Stemmed versus stemless total shoulder arthroplasty: a comparison of operative times
Background: Total shoulder arthroplasty (TSA) is the gold standard treatment of end-stage glenohumeral osteoarthritis. TSA with stemless humeral implants have shown comparable rates of success to stemmed components. Prolonged operative time is associated with increased cost, surgical, and medical complications, and higher rates of infection. Therefore, the goal of this study was to evaluate operative time with stemless TSA compared to stemmed TSA. We hypothesize that stemless TSA will be associated with less operative than stemmed TSA. Methods: In this retrospective case-control study of 80 consecutive patients, 40 patients underwent stemless TSA and 40 patients underwent stemmed TSA. To eliminate potential bias due to individual surgeons surgical techniques, the cohorts were matched by surgeon in a 1:1 ratio. Only primary TSA, without augmented glenoid implants, were included. We evaluated the difference in operative time between groups. Operative time was defined as time from incision to commencement of wound closure. Results: Our sample included 62.5% and 55% females in the stemmed and stemless cohorts respectively. Patients in the stemless group were noted to be younger with a mean age of 61 compared to 68 in the stemmed group (P < .01). The BMI between both cohorts were comparable at 29.72 and 30.04 in the stem and stemless cohorts, respectively (P = .84). Operative time was noted to be significantly less in the stemless TSA cohort. Specifically, a 13.53 minutes difference was noted with a mean time of 100.35 vs. 86.82 minutes (P = .04). Conclusion: In this case-control study, matched by surgeon to avoid technique bias, evaluating stemmed and stemless humeral components for anatomic TSA, we noted a significantly shorter operative time in favor of stemless TSA. The clinical and economic impact of this difference remains unclear. Level of evidence: Level III, retrospective case-control study.
Anastasio, AT; Okafor, C; Garrigues, GE; Klifto, CS; Lassiter, T; Anakwenze, O
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