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J Shoulder Elbow Surg. 2018 Jan;27(1):53-58. doi: 10.1016/j.jse.2017.06.042. Epub 2017 Aug 31.

Proximal stress shielding is decreased with a short stem compared with a traditional-length stem in total shoulder arthroplasty.

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Southern Oregon Orthopedics, Medford, OR, USA; Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, OR, USA. Electronic address:
Southern Oregon Orthopedics, Medford, OR, USA.
Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.
The Cleveland Shoulder Institute, Beachwood, OH, USA.
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA; The Orthopedic Clinic Association, Phoenix, AZ, USA.



This study compared the outcome and radiographic humeral adaptations after placement of a traditional-length (TL) or short-stem (SS) humeral component during total shoulder arthroplasty (TSA). The hypothesis was there would be no difference in outcome or radiographic adaptations.


A multicenter retrospective review was performed of primary TSAs performed with a TL or SS press-fit humeral component. The stems were identical in geometry and coating, with the only variable being stem length. Functional outcome and radiographs were reviewed at a minimum of 2 years postoperatively in 58 TL stems and 56 SSs.


There were significant improvements in all range of motion and functional outcome from baseline (P < .001) but no difference between the groups (P > .05). TL stems were placed in anatomic alignment 98% of the time compared with 86% of the SS cases (P = .015), but alignment did not influence outcome. Cortical thinning was more common in the medial metaphysis with the TL stem (74%) than with the SS (50%; P = .008). Partial calcar osteolysis was seen in 31% of TL stems and in 23% of SSs (P = .348). There was no difference in loosening or shift between the 2 groups.


There is no difference in functional outcome at short-term follow-up between a TL stem and a SS in TSA. The pattern of radiographic adaptations may differ based on stem length. Further study is needed to evaluate the mid- to long-term differences, particularly with regard to calcar osteolysis.


Total shoulder arthroplasty; bone adaptations; humeral loosening; metaphyseal fixation; press fit; short stem; stress shielding

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