HEMIARTHROPLASTY - STEMS

 Four low quality studies (Odquist et al. 2018, Rasmussen et al. 2018, Lebon et al. 2014, Fourman et al. 2019) met inclusion criteria to make evidence-based recommendations related to the outcome of stemmed, stemless, and resurfacing humeral components. Rasmussen et al. reported Finnish registry data and compared stemmed to stemless (metaphyseal fixation) anatomic total shoulder arthroplasty demonstrating that male gender/sex and previous surgery were the only risk factors related to increase risk of revision surgery. Implant type did not influence outcome at final follow up with 6-year survivorship (95.3% stemless and 95.8% stemmed). Most common indication for revision was infection. Fourman et al. compared resurfacing to stemmed humeral implant hemiarthroplasties and demonstrated no difference with regards to ASES, function, or patient satisfaction, but statistically significant (p<0.05) better pain relief for the stemmed group (this did not reach MCID). Similarly, Lebon et al. compared stemmed with resurfacing hemiarthroplasty and found significantly higher revision rate in the resurfacing group due to glenoid wear (9.8% resurfacing group; 0% hemiarthroplasty group). There was no statistically significant difference in Constant score, subjective shoulder value, Quick-DASH, pain, or range of motion between groups.

The data from these low-quality studies provides early information that any of these implants are reasonable and safe options but should be used with caution as there is no long-term outcome studies.

Strength of Evidence (quality of evidence): Limited

Benefits & Harms:

There are no additional harms or risks associated with this recommendation as all of these humeral options are currently being used.

Outcome Importance:

Guidance with regards to the best and most reliable implant option will help surgeon’s choice the implant that can reliably/ predictably provide successful outcome with low risk of the need for reoperation from implant failure.

Cost Effectiveness/Resource Utilization:

As with any implant related recommendation the goals for successful treatment options with low risk of component related failure. Avoidance of the need for revision surgery will keep costs down and keep the need for utilization of additional future health care resources minimized.

Acceptability:

These implants are already in use clinically, this recommendation does not impact a change in practice until future well-designed high-quality studies are performed.

Feasibility:

There is no change in practice recommendation associated with this statement therefore as all of these humeral options are being used it will alter current treatment.

Future Research:

High quality studies with long term follow up (>10 years) directly comparing stemmed, stemless, and humeral resurfacing for both hemiarthroplasty as well as anatomic total shoulder arthroplasty are needed to determine if one implant type provides better outcome, pain relief, and survivorship.