A cohort comparison of humeral implant designs in reverse shoulder arthroplasty: does implant design lead to lower rates of complications and revision?

Abstract

The purpose of this study was to evaluate the outcomes, revisions, and complications between a first-generation cemented modular humeral implant and a second-generation monolithic, primarily uncemented humeral implant in reverse total shoulder arthroplasty with 135° neck-shaft angle and varying degrees of metallic glenosphere offsets. We retrospectively evaluated patients undergoing reverse total shoulder arthroplasty from 2004 to 2014 with a first-generation cemented modular humeral implant (400 patients) or second-generation monolithic humeral stem (231 patients), who had at minimum 2-year clinical and radiographic follow-up. Both groups of patients had similar improvement of clinical outcomes (American Shoulder and Elbow Surgeons +30 points vs. +34 points, respectively) with improvements in all planes of motion (forward flexion +70° vs. +75°, abduction +61° vs. +71°, external rotation +23° vs. +22°, and internal rotation +1.6 vs. +1.5 level improvement, respectively). The incidence of humeral loosening for the cemented group was 3.6%, whereas in the uncemented group it was 0.4% (P = .01). A total of 28 shoulders treated with the cementing technique (4.0%) and 6 patients treated with the press-fit technique (1.5%) were revised (P = .028). The rate of postoperative acromial fractures within the first year was 3.4% in the cemented group and 1.8% in the uncemented group (P = .177). Both the first-generation cemented modular humeral stem implant and the second-generation monolithic humeral stem implant had equivalent clinical outcomes. In addition, with the monolithic stem primarily using press-fit fixation, there was a significant reduction in the incidence of radiographic loosening and the need for revision compared with a cemented stem.