Screw fixation in stemless shoulder arthroplasty for the treatment of primary osteoarthritis leads to less osteolysis when compared to impaction fixation

BMC Musculoskelet Disord. 2020 May 12;21(1):295. doi: 10.1186/s12891-020-03277-3.


Background: Stemless total shoulder arthroplasty is a well-established and reliable surgical treatment option for glenohumeral osteoarthritis resulting in loss of pain and improvement of shoulder function. Currently the two methods for the fixation of the humeral component are either screw fixation or impaction. The purpose of this study is the clinical and radiological comparison of two different stemless designs (screw fixation vs impaction) for total shoulder arthroplasties in patients suffering from primary glenohumeral osteoarthritis.

Methods: A retrospective cohort study including 39 patients with a mean age of 67 years and a minimum follow-up of 2 years was performed. Patients were separated into two groups based on the selected implant. In group A (n = 18) a screw fixation design and in group B (n = 21) an impaction type design was used. For clinical examination the Constant-Murley-Score (CS) and Subjective-Shoulder-Value (SSV) were evaluated. Radiological examination was performed on true-AP, axial and Y-view radiographs.

Results: In group A the CS increased from 27.1 to 65.2 points and SSV from 27.3 to 76.7% (p > 0.05). No osteolysis of the medial calcar or subsidence of the humeral implant were found in this group. In group B the CS increased from 29.0 to 72.6 points and SSV from 33.1 to 85% (p < 0.05). Osteolysis of the medial calcar was present in seven patients in this group. No signs for humeral loosening were found in both groups.

Conclusion: Impaction and screw fixation total shoulder arthroplasty for primary glenohumeral osteoarthritis using a stemless device provide reliable clinical results. The screw fixation seems to prevent osteolysis of the medial calcar.

Keywords: Impaction design; Primary osteoarthritis; Screw fixation; Stemless shoulder arthroplasty.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Shoulder / methods*
  • Bone Screws*
  • Female
  • Follow-Up Studies
  • Humans
  • Humeral Head / surgery
  • Male
  • Middle Aged
  • Osteoarthritis / diagnostic imaging
  • Osteoarthritis / surgery*
  • Osteolysis / diagnostic imaging*
  • Prosthesis Design
  • Prosthesis Retention / methods*
  • Radiography
  • Retrospective Studies
  • Shoulder Joint / diagnostic imaging
  • Shoulder Joint / surgery*
  • Shoulder Prosthesis
  • Treatment Outcome