Stemless reverse shoulder arthroplasty: indications, technique and European experience
Reverse shoulder prostheses are increasingly used in recent years for treatment of glenohumeral arthropathy with deficient rotator cuff such as: rotator cuff arthropathy, rheumatoid arthritis, proximal humeral fractures sequela, irreparable rotator cuff tears, and failed shoulder replacement. Good mid-term and long-term results with restoration of active elevation have been reported. However, early studies showed relatively high rates of complications (24–50%) and many of them require further surgery. Most of the current designs of rTSA are with a humeral diaphyseal stem. A significant part of the reported intra-operative and postoperative complications, as well as difficulties arising during revision surgery, are related to the diaphyseal humeral component. Therefore, preservation of bone stock has become a major goal. Metaphyseal cementless implants without a diaphyseal stem have been developed to preserve bone and resect only minimal amount of bone. In 2005 the first stemless reverse TSAs were introduced for clinical use in Europe, with the Verso shoulder [Innovative Design Orthopaedics, London, UK (formerly Biomet, UK)] in UK and the TESS reverse shoulder (Biomet, France) in France. This review examines the European experience with stemless metaphyseal reverse TSAs, the history, the design rationale, the indications and the clinical and radiological outcome. The European experience with stemless metaphyseal reverse TSAs now spans over 13 years, with results that are at least equal with the stemmed implants. Specific design biomechanical considerations will be discussed.