Stemless anatomic total shoulder arthroplasty: a systematic review and meta-analysis

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. Methods: A systematic search was conducted using MEDLINE, Embase, PubMed, and CENTRAL (Cochrane Central Register of Controlled Trials) to retrieve all relevant studies. Results: The literature search yielded 1417 studies, of which 22 were included in this review, with 962 patients undergoing stemless TSA. Stemless TSA led to significant improvements in range of motion and functional scores in all included studies. Meta-analysis of comparative studies between stemless and stemmed TSA identified no significant differences in postoperative Constant scores (mean difference [MD], 1.26; 95% confidence interval [CI],-3.29 to 5.81 points; P=.59) or complication rates (odds ratio, 1.79; 95% CI, 0.71-4.54; P=.22). Stemless TSA resulted in a significantly shorter operative time compared with stemmed TSA (MD,-15.03 minutes; 95% CI,-23.79 to -6.26 minutes; P=.0008). Stemless TSA also resulted in significantly decreased intraoperative blood loss compared with stemmed TSA (MD,-96.95 mL; 95% CI,-148.53 to -45.36 mL; P=.0002). Conclusion: Stemless anatomic TSA resulted in similar functional outcomes and complication rates to stemmed TSA with decreased operative time and lower blood loss. Further research is required to investigate the long-term durability of the stemless implant. Level of evidence: Level IV; Systematic Review (C) 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.