Stemless vs. stemmed reverse total shoulder arthroplasty as primary treatment in the elderly: A meta-analysis

Reverse total shoulder arthroplasty (RTSA) is widely used for cuff-deficient and degenerative shoulder conditions in older adults. While stemmed implants offer long-term success, stemless designs have gained attention due to bone preservation and ease of revision, but evidence remains limited.

A systematic search was performed in PubMed, Scopus, Cochrane Library, and Google Scholar till June 2025. Five studies met the inclusion criteria. Key outcomes included satisfaction, Visual Analog Scale for pain, functional scores, shoulder range of motion (ROM), fracture-related complications (acromial stress and periprosthetic fractures), implant-related complications (component loosening, radiolucent lines, scapular notching, infection), revision, and general complications (shoulder dislocation, musculocutaneous nerve injury, symptomatic mesoacromion, stiffness, hematoma, transient paresthesia).

Stemless RTSA was associated with significantly higher patient satisfaction (p = 0.003), better Quick-Disability of the Arm, Shoulder, and Hand scores (p = 0.001), and superior ROM in forward elevation (p = 0.03) and internal rotation (p = 0.006). No significant differences were observed in pain levels, American Shoulder and Elbow Surgeons or Constant scores, external rotation or abduction ROM, fracture- and implant-related complications, revision rates, or general complication rates.

Stemless RTSA offers comparable safety and may improve functional outcomes and satisfaction in selected elderly patients, particularly when adequate metaphyseal bone stock allows its use. Further long-term studies are needed to assess durability.