Cemented vs. Press-Fit Humeral Stems: A Matched Cohort Analysis at a Mean Follow-Up of 10 years.
Academic Article
Overview
abstract
INTRODUCTION: While cementation of humeral stems has long been considered the gold standard for anatomic shoulder arthroplasty (aTSA), cementless, or press-fit, fixation offers a relatively cheaper and less demanding alternative, particularly in the setting of a revision procedure. However, this approach has been accompanied by concerns of implant loosening and high rates of radiolucency. In the present study we performed a propensity matched comparison of clinical and patient-reported outcomes between cemented and cementless fixation techniques for aTSA. METHODS: This study was a retrospective comparison of 50 shoulders undergoing aTSA: 25 using cemented humeral fixation versus 25 using press-fit humeral fixation. Patients in the two groups were propensity matched according to age, sex, and preoperative ASES score. Primary outcome measures included range of motion (ROM) (forward elevation, external rotation, internal rotation), patient reported outcomes (American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), Visual Analog Scores (VAS)), and implant survival. RESULTS: At baseline, the two fixation groups were similar in regard to age, sex, BMI, preoperative ASES score, and surgical indication. Mean follow-up was 11.7 ± 4.95 years in the cemented cohort and 9.13 ± 3.77 years in the press-fit cohort (p=0.045). Both groups demonstrated significant improvements postoperatively in all included ROM and patient-reported outcomes. However, press-fit patients reported significantly better VAS, ASES, and SST scores. Mean VAS pain score was 1.1 ± 1.8 in press-fit patients and 3.2 ± 3.0 in cemented patients (p=0.005). The mean ASES score was 87.7 ± 12.4 in press-fit patients and 69.5 ± 22.7 in cemented patients (p=0.002). Lastly, the mean SST score was 9.8 ± 3.1 in press-fit patients and 7.7 ± 3.7 in cemented patients (p=0.040). Both fixation techniques provided lasting implant survivorship with only a single revision operation in each of the cohorts. CONCLUSION: Herein, we provide a propensity matched, long-term comparison of patients receiving anatomic shoulder arthroplasty stratified according to humeral stem fixation technique. The results of this analysis illustrate that both types of humeral fixation techniques yield durable and significant improvements in shoulder function with similar rates of survival at 10 years of follow-up.
