violated during implantation. Additional potential benefits include decreased intraoperative blood loss and surgical time; easier component extraction during revision surgery; the flexibility to place the component in any version, inclination, and offset; decreased risk of intraoperative humeral shaft fractures; and reduced stress shielding. Despite these benefits, stemless humeral components have their own unique risks and limitations. Making a humeral head osteotomy without a referencing stem can be more challenging than with stemmed components. Early loosening may occur in the osteopenic bone if initial metaphyseal bone fixation is SIGNIFICANCE OF STEMLESS SHOULDER ARTHROPLASTYAnand Murthi
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