Uncemented total shoulder arthroplasty. A review.

Clinicians have had much experience with uncemented humeral components. A press-fitted humeral component will usually remain stable in the absence of a glenoid component. From the information available, surgeons should not continue to use press-fitted humeral components for total shoulder arthroplasty. Tissue ingrowth humeral components offer promise; however, the reports to date have short or intermediate length followup, and radiographic results do not equal those of cemented components. Early clinical results with tissue ingrowth glenoid components are excellent; radiographically evident changes occur much less frequently than they do following cement fixation. However, their disadvantage is the possibility of accelerated polyethylene wear and subsequent metal-induced synovitis. As such, there are no clear cut indications for cement fixation versus tissue ingrowth fixation for the glenoid component other than those intuitively based on bone quality and quantity in the glenoid fossa. Accruing experience will help to define the indications better, but given the similarity of clinical outcomes to date, distinction between the options may be difficult.