Stemless Humeral Implants in Total Shoulder Arthroplasty

Through an iteration of various advancements, both short stem and stemless options for humeral fixation have been proposed and have shown clinical promise. The proposed benefits of a stemless humeral implant include greater bone preservation, less stress shielding, less risk of a diaphyseal stress riser, decreased surgical time, and less intraoperative blood loss. Potential downsides include the dependence on proximal bone quality for fixation, increased cost, the dependence on the strength of subscapularis fixation, and pending FDA approval for multiple implants. The purpose of this article is to review the evidence behind stemless implants including the biomechanical advantages and disadvantages, surgical technique, and clinical outcomes.