Willems Joost I P, Hoffmann Jim, Sierevelt Inger N, van den Bekerom Michel P J, Alta Tjarco D W, van Noort Arthur
Spaarne Gasthuis, Hoofddorp, The Netherlands.
Xpert Orthopedics, Amsterdam, The Netherlands.
EFORT Open Rev. 2021 Jan 4;6(1):35-49. doi: 10.1302/2058-5241.6.200067. eCollection 2021 Jan.
Stemless shoulder arthroplasty relies solely on cementless metaphyseal fixation and is designed to avoid stem-related problem such as intraoperative fractures, loosening, stress shielding or stress-risers for periprosthetic fractures.Many designs are currently on the market, although only six anatomic and two reverse arthroplasty designs have results published with a minimum of two-year follow-up.Compared to stemmed designs, clinical outcome is equally good using stemless designs in the short and medium-term follow-up, which is also the case for overall complication and revision rates.Intraoperative fracture rate is lower in stemless compared to stemmed designs, most likely due to the absence of intramedullary preparation and of the implantation of a stem.Radiologic abnormalities around the humeral implant are less frequent compared to stemmed implants, possibly related to the closer resemblance to native anatomy.Between stemless implants, several significant differences were found in terms of clinical outcome, complication and revision rates, although the level of evidence is low with high study heterogeneity; therefore, firm conclusions could not be drawn.There is a need for well-designed long-term randomized trials with sufficient power in order to assess the superiority of stemless over conventional arthroplasty, and of one design over another. Cite this article: 2021;6:35-49. DOI: 10.1302/2058-5241.6.200067.
无柄肩关节置换术仅依靠非骨水泥型干骺端固定，旨在避免与柄相关的问题，如术中骨折、松动、应力遮挡或假体周围骨折的应力集中。目前市场上有多种设计，尽管只有六种解剖型和两种反向置换设计有至少两年随访结果的报道。与有柄设计相比，在短期和中期随访中，无柄设计的临床效果同样良好，总体并发症和翻修率也是如此。与有柄设计相比，无柄设计的术中骨折率较低，这很可能是由于无需进行髓内准备和植入柄。与有柄假体相比，肱骨假体周围的放射学异常较少见，这可能与更接近自然解剖结构有关。在无柄假体之间，在临床效果、并发症和翻修率方面发现了一些显著差异，尽管证据水平较低且研究异质性较高；因此，无法得出确凿结论。需要设计良好、有足够效力的长期随机试验，以评估无柄假体相对于传统关节置换术的优越性，以及一种设计相对于另一种设计的优越性。引用本文：2021;6:35 - 49。DOI: 10.1302/2058 - 5241.6.200067。
