Purpose of the study: The purpose of this retrospective analysis was to assess long-term clinical and radiological outcome of humeral stems inserted without cement for shoulder arthroplasty.

Material and methods: The series included 37 shoulder arthroplasties (11 simple humerus prostheses and 26 total shoulder arthroplasties) performed between 1985 and 1998. Press-fit humeral stems were used for these patients with primary and posttraumatic shoulder degeneration and osteonecrosis. There were 13 Neer II (3M) prostheses and 24 Modular Shoulder prostheses (3M) which were designed for implantation with cement. Mean follow-up was 9.2 years (range 5.8–13.6 years). This series included 22 women and 15 men, mean age 57.7 years (range 33–82). The Constant score and the Neer classification were noted. Lucent lines, endosoteal erosion, and stem migration or tilt were noted on plain x-rays. A stem was considered ‘at risk’ of loosening in the presence of tilt or migration or lucent lines measuring > 2 mm in > 3 zones.

Results: At last follow-up, the mean non-weighted Constant score was 57/100 (16/95) and according to Neer, outcome was satisfactory in 70%. There was no complication and no revision related to the cementless stem was needed. The radiographic analysis failed to identify any stem migration. Lucent lines were observed for 22 components (59%), endosteal erosion for 12 (32%) and tilt for 5 (14%). Seven stems were considered at risk (19%). The prevalence of at risk stems was not correlated with patient-related or disease-related features, nor to the type of prosthesis, the length of follow-up or clinical outcome in terms of pain, Constant score or Neer classification.

Discussion: Neer initially designed a humeral component to be inserted with cement. This technique provided a humeral fixation which was very reliable, with very few loosenings reported. It was nevertheless very difficult to remove the cemented stem. For this reason, certain surgeons continued to use these stems designed for cemented implantation in a press-fit manner for simple humeral prostheses and for total shoulder arthroplasty.

Conclusion: This study demonstrated the favorable results obtained using these press-fit stems for shoulder arthroplasty. The rate of clinical looseninf was low at long-term follow-up.

Purpose of the study: The purpose of this study was to compare mid-term results after total shoulder arthroplasty (TSA) versus simple humeral arthroplasty (SHA) for the treatment of primary centered osteoarthritic degeneration of the shoulder joint.

Material and methods: The series included 41 Aequalis prostheses (27 TSA, 14 SHA) implanted by the same surgeon. TSA was performed in 21 women and six men, mean age 68.3 years (range 51–78). SHA was performed in nine women and five men, mean age 68.3 years (range 58–83). The glenoid cavity presented concentric wear (type A) in 70% and asymmetric wear (type B) in 30% of patients undergoing TSA. Type A wear was observed in 57% of the patients undergoing SHA and type B (or C) wear in 43% of them. Mean follow-up was 35 months (range 24–49) for TSA and 37 months (24–59) for SHA. The Constant score and the Neer classification were noted. The position of the implants and lucent lines was noted on plain x-rays.

Results: For the TSA patients, the mean non-weighted Constant score was 82/100 points (gain of 48 points), anterior elevation was 151° (gain 54°), and active external rotation 44° (gain 29°). For the SHA patients, the mean non-weighted Constant score was 71/100 points (gain 41 points), active anterior elevation 135° (ain 46°), and active external rotation 43° (gain 28°). The Neer classification demonstrated excellent or satisfactory outcome for 93% of the TSA patients and 86% of the SHA patients. TSA was more effective than SHA for pain relief (p=0.045). Periglenoid lucent lines were observed for 63% of the TSA but with no loosening or complication for the glenoid component at last follow-up.

Discussion: Compared with a simple humeral prosthesis, total shoulder arthroplasty was more effective for the treatment of primary centered osteoarthritis of the shoulder joint.

Purpose: We conducted a retrospective study of 20 total elbow prostheses GUEPAR humerocubital and humeroradial (G3) implanted in 19 patients with rheumatoid arthritis. This anatomic metal-polyethylene prosthesis is available in a left and right model and in two sizes, large and small. A radial head prosthesis is now available in addition to the humerocubital prosthesis. The radial head prosthesis has an intramedullary metallic stem and a mobile polyethylene cup which comes in several sizes.

Material and methods: Among 20 prostheses implanted between 1997 and 2001, four were first-generation prostheses which did not have a radial head. At three to four years, these four prostheses developed valgus instability with deterioration of the polyethylene of the cubital piece requiring revision with a new generation GUEPAR associated with a radial head. This gave two good results and two failures revised with a semi-constrained prosthesis. For the 16 other cases of rheumatoid disease, the G3 humerocubital prosthesis associated with a radial head was inserted. These 16 prostheses were followed two years and were retained for this analysis. The posterior approach was used with inverted-V section of the triceps using the surgical technique recommended by the promoters. Patients had permanent severe to moderate pain. The Mayo Clinic score (1992 including daily life activities) was 33/100. Radiographically, seven elbows were Larsen grade III, nine grade IV, seven grade IIA and nine grade IIIb (Larsen classification modified by the Mayo Clinic).

Results: All patients were reviewed with mean follow-up of two years (1–5). The Mayo Clinic score improved from 33/100 to33/90 with outcome considered excellent in 15 elbows and fair in one.

Discussion: We recommend total elbow prostheses for rheumatoid arthritis patients. Semi-constrained prostheses have indications in certain cases of massive destruction, but the minimally or non-constrained gliding prostheses, such as the GUEPAR prosthesis, are part of the evolution of these prostheses, just as was the case for knee prostheses. These good results can be expected to persist over time.