Short- to midterm outcomes of stemless reverse total shoulder arthroplasty: a systematic review

Reverse total shoulder arthroplasty (rTSA) using stemless humeral components is gaining popularity. Advantages include humeral bone preservation, reduced operative time, and decreased blood loss. However, stemless implants may increase malpositioning and component loosening rates. We evaluated outcomes following stemless rTSA.

Comprehensive screening of EMBASE, PubMed, and MEDLINE until June 2024 for studies reporting stemless rTSA clinical outcomes was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies were assessed for methodological quality using the Methodological Index for Non-Randomized Studies (MINORS) instrument. Outcomes included demographics, functional outcomes, patient-reported outcome measures, complications, and radiographic outcomes. Stemmed and stemless implant comparisons in cohort studies were pooled for analysis.

Thirteen studies with moderate methodological quality were included. Five hundred ninty-two patients (598 shoulders) provided a mean follow-up of 41.8 months and age of 70.6 years. Weighted mean improvement in flexion, abduction, and Constant score were +47.8°, +42.5°, and +31.7, respectively. Complication, reoperation, scapular notching, and asymptomatic humeral component loosening rates were 14.3%, 7.0%, 17.7%, and 3.3%, respectively. Among stemless and stemmed rTSA comparative studies, no differences in patient-reported outcome measures, functional outcomes, and complications were noted.

Stemless rTSA improved clinical outcomes, with similar complications and reoperation rates to stemmed designs. Further comparative and registry-based studies should evaluate long-term stemless rTSA outcomes.