Radiographic changes differ between two different short press-fit humeral stem designs in total shoulder arthroplasty

J Shoulder Elbow Surg. 2018 Feb;27(2):217-223. doi: 10.1016/j.jse.2017.08.010. Epub 2017 Sep 28.


Background: The purpose of this study was to compare the radiographic changes of the humerus in the short term after total shoulder arthroplasty with two different short-stem humeral components. The hypothesis was that there would be no difference in radiographic changes or functional outcome based on component type.

Methods: A retrospective review was conducted of primary total shoulder arthroplasties performed with a short press-fit humeral component. Group A included a collarless humeral stem with an oval geometry and curved stem (Ascend or Ascend Flex; Wright Medical, Memphis, TN, USA). Group B included a humeral stem with a metaphyseal collar, rectangular geometry, and straight stem (Apex; Arthrex, Inc., Naples, FL, USA). Radiographic changes and functional outcome were evaluated at a minimum of 2 years postoperatively.

Results: There were 42 patients in group A and 35 patients in group B available for analysis. There was no difference in functional outcome between the groups. In group A, the mean total radiographic change score of the humerus was 3.9, with changes classified as low in 38% and high in 62%. In group B, the mean total radiographic change score of the humerus was 2.5, with changes classified as low in 77% and high in 23% (P < .001). Medial calcar osteolysis was present in 71% of group A compared with 28.5% of group B (P < .001).

Conclusion: At short-term follow-up, there is no difference in functional outcome or revision between 2 different humeral stem designs. However, bone adaptive changes and the rate of medial calcar osteolysis are significantly different.

Keywords: Total shoulder arthroplasty; bone adaptations; humeral loosening; metaphyseal fixation; press fit; short stem; stress shielding.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Shoulder / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prostheses and Implants*
  • Prosthesis Design
  • Radiography / methods*
  • Retrospective Studies
  • Shoulder Joint / diagnostic imaging*
  • Shoulder Joint / surgery