Current state of short-stem implants in total shoulder arthroplasty: a systematic review of the literature

BACKGROUND: Humeral stem length in anatomic total shoulder arthroplasty (TSA) continues to decrease in an attempt to preserve bone. Outcomes following short-stem TSA are not well documented. The purpose was to systematically review and report the outcomes and revisions following short-stem humeral implants for TSA. METHODS: A systematic review was registered with PROSPERO and performed with PRISMA guidelines using 3 publicly available free databases. Therapeutic clinical outcome investigations reporting TSA outcomes of short-stem implants with levels of evidence I-IV were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and described. RESULTS: Thirteen studies were included (average follow-up: 33 months, range 24-84 months; 8 studies [62%] were multicenter and 6 [46%] were from Europe). All studies were published in the last 8 years, and almost all (12/13, 92%) reported results of uncemented components. Most of the studies (9/13, 70%) reported results from the Aequalis Ascend or Ascend Flex Stem (Tornier). Improvements were seen in all measured range of motion planes and patient-reported outcome scores. Complications were infrequent, with a 2% humeral loosening rate, a 3% overall revision rate, and a 1% rate of revision for aseptic humeral loosening. Radiographic results showed a 13% rate of radiolucent lines, a 16% rate of condensation lines, and a 22% rate of calcar osteolysis. CONCLUSION: Short-stem TSA humeral implants provide excellent results, with low revision rates in the short term. Long-term follow-up will be necessary to understand the clinical impact of radiographic calcar osteolysis.