Challenge of the Week / Shoulder & Elbow / 12.10.2021

A 48-year-old female patient underwent open reduction and internal fixation of a proximal humeral fracture using a fibular allograft 2 years ago and now presents with pain and stiffness. On imaging, despite maintaining anatomic reduction, she has evidence of osteonecrosis of the humeral head and rapid progression of arthritis in her shoulder. Her infection workup is negative. If she is scheduled for an anatomic shoulder arthroplasty, which of the following would be the main advantage of using a stemless rather than a stemmed implant?

    • Ease of future revision
    • Ease of revision is a major advantage of a stemless humeral component. With a healed fibular allograft, using a stemless component will make this surgery and future revisions easier.
    • Sparing of the intramedullary canal
    • This patient had open reduction and internal fixation of a proximal humeral fracture with fibular grafting, and the medullary canal has been compromised.
    • Less intra-operative blood loss
    • Although reducing intra-operative blood loss is a hypothetical advantage of a stemless implant, studies have not shown any difference between stemmed and stemless implants with regard to blood loss.
    • Better glenoid exposure
    • Both stemmed and stemless humeral components utilize a humeral head cut and afford good glenoid exposure in contrast to humeral head resurfacing.


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