Stemless Shoulder Arthroplasty.

Stemless humeral components for shoulder arthroplasty represent the fourth generation of modern prosthetic shoulder implants. Because of their metaphyseal fixation, the implantation technique is rather straightforward and preserves the humeral canal from violation. Substantial benefits have been highlighted with such a design, including less perioperative morbidity, independence from the proximal humeral anatomy, preservation of bone stock, ease of potential revision surgeries, and limited risk of complex periprosthetic fractures. Initially conceived to better re-create the center of rotation of the humeral head in anatomic arthroplasties, their use has been successfully extended to reverse total shoulder arthroplasty. Provided that contraindications are respected (eg, poor proximal humeral bone quality, proximal humerus fractures, patients who are elderly and/or overweight), short-term and midterm functional outcomes as well as postoperative complications appear to be similar to those of traditional stemmed implants, without increased risk of loosening of the humeral component.