Uncemented total shoulder arthroplasty. A review

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Medical Device Engineering

Background:

• Clinicians possess extensive experience with uncemented humeral components, often achieving stability without a glenoid component.
• Press-fitted humeral components are commonly used, but their long-term efficacy in total shoulder arthroplasty requires careful consideration.
• Tissue ingrowth components present potential advantages but have limited follow-up data and variable radiographic outcomes compared to cemented options.

Purpose of the Study:

• To evaluate the current evidence regarding uncemented humeral and glenoid components in total shoulder arthroplasty.
• To compare the clinical and radiographic outcomes of cement fixation versus tissue ingrowth fixation for shoulder arthroplasty components.
• To identify clear indications for cement versus tissue ingrowth fixation in glenoid component placement.

Main Methods:

• Review of existing clinical literature and radiographic studies on uncemented and cemented humeral and glenoid components.
• Analysis of short- to intermediate-term follow-up data for tissue ingrowth humeral components.
• Assessment of early clinical results and radiographic changes associated with tissue ingrowth glenoid components.

Main Results:

• Press-fitted humeral components are generally stable but their continued use in total shoulder arthroplasty is discouraged.
• Tissue ingrowth humeral components show potential but lack long-term data and do not yet match cemented component radiographic results.
• Tissue ingrowth glenoid components demonstrate excellent early clinical outcomes with reduced radiographic changes, though polyethylene wear and synovitis are concerns.

Conclusions:

• Current evidence suggests surgeons should discontinue the use of press-fitted humeral components for total shoulder arthroplasty.
• While tissue ingrowth glenoid components offer promising early results, indications for cement versus tissue ingrowth fixation remain unclear, often based on bone quality.
• Further long-term studies are necessary to definitively establish the superiority of cement fixation or tissue ingrowth fixation for glenoid components, as current clinical outcomes are similar.