Stemless / Short-Stem Shoulder Arthroplasty

Anatomic total shoulder arthroplasty can use a standard-length stem, a short-stem, or a stemless humeral component, and the trend is towards shorter components. A stemless implant fixes entirely in the proximal humeral metaphysis with no diaphyseal stem. The rationale is to preserve humeral bone stock (easing revision), shorten operative time, and avoid diaphyseal-stem problems - periprosthetic fracture, difficult stem removal, and stress shielding (proximal bony adaptation/radiolucent lines). The key requirement is adequate proximal humeral bone quality, so stemless is avoided in severe osteoporosis, large cysts, AVN or deformity. Clinically, outcomes (motion, PROMs, complications, revision) are broadly equivalent across stem lengths, with shorter operative time and fewer humeral radiolucent lines for the shorter components; longer-term durability data are still maturing.

• Select by bone quality: stemless requires adequate proximal humeral metaphyseal bone - avoid it in severe osteoporosis, large subchondral cysts, AVN with collapse, or significant deformity, where a stemmed implant gains diaphyseal fixation.
• Reap the advantages: bone preservation, shorter operative time, and less stress shielding/fewer humeral radiolucent lines.
• Plan for revision: preserved bone stock makes conversion of a failed stemless/short-stem implant to a stemmed anatomic or reverse arthroplasty relatively straightforward.
• Counsel on the evidence: short-to-mid-term outcomes are comparable to stemmed implants, but longer-term survivorship data are still maturing, so use stemless/short-stem in appropriately selected patients."