Clinical comment

Current opinion suggests that most surgeons prefer to use an uncemented humeral component in North America, and implant manufacturers have therefore developed and marketed uncemented implants over recent years.⁴ However, there is limited evidence comparing functional outcomes of cemented versus uncemented humeral components in TSA.

Available literature and quality of the evidence

• Level I: 1 prospective randomized study.
  
• Level III: 2 retrospective cohort studies.

Findings

In a prospective randomized study, Litchfield et al. compared cemented (n = 80 patients) with uncemented (n = 81) humeral components (Bigliani/Flatow Total Shoulder Solution, Zimmer, Warsaw, IN, USA) for TSA. They showed a significant difference in Western Ontario Osteoarthritis of the Shoulder (WOOS) score at postoperative intervals of 12, 18, and 24 months (p = 0.009, 0.001, 0.028, respectively) in favor of the cemented humeral component. The authors reported no difference in motion or strength improvement between the two groups, compared to preoperative values. Operative time was significantly less for the uncemented group: 1.7 hours versus 2.3 hours (p = 0.03). The authors concluded that a cemented humeral component provides better quality of life than an uncemented humeral component. It is important to note that in this study there was a significantly higher number of men in the cemented group compared to the uncemented group, and the differences between the two groups may be due to improvement in male participants. Additionally, the prosthesis used in this study was not specifically designed for bony ingrowth, which could significantly alter outcomes for the uncemented group.⁵ Therefore, it may be difficult to extrapolate the results of this study to other implants.

Though there are no other studies directly comparing outcomes in anatomic TSA between cemented and uncemented humeral components, there are two retrospective cohort studies comparing outcomes with cemented and uncemented humeral stems in reverse total shoulder arthroplasty (rTSA). In a review of 100 operations (51 with cemented and 32 with uncemented humeral stems) performed using the Exactech Equinoxe® System, King et al. showed significant improvement in the 12‐item Simple Shoulder Test, 12‐item Short Form, Shoulder Pain and Disability Index 130 (SPADI‐130), American Society of Shoulder and Elbow Surgeons (ASES) score, and normalized Constant scores for both groups, with no significant differences between the two at two‐year follow‐up. Additionally, there was no significant difference in complication rate between the two groups.¹

In a second retrospective cohort study comparing outcomes between cemented and uncemented humeral components in rTSA, Wiater et al. compared 64 cases of cementless rTSA with 37 cases of cemented rTSA. Outcome measures included Constant–Murley scores, American Shoulder and Elbow Surgeons scores, Visual Analog Scale (VAS) pain scores, range of motion, patient satisfaction, and radiographic evidence of complication. Findings included significant improvements in all functional scores, forward flexion, and internal rotation with no significant difference between these values in cemented versus uncemented rTSA. Similarly, there were no differences in radiographic evaluation or complication rate between the two cohorts.⁶

Resolution of clinical scenario

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