short stems and stemless shoulder arthroplasty: current concepts review

Historically, the shoulder arthroplasty humeral component has been designed for the management of infections, tumours and fractures. in all these cases the stem was needed as a scaffold. original humeral components were not developed for use in shoulder arthritis, so these designs and derivates had a long stem. the newest humeral implants innovations consist in shortening of the implant, or even removing the whole stem, to rely on stemless fixation at the level of the metaphysis. this implies the advantages of preserved bone stock, less stress shielding, eliminating the diaphyseal stress riser, easier implant removal at revision, and humeral component placement independent from the humeral diaphyseal axis. nowadays, surgeons try to balance the need for a stable fixation of the humeral component with the potential need for revision surgery. complications of revision shoulder arthroplasty are related to the need for removing a well-fixed humeral stem, the length of the procedure, and the need to treat severe bone loss. level of evidence: v