Doerr MS N, Attenasio DO A, Gencarelli jr. BS P, Tang MD A, Liporace MD F, Yoon MD R
Jersey City Medical Center, Jersey City, NJ, United States
Objective
The use of cemented or uncemented humeral stems for the treatment of rotator cuff(RTC) arthropathy and proximal humerus fractures(PHF) during reverse shoulder arthroplasty(rTSA) is an area of ongoing debate. The purpose of this study was to compare survivorship, functional outcomes and complication rates.
Methods
We conducted a retrospective review of patients undergoing rTSA performed at a single medical center between 2018 and 2020. Minimum follow-up period was 2-years. Patients were separated into two groups. Patient demographics, comorbidities, operative data, range-of-motion (ROM) and functional outcomes such as Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) were evaluated. A Kaplan-Meier survival curve with log-rank tests was used to compare survivorship defined as reoperation or implant failure.
Results
Forty-eight patients were identified. Twelve(25%) patients received a cemented stem while 36 (75%) did not. Mean follow-up was similar between the two groups(3.0±0.6 years vs 3.0±0.7 years,p=0.91). Cemented stems were used more for PHFs while uncemented were used more for RTC arthropathy(p<0.002). Patients in the cemented group had greater qDASH scores vs. in the uncemented group at baseline(78.2±11.7vs.67.6±11.3, p=0.008) and at latest follow-up(31.6±19.3vs.21.4±12.4, P<0.04). ROM was increased in all measured planes and continued to improve at 3-month, 6-month, 12-month, and 24-month follow-ups for both groups. There was no difference in delta ROM at any time point with the exception of flexion/extension and abduction/adduction, which demonstrated greater delta improvement in uncemented stems at 2-years follow-up(p=0.009, p=0.004). The cemented group trended towards having higher reoperation rates though these findings were not significant(25%vs.8%, p=0.16). A Kaplan-Meier curve demonstrated similar trends for survivorship up to 4-years(74.1% cemented group vs. 91.7% uncemented group,p=0.11).
Conclusions
In rTSA, uncemented stems provide similar survivorship and complication rates with slightly improved flexion/extension and abduction/adduction at latest follow-up when compared to cemented. Uncemented stems trended towards lower reoperation rates albeit not significant. Future studies with longer follow-up times are required to confirm these findings.
