Stemless implants may have advantages over stemmed implants in shoulder arthroplasty
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Although stemmed and stemless implants for shoulder arthroplasty have equivalent outcomes, a presenter noted stemless implants are more technically forgiving, efficient, lead to less stress shielding and are easier to revise.
In his presentation at the American Shoulder and Elbow Surgeons Specialty Day Meeting, Andrew Jawa, MD, noted stemless implants provide excellent short-term outcomes and few complications. Although published literature has shown equivalent outcomes between stemless and stemmed implants, Jawa noted it is easier to place the head of a stemless implant anatomically.
“It follows that if you have a simpler technique, you are going to have a more efficient surgery. It is going to be faster,” Jawa said.
He added stemless arthroplasties will have stress shielding, but less than that of stemmed arthroplasty. Jawa also noted that stemless implants are easier to revise.
However, currently, stemless implants cost more than stemmed implants, according to Jawa.
“We have done some work that shows the implant takes up the highest proportion of the cost in an episode of care and the cost is higher for a stemless at this point,” Jawa said. “But as more and more people do stemless, it is only about 6%, and fewer people do stemmed, that price is going to come down.”
Perspective
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Stemless humeral implants for anatomic shoulder replacements are gaining popularity due to the points outlined by Andrew Jawa, MD, – shorter surgical time, easier revision and more bone preservation. However, disadvantages include a technically more difficult subscapularis repair and the current inability to convert the stemless implant to a reverse shoulder replacement. As these barriers are removed, we will see more widespread adoption of stemless implants.
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Jawa A. Point/counterpoint: Stem vs. stemless: Pro stemless. Presented at: American Shoulder and Elbow Surgeons Specialty Day Meeting; Feb. 27, 2021 (virtual meeting).
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