ReviewJournal of orthopaedics2025
Does stem length affect proximal humeral stress shielding? A systematic review.
Review in Journal of orthopaedics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
- The Stryker Perform and Univers Apex short stems have different patterns of stress shielding but comparably low rates of loosening after reverse total shoulder arthroplasty.Journal of shoulder and elbow arthroplasty · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Introduction: Total shoulder arthroplasty (TSA) has increased in use, with revision surgeries also increasing. One cause of revision is aseptic loosening driven by stress shielding-a condition where altered load distribution leads to proximal humeral osteolysis surrounding the humeral prosthesis. This systematic review compares stress shielding between traditional-length (TL) and short-stem (SS) humeral prostheses, hypothesizing that SS stems reduce stress shielding. Methods: A systematic search of Cochrane, Embase, and Medline databases was conducted. Inclusion criteria targeted studies from the last 10 years reporting radiographic outcomes of TL and SS stems. Pooled radiographic measures were stratified into a 5-zone analysis of the proximal humerus for comparison. These included cortical thinning and osteopenia (CNO), condensation lines (CL), spot welds (SW), and an overall adaptive change score. An additional GLIMMIX procedure was performed to evaluate the effect that technique and stem length had on radiographic outcomes using random effects modeling. Results: A total of 7 studies were included, and 620 patients were analyzed, with 422 receiving SS and 198 receiving TL humeral prostheses. The weighted average follow-up was 34.8 months. TL showed higher rates of CNO around the superior-lateral humeral prosthesis, and SS showed higher rates of CNO around the inferior-lateral and medial prosthesis. TL showed higher rates of SW around the superior-lateral and medial prosthesis, but SS showed higher rates of SW around the distal-lateral and medial prosthesis. No differences were found in CL for any group or for any measure under the stem. A significantly greater proportion of TL patients had low adaptive change scores, with more SS patients possessing high adaptive change scores. Technique did not show any significant effects on radiographic outcomes while stem length showed a significant effect on CNO in the distal-lateral zone (F-Value = 19.72, p = 0.04, OR = 0.106, 95 % CI [0.012-0.932]). Conclusion: This study demonstrated radiographic differences between short and traditional-length stems that suggest unique patterns of bone remodeling. While short stems may better preserve proximal lateral bone, the higher incidence of distal cortical changes warrants careful patient selection, and traditional-length stems may remain preferable when metaphyseal fixation or bone quality is a concern.
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