Outcomes of a cementless onlay short stem reverse shoulder arthroplasty in elderly patients: a comprehensive analysis of clinical and radiological findings

Arch Orthop Trauma Surg. 2024 Apr 23. doi: 10.1007/s00402-024-05321-6. Online ahead of print.

Abstract

Objective: The objective of this study was to evaluate clinical and radiological outcomes of a short stem reverse shoulder prosthesis with metaphyseal fixation specifically in older patients.

Methods: All patients, older than 70 years, submitted to a Reverse Shoulder Arthroplasty (RSA) using a cementless onlay short stem (Aequalis Ascend™ Flex Convertible Shoulder System (Stryker®)) from January 2017 to December 2021, with a minimum follow-up of 2 years, were included. Postoperative radiographs were assessed for stem loosening, subsidence, and varus-valgus tilt. Range of motion, visual analogue scale for pain, constant score, complication rate and revision rate were also analysed.

Results: A total of 34 patients with a mean age of 75 years (range 71-83 years) were submitted to a cementless onlay short stem RSA with a Bone Increased Off-Set (BIO-RSA) construct. The mean follow-up period was 61 months (range 54-87). Significant improvements (p < 0.001) were observed for the constant score and range of motion from the preoperative state to final follow-up. One case exhibited a significant varus deviation (> 5˚) during the follow-up period. No case of stem loosening was identified. There was only one case of complication because of post-traumatic dislocation, but the stem didn't need revision.

Conclusion: Short stem RSA, even in patients older than 70 years, can yield a stable fixation with a good clinical and radiological outcome at short-medium term follow-up.

Level of evidence: Level III; Retrospective Study.

Keywords: Elderly; Humeral Stem; Reverse Shoulder Arthroplasty; Short stem.; Shoulder Joint; Shoulder prosthesis.