Uncemented versus cemented humeral stem fixation in reverse shoulder arthroplasty

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Abstract
This study compares the radiographic and functional outcomes of uncemented and cemented humeral fixation in reverse total shoulder arthroplasty (RTSA). A prospective research database was reviewed for RTSA patients from 2007 to 2010. Inclusion criteria were primary RTSA from one manufacturer (Exactech Equinoxe®) with a grit-blasted metaphyseal humeral stem and two year minimum follow-up. Exclusion criteria included shoulder arthroplasty for fractures, fracture sequelae or inflammatory arthropathy. Radiographic and functional outcomes were compared between the uncemented and cemented groups. A total of 97 patients (58 women, 39 men) with 100 RTSAs met the inclusion criteria. Radiographic and clinical two year follow-up was available in 80 % (51 RTSAs) of the uncemented group and 89 % (32 RTSAs) of the cemented group (mean follow-up 3.5 years). Average age at surgery was 72 years. Both groups showed significant improvements in the 12-item Simple Shoulder Test (SST-12), 12-item Short Form (SF-12), Shoulder Pain and Disability Index 130 (SPADI-130), American Society of Shoulder and Elbow Surgeons (ASES) score and normalised Constant scores. One humeral loosening was seen in each group (2 % uncemented, 3 % cemented). Both groups’ overall component revision rate was 6 % (one in each group relating to humeral component failure). There were no significant differences in complication rates, change in functional scores and range of motion improvement. Humeral component press-fitting in RTSA provides similar outcomes as cementation at a minimum two year follow-up.

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