JSES - 2026-04-01 - Journal Article; Comparative Study
Impact of cement use and stem length on clinical outcomes in revision reverse shoulder arthroplasty: is a short stem with cementless fixation a viable option?
Lee H, King JJ, Wright JO, Pendarvis J, Hartman J, Farmer KW, Struk AM, Wright TW
Topics
Key Takeaway
In revision reverse TSA, short cementless stems achieved Constant score improvement of 23.5 points versus 3.5 points for long stems (P=.018), with a 0% humeral stem re-revision rate at minimum 2-year follow-up.
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Summary
This study compared clinical outcomes of revision RSA stratified by humeral stem fixation method (cemented n=45 vs. cementless n=68) and stem length (short n=16, standard n=79, long n=18) using a single-institution prospective database spanning 2005–2023. Cemented and cementless fixation produced equivalent ROM and outcome scores, with overall re-revision rates of 7.2% and 14.9% respectively (P=.204). Short and standard stems outperformed long stems in active abduction improvement (34° and 37° vs. 0°, P=.045 and P=.001) and Constant score gain, with short stems achieving 0% humeral stem re-revision.
Key Limitation
The short-stem cohort (n=16) is underpowered to detect clinically meaningful differences in complication and re-revision rates, making the 0% re-revision finding unreliable for practice-changing conclusions.
Original Abstract
BACKGROUND
Revision reverse total shoulder arthroplasty (rTSA) is performed as a salvage procedure after failed shoulder arthroplasty. However, it presents substantial challenges compared to primary rTSA due to altered anatomy and compromised bone quality. This study aimed to compare clinical outcomes of revision rTSA based on the revision humeral stem fixation methods (cemented vs. cementless) and stem length (short vs. standard vs. long).
METHODS
We conducted a retrospective analysis using a prospectively maintained shoulder arthroplasty database from a single institution. All revision rTSAs performed between 2005 and 2023 with a minimum 2-year follow-up were included. Patients were excluded for revision from a primary antibiotic spacer placed in the native shoulder or a history of multiple arthroplasty procedures. The final cohort consisted of 113 revision rTSAs (45 cemented vs. 68 cementless; 16 short vs. 79 standard vs. 18 long). Demographic data, surgical characteristics, outcome scores, active range of motion (ROM), complications, and re-revision rates were compared across cohorts.
RESULTS
Revision rTSA showed no significant differences in active ROM or outcome scores between the cemented and cementless humeral fixation cohorts. The short and standard stem cohorts demonstrated greater improvement in active abduction compared to the long stem cohort (34 ± 32 vs. 0 ± 18; P = .045; 37 ± 41 vs. 0 ± 18; P = .001). Similarly, they exhibited greater improvement in the Constant score (23.5 ± 17.7 vs. 3.5 ± 10.5; P = .018; 19.1 ± 19.5 vs. 3.5 ± 10.5; P = .012). Overall re-revision rates in the cemented and cementless cohorts were 7.2% and 14.9%, respectively, and humeral stem re-revision rates were 7.2% and 9.9%, respectively. (P = .204 and P = .746). Overall re-revision rates in the short, standard, and long stem cohorts were 3.7%, 13.7%, and 11.5%, respectively, and humeral stem re-revision rates were 0%, 10.3%, and 11.5%, respectively. (P = .361 and P = .199).
CONCLUSION
The use of a short stem in revision rTSA demonstrated clinical outcomes comparable to other stem lengths. Complications and re-revision rates did not significantly differ by cement use or stem length.