Primary reverse shoulder replacement with a short stem: A systematic literature review

Total shoulder arthroplasty implant designs have continued to evolve over the years. One recent change has been the shortening of the humeral component to preserve bone stock and to facilitate revision surgery. Despite promising clinical results, radiographic bone adaptions occur frequently in short-stem total shoulder arthroplasty, and limited data exist on short-stem reverse shoulder arthroplasty (RSA). The purpose of this systematic review was to provide an overview about the functional and radiographic outcomes after an uncemented short-stem RSA, as well as identify areas of clinical importance that are underreported in the current literature.

A systematic review of the literature was performed in accordance with the PRISMA guidelines using PubMed, Cochrane Central Register of Controlled Trials, and EMBASE. Clinical outcome studies reporting on short-stem RSA outcomes with evidence level I-IV were included. Demographics, clinical and radiological outcomes, as well as complications and revision data were systematically analyzed and described.

Ten studies, published between 2014 and 2019, reporting on 555 shoulders with a mean follow-up of 32 months (range, 20-99.6 months) met the inclusion criteria. For all studies cuff tear arthropathy was the main indication for RSA (36%), followed by primary osteoarthritis (20%). Clinical outcome was reported in nine of ten studies, with range of motion improving in all studies. Six of the seven studies that used the Constant score (CS) demonstrated significant improvement (27.9 points to 69.3 points in weighted means). All studies reported on radiographic changes and bone adaptions. Among these, scapular notching was the most commonly observed (60 out of 327 cases, 18%) but without any described implication on clinical outcomes. No stem loosening was recorded at any final follow-up. A total of 63 complications (12.9%) were reported, with scapula fractures being the most commonly reported complication. Revision surgery was necessary in 24 cases (4.9%).

Good clinical results, comparable with long-stem RSAs, are reported at short-term follow-up for short-stem RSAs. Humeral bone adaptions occur frequently but aseptic stem loosening is not a matter of concern at short-term follow-up. An area of clinical importance that is under-reported is the relation between filling ratio and stem alignment in short-stem RSA.