title: Functional midterm follow-up comparison of stemless total shoulder prostheses versus conventional stemmed anatomic shoulder prostheses using a 3D-motion-analysis Radiological changes do not influence clinical mid-term outcome in stemless humeral head replacements with hollow screw fixation: a prospective radiological and clinical evaluation Nine-year outcome after anatomic stemless shoulder prosthesis: clinical and radiologic results. Sidus Stem-Free Shoulder System for primary osteoarthritis: short-term results of a multicenter study. Higher preoperative sensitivity to pain and pain at rest are associated with worse functional outcome after stemless total shoulder arthroplasty: A PROSPECTIVE COHORT STUDY Outcomes after shoulder replacement: comparison between reverse and anatomic total shoulder arthroplasty. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Impact of prosthetic design on clinical and radiologic outcomes of total shoulder arthroplasty: a prospective study. Clinical and Radiographic Outcomes of the Simpliciti Canal-Sparing Shoulder Arthroplasty System: A Prospective Two-Year Multicenter Study. Stemmed versus stemless total shoulder arthroplasty: a preliminary report and short-term results The effect of intravenous tranexamic acid on blood loss and early post‐operative pain in total shoulder arthroplasty Midterm results of stemless shoulder arthroplasty: a prospective study. Methodological index for non‐randomized studies (MINORS): development and validation of a new instrument Short stem shoulder replacement Fatty infiltration and muscle atrophy of the rotator cuff in stemless total shoulder arthroplasty: a prospective cohort study.
abstract: Background The aim of this study is to compare the functional midterm outcome of stemless shoulder prostheses with st and ard anatomical stemmed shoulder prostheses and to show that the STEMLESS results are comparable to the STEMMED with respect to active maximum range of shoulder motion ( ROM ) and Constant score ( CS ) . Methods Seventeen patients underwent total shoulder arthroplasty ( TSA ) in 25 shoulder joints .  Stemless TSA was performed in 12 shoulder joints ( group STEMLESS ) , third-generation stemmed TSA in 13 shoulder joints ( group STEMMED ) . Functional results were documented using the CS . 3D-motion- analysis using the Heidelberg upper extremity model ( HUX ) was conducted to measure active maximum ( ROM ) . Results The group STEMLESS achieved a CS of 67.9 ( SD 12.0 ) points and the group STEMMED of 70.2 ( SD 5.8 points ) without significant difference between the groups ( p = 0.925 ) . The maximum ROM of the group STEMLESS , ascertained by 3-D-motion- analysis , was in forward flexion 125.5 ° ( SD 17.2 ° ) , in extension 49.4 ° ( SD 13.8 ° ) , in abduction 126.2 ° ( SD 28.5 ° ) and in external rotation 40.3 ° ( SD 13.9 ° ) . The maximum ROM of the group STEMMED , also ascertained by 3-D-motion analysis , was in forward flexion 135.0 ° ( SD 16.8 ° ) , in extension 47.2 ° ( SD 11.5 ° ) , in abduction 136.3 ° ( SD 24.2 ° ) and in external rotation 40.1 ° ( SD 12.2 ° ) . The maximum ROM of the STEMLESS group was lower in forward flexion and abduction , higher in extension and almost identical in external rotation . But there was no significant difference ( forward flexion p = 0.174 , extension p = 0.470 , abduction p = 0.345 , external rotation p = 0.978 ) . Conclusion Both types of shoulder prostheses achieve a similar and good active ROM and similar results in CS.Trial registration DRKS00013166 , retrospectively registered , Background Stemless shoulder arthroplasty is a fairly new concept . Clinical and radiological follow-up is essential to prove implant safety and concept . This prospect i ve single-centre study was performed to evaluate the influence of radiological changes on clinical mid-term outcome following stemless humeral head replacement with hollow screw fixation . Methods Short- and mid-term radiological and clinical evaluations were performed in 73 consecutive shoulders treated mainly for idiopathic and posttraumatic osteoarthritis with stemless humeral head arthroplasty including 40 hemi- ( HSA ) and 33 total shoulder arthroplasties ( TSA ) . Operating times of stemless implantations were compared to  110 stemmed anatomical shoulder prostheses .  Appearances of humeral radiolucencies or radiological signs of osteolysis or stress shielding were assessed on st and ardized radiographs . Patients ’ clinical outcome was evaluated using the Constant score and patients ’ satisfaction was documented . Results Radiological changes , detected in 37.0 % , did not affect clinical outcome . Constant scores significantly improved from baseline to short and mid-term follow-up ( p < 0.001 ) . The majority of patients ( 96.2 % ) were satisfied with the procedure . No loosening of the humeral head component was detected during a mean follow-up of 58 months . Operating times were significantly shorter with stemless compared to stemmed implants ( p < 0.001 ) . Conclusions Clinical mid-term outcome after stemless humeral head replacement was not affected by radiological changes . Trial registration The institutional review board ( St. Vincent Hospital Vienna ; 201212_EK01 ; date of issue : 11.12.2012 ) approved the study . The trial was registered at Clinical Trials.gov ( NCT02754024 ) . Retrospective registration BACKGROUND Several stemless shoulder implants are available on the market , but only a few studies have presented results with sufficient mid- to long-term follow-up . The present study evaluated clinical and radiologic outcomes 9 years after anatomic stemless shoulder replacement . METHODS This is a prospect i ve cohort study evaluating the  stemless shoulder prosthesis since 2005 .  Anatomic stemless shoulder replacement using a single prosthesis was performed in 49 shoulders ; 17 underwent total shoulder replacement , and 32 underwent hemiarthroplasty . Forty-three patients were clinical ly and radiologically monitored after a mean of 9 years ( range , 90 - 127 months ; follow-up rate , 88 % ) . The indications for shoulder replacement were primary osteoarthritis in 7 shoulders , post-traumatic in 24 , instability in 7 , cuff tear arthropathy in 2 , postinfectious arthritis in 1 , and revision arthroplasty in 2 . RESULTS The Constant-Murley Score improved significantly from 52 % to 79 % ( P < .0001 ) . The active range of motion also increased significantly for flexion from 101 ° to 118 ° ( P = .022 ) , for abduction from 79 ° to 105 ° ( P = .02 ) , and for external rotation from 21 ° to 43 ° ( P < .0001 ) . Radiologic evaluation revealed incomplete radiolucency in 1 patient without clinical significance or further intervention . No revision caused by loosening or countersinking of the humeral implant was observed . CONCLUSIONS The 9-year outcome after stemless shoulder replacement is comparable to that of third- and fourth-generation st and ard shoulder arthroplasty BACKGROUND The aim of this prospect i ve multicenter study was to evaluate clinical and radiologic results of a new metaphyseal anchored system . This system features a different anchor geometry that potentially leads to better bony integration and less loosening . METHODS From November 2012 until December 2015 , 148 patients ( 151 shoulders ) were treated with the Sidus Stem-Free Shoulder System at 9 centers in Europe . The main indication was primary osteoarthritis ( 80.1 % ) . This analysis only includes patients diagnosed with primary osteoarthritis ( n = 121 ) . A clinical evaluation was performed using the Constant-Murley score , Subjective Shoulder Value , American Shoulder and Elbow Surgeons St and ardized Shoulder Assessment Form , and range of motion . Radiologic assessment was based on the occurrence of radiolucent lines and signs of implant migration , osteolysis , loosening , and heterotopic ossification . RESULTS We evaluated 105 patients after a follow-up period of 2 years . There were 53 women and 52 men . The average age was 64 years . Total shoulder arthroplasty was performed in 73 cases and hemiarthroplasty in 32 . The Constant-Murley score improved from 26 points preoperatively to 70 points at 2 years ' follow-up ( P < .001 ) . The Subjective Shoulder Value increased from 34 % to 84 % ( P < .001 ) , and the American Shoulder and Elbow Surgeons St and ardized Shoulder Assessment Form increased from 34 points to 86 points ( P < .001 ) . Radiologically , neither migration nor loosening was found . However , radiolucent lines of 2 mm or greater could be detected around the glenoid in 2 cases , but none of them have had clinical relevance yet . The overall complication rate was 6.7 % , and the revision rate was 0 % . CONCLUSION Patients with the Sidus Stem-Free Shoulder System achieve good clinical and radiologic short-term results that are comparable with the results of other stem-free shoulder implants Aims The aims of this study were to investigate any possible relationship between a preoperative sensitivity to pain and the degree of pain at rest and on exertion with postoperative function in patients who underwent stemless total shoulder arthroplasty ( TSA ) . Patients and Methods In this prospect i ve study , we included 63 patients who underwent stemless TSA and were available for evaluation one year postoperatively . There were 31 women and 32 men ; their mean age was 71 years ( 53 to 89 ) . The pain threshold , which was measured using a Pain Matcher ( PM ) unit , the  degree of pain ( visual analogue scale at rest and on exertion , and function using the short version of the Disabilities of the Arm , Shoulder and H and question naire ( QuickDASH ) , were recorded preoperatively , as well as three and 12 months postoperatively . Results We found an inverse relationship between both the preoperative PM threshold and pain ( VAS ) at rest and the 12‐month postoperative QuickDASH score ( Pearson correlation coefficient ( r ) ≥ 0.4 , p < 0.05 ) . A linear regression analysis showed that the preoperative PM threshold on the affected side and preoperative pain ( VAS ) at rest were the only factors associated with the QuickDASH score at 12 months . Conclusion These findings indicate the importance of central sensitization in the restoration of function after TSA . Further studies are required to investigate whether extra analgesia and rehabilitation could influence the outcome in at risk patients BACKGROUND Anatomic total shoulder arthroplasty ( TSA ) and reverse total shoulder arthroplasty ( RTSA ) are increasingly common procedures employed to treat arthritic conditions . Although TSA is a widely accepted procedure for glenohumeral arthritis with intact rotator cuff , concerns about RTSA persist because of variable complication rates and outcomes . METHODS This is a prospect i ve , case-control study comparing outcomes and complications after TSA and RTSA . The study included 47 patients undergoing TSA for glenohumeral arthritis and 53 patients undergoing RTSA for rotator cuff tear arthropathy . Average clinical follow-up was more than 2 years in both groups . Major complications included infection , periprosthetic fracture , instability , glenoid loosening , and need for revision surgery . Patient outcome measures included the American Shoulder and Elbow Surgeons score , pain visual analog scale score , and goniometer-measured range of motion . Plain radiographs were review ed to assess for degree of glenoid lucency in TSA and scapular notching in RTSA . RESULTS At 2 years , there were no differences in rate of major complications  ( TSA , 15 % ; RTSA , 13 % ; P = .808 ) or revision surgeries  ( TSA , 11 % ; RTSA , 9 % ) . Outcomes assessed by the American Shoulder and Elbow Surgeons score and visual analog scale were also similar between the 2 groups . TSA patients had greater external rotation than RTSA patients did ( 53 ° vs 38 ° ; P = .001 ) . Otherwise , forward flexion , abduction , and internal rotation were comparable in range of motion . CONCLUSIONS TSA and RTSA  have similar complication rates , need for revision , patient-reported outcomes , and range of motion at 2 years of follow-up . The use of side-by-side cohorts in this study allows st and ardized comparison between these 2 shoulder arthroplasty procedures Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND This prospect i ve longitudinal study compared clinical and radiologic outcomes of  total shoulder arthroplasty ( TSA )  using 3 different prosthetic design s , the Neer II system , the Bigliani-Flatow ( BF ) , and a stemless prosthesis , the Total Evolutive Shoulder System ( TESS ) . MATERIAL S AND METHODS Patients with advanced osteoarthritis of the glenohumeral joint who underwent TSA  were followed up for 2 years . Four patient-oriented disability outcomes were used . The clinical data collected before surgery and at follow-up assessment s during a 2-year period included active range of motion ( ROM ) in 6 directions and strength . Radiographic signs of glenoid and humeral component loosening were recorded . The incidence of humeral head subluxation was documented . RESULTS Seventy-four patients completed the study . There was a significant improvement in the 4 disability measures , ROM , and strength at 2 years in all 3 groups ( P < .0001 ) . Active external rotation at 90 ° abduction was statistically significantly lower in the Neer II group ( P = .001 ) . The incidence of lucent lines around the glenoid component was higher in the Neer II group ( P = .0002 ) . No statistically significant relationship was seen between type of prosthesis and patient satisfaction ( P > 0.05 ) . CONCLUSIONS The 3 types of TSA prostheses used in this study all provided significant improvement in pain and function and were associated with high patient satisfaction . The Neer II was associated with less active external rotation and more lucent lines BACKGROUND Stemmed humeral components have been used since the 1950s ; canal-sparing ( also known as stemless ) humeral components became commercially available in Europe in 2004 . The Simpliciti total shoulder system ( Wright Medical , formerly Tornier ) is a press-fit , porous-coated , canal-sparing humeral implant that relies on metaphyseal fixation only . This prospect i ve , single-arm , multicenter study was performed to evaluate the two-year clinical and radiographic results of the Simpliciti prosthesis in the U.S. METHODS One hundred and fifty-seven patients with glenohumeral arthritis were enrolled at fourteen U.S. sites between July 2011 and November 2012 in a U.S. Food and Drug Administration ( FDA ) Investigational Device Exemption (IDE)-approved protocol . Their range of motion , strength , pain level , Constant score , Simple Shoulder Test ( SST ) score , and American Shoulder and Elbow Surgeons ( ASES ) score were compared between the preoperative and two-year postoperative evaluations . Statistical analyses were performed with the Student t test with 95 % confidence intervals . Radiographic evaluation was performed at two weeks and one and two years postoperatively . RESULTS One hundred and forty-nine of the 157 patients were followed for a minimum of two years . The mean age and sex-adjusted Constant , SST , and ASES scores improved from 56 % preoperatively to 104 % at two years ( p < 0.0001 ) , from 4 points preoperatively to 11 points at two years ( p < 0.0001 ) , and from 38 points preoperatively to 92 points at two years ( p < 0.0001 ) , respectively . The mean forward elevation improved from 103 ° ± 27 ° to 147 ° ± 24 ° ( p < 0.0001 ) and the mean external rotation , from 31 ° ± 20 ° to 56 ° ± 15 ° ( p < 0.0001 ) . The mean strength in elevation , as recorded with a dynamometer , improved from 12.5 to 15.7 lb ( 5.7 to 7.1 kg ) ( p < 0.0001 ) , and the mean pain level , as measured with a visual analog scale , decreased from 5.9 to 0.5 ( p < 0.0001 ) . There were three postoperative complications that result ed in revision surgery : infection , glenoid component loosening , and failure of a subscapularis repair . There was no evidence of migration , subsidence , osteolysis , or loosening of the humeral components or surviving glenoid components . CONCLUSIONS The study demonstrated good results at a minimum of two years following use of the Simpliciti canal-sparing humeral component . Clinical results including the range of motion and the Constant , SST , and ASES scores improved significantly , and radiographic analysis showed no signs of loosening , osteolysis , or subsidence of the humeral components or surviving glenoid components . LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence Abstract Background Although several studies have been performed on the use of various devices in total shoulder arthroplasty ( TSA ) , no data are available in order to establish whether to prefer stemmed or stemless humeral components . Thus , the purpose of our study was to evaluate the short-term functional outcome in a cohort of subjects treated with TSA r and omized to treatment with stemmed or stemless prosthesis .  Methods In this prospect i ve longitudinal study , we r and omized to treatment with stemmed ( group 1 ) or with stemless ( group 2 ) humeral component in nineteen subjects ( 2 M and 17 F ) diagnosed with humeral primary osteoarthritis with indication to TSA . We evaluated the range of movement of all the participants and the functional outcome using Constant score and simple shoulder test ( SST ) before and after 2 years from surgery . Results No differences were detected after 2 years from surgery in the two groups in terms of functional scores and range of motion ( p > 0.05 ) . ConclusionS temmed and stemless prostheses are comparable in terms of functional outcome . These data might be useful for the surgeon in order to choose more tissues-paring method ologies and less invasive procedures , such as stemless humeral implants Aims The purpose of the present study was to evaluate the impact of intravenous tranexamic acid on the reduction of blood loss , transfusion rate , and early post‐operative clinical outcome in total shoulder arthroplasty . Patients and Methods A r and omised , placebo‐controlled trial which included 54 patients undergoing unilateral primary stemless anatomical or stemmed reverse total shoulder arthroplasty was undertaken . Patients received either 100 ml saline ( placebo , n = 27 ) , or 100 ml saline together with 1000 mg of tranexamic acid ( TXA , n = 27 ) intravenously prior to skin incision and during wound closure . Peri‐operative blood loss via an intra‐articular drain was recorded and total blood loss was calculated . The post‐operative transfusion rate was documented . Assessment of early clinical parameters included the visual analogue scale for pain ( VAS ) , documentation of haematoma formation and adverse events . Results Mean peri‐operative blood drainage ( placebo : 170 ml versus TXA : 50 ml , p = 0.001 ) and calculated mean total blood loss  ( placebo : 1248.2 ml versus TXA : 871.0 ml , p = 0.009 ) were significantly lower in the TXA group . No transfusions were necessary during the study period in either group . Mean VAS for pain significantly decreased from pre‐operative ( VAS 7 ) to the early post‐operative period ( VAS 1.7 , p < 0.001 ) . Significant differences regarding mean post‐operative pain between placebo ( VAS 2.0 ) and TXA ( VAS 1.3 ) were detected ( p = 0.05 ) . The occurrence of haematomas was significantly more frequent in the placebo ( 59.3 % , n = 16 ) than in the TXA group ( 25.9 % , n = 6 , p = 0.027 ) . Whereas only mild haematomas developed in the TXA group , in the placebo group a total of 22.2 % ( n = 6 ) developed either moderate or severe haematomas . No adverse events associated with administration of TXA occurred . Conclusion Intravenous administration of TXA successfully reduced mean peri‐operative blood drainage , total estimated blood loss , pain during the first post‐operative days , and haematoma formation in total shoulder arthroplasty BACKGROUND This study evaluated the functional and radiologic results of shoulder arthroplasty using a single type of stemless humeral head implant  with a minimum follow-up of 5 years . METHODS  Stemless shoulder arthroplasties in 78 patients at a mean age of 58 years were prospect ively evaluated at a mean clinical and radiologic follow-up of 72 months . Functional results were documented using the age- and sex-adjusted Constant score with st and ardized radiographic examination . RESULTS The Constant score improved significantly from 38.1 % to 75.3 % ( P < .0001 ) . Active range of motion improved significantly for flexion ( from 114 ° to 141 ° ) , abduction ( from 74 ° to 130 ° ) , and external rotation ( from 25 ° to 44 ° ; P < .0001 ) . Bone mineral density was reduced in 34.9 % of the older population , without an influence on shoulder function ( Constant score without lowering of bone density ; 73 % ; Constant score with lowering of bone density 80 % ; P = .404 ) . The overall complication rate was 12.8 % , with an overall revision rate of 9 % . None of the stemless implants were revised for loosening . CONCLUSION The functional and radiologic results of the stemless shoulder arthroplasty are comparable to the third and fourth generation of st and ard stem arthroplasty Background : Because of specific method ological difficulties in conducting r and omized trials , surgical research remains dependent predominantly on observational or non‐r and omized studies . Few vali date d instruments are available to determine the method ological quality of such studies either from the reader 's perspective or for the purpose of meta‐ analysis . The aim of the present study was to develop and vali date such an instrument Context : It is agreed that it is important to anatomically reproduce the proximal humeral anatomy when performing a prosthetic shoulder replacement . This can be difficult with a long stemmed prosthesis , in particular if there is little relationship of the metaphysis to the humeral shaft . The ‘ short stem ’ prosthesis can deal with this problem . Aims : A prospect i ve study assessed the results of total shoulder arthroplasty using a short stem humeral prosthesis , a ceramic humeral head , and a pegged cemented polyethylene glenoid . Material s and methods : Patients with primary shoulder osteoarthritis were recruited into this prospect i ve trial and pre-operatively had the ASES , Constant , SPADI , and DASH scores recorded . The patients were clinical ly review ed at the two weeks , eight weeks , one year , and two year mark with completion of a data form . Radiological evaluation was at the eight week , one year and two year follow-up . At the one and two year follow-up the satisfaction rating , the range of passive and active motion , Constant , ASES , SPADI , DASH and pain results were recorded and analysed with SPPS 20 . Results : During the study period 97 short stem , ceramic head total shoulder replacements were carried out . At the time of follow-up 12 were two years from operation and 38 one year from operation . Active elevation was overall mean 160 degrees . Constant scores were 76 at 1 year , and 86 at 2 years , ASES 88 and 93 , and satisfaction 96 % and 98 % respectively at one and 2 year follow up . There were no problems during insertion of the humeral prosthesis , or any radiolucent lines or movement of the prosthesis on later radiographs . Conclusion : The short stem prosthesis had no complications , and on follow up radiographs good bone fixation . These fairly short term clinical results were overall good BACKGROUND The influence of preoperative rotator cuff fatty infiltration ( FI ) and muscle atrophy ( MA ) on the postoperative outcome of  total shoulder arthroplasty ( TSA ) has only rarely been investigated and reported in the literature . We hypothesized that more FI and MA would be associated with a worse postoperative functional outcome . METHODS This prospect i ve cohort study included 63 patients ( 31 female and 32 male patients ; mean age , 71 years [ range , 53 - 89 years ; st and ard deviation , 7 years ] ) with primary osteoarthritis of the shoulder operated on with anatomic stemless TSA .  Preoperatively and at 3 months and 1 year after the operation , the functional outcome ( QuickDASH [ short version of Disabilities of the Arm , Shoulder and H and question naire ] score ) and range of motion ( ROM ) ( goniometer ) and strength ( dynamometer ) for abduction at the scapular plane and for external rotation were measured . The degree of preoperative FI and MA was evaluated using computed tomography scans according to the Goutallier classification and Warner classification , respectively , for the supraspinatus and infraspinatus . RESULTS We found clinical ly and statistically significant improvements in functional outcome , strength , and ROM at both 3 months and 1 year of follow-up compared with those preoperatively . The Pearson correlation coefficient ( r ) showed significant correlations between preoperative supraspinatus and infraspinatus FI and MA and preoperative and 1-year postoperative shoulder abduction and external rotation strength but not ROM . However , we found no influence of the rotator cuff FI and MA on the functional outcome after TSA . CONCLUSION We demonstrated a significant correlation between rotator cuff FI and MA and strength but not ROM of the shoulder joint
target: Stemless anatomic TSA result ed in similar functional outcomes and complication rates to stemmed TSA with decreased operative time and lower blood loss .
background: BACKGROUND Stemless anatomic total shoulder arthroplasty ( TSA ) is used in the treatment of osteoarthritis of the shoulder joint and other degenerative shoulder diseases .
  It has several proposed advantages over stemmed TSA including increased bone preservation , decreased operative time , and easier removal at revision .