Cementless Prosthetic Fixation: When Less Is More-In the Affirmative

Shoulder arthroplasty is a reliable treatment for pain relief and restoration of function in patients with degenerative conditions of the glenohumeral joint. The designs of shoulder prostheses has evolved since Neer first introduced his original press-fit humeral hemiarthroplasty component back in 1951. This was followed by the development of a glenoid prosthesis for resurfacing of arthritic glenoid surfaces. Use of cement for fixation of both humeral and glenoid components became the gold standard for many years in the treatment of glenohumeral degenerative conditions, such as osteoarthritis and rheumatoid arthritis. The trend toward performing shoulder arthroplasty in younger, more active patients has led to a transition back to cementless fixation to preserve bone stock and make revision surgery easier. In addition, the concept of cementless surface replacement has also been described for treatment of arthritic conditions in younger patients. Results have been equivocal with uncemented versus cemented prostheses used on the humeral side. However, there have been problems with metal backed, press-fit glenoid fixation. At the current time, cemented all-polyethylene glenoid components remain the choice for most shoulder surgeons. As the technology improves, the use of press-fit, bone in-growth designs may become a more reliable alternative.