Prevalence and risk factors for stem subsidence following reverse shoulder arthroplasty using on-lay press-fit short stems

Prevalence and risk factors for stem subsidence following reverse shoulder arthroplasty using on-lay press-fit short stems | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and risk factors for stem subsidence following reverse shoulder arthroplasty using on-lay press-fit short stems Rei Nishiura, katusumasa Nakazawa, Tomoya Manaka, Yoshihiro Hirakawa, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7717771/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Mar, 2026 Read the published version in Archives of Orthopaedic and Trauma Surgery → Version 1 posted 9 You are reading this latest preprint version Abstract Introduction: In reverse shoulder arthroplasty (RSA), press-fit short stems offer benefits such as reduced operative time and bone preservation. However, stem subsidence has been reported, although the risk factors remain unclear. This study aimed to determine the prevalence and risk factors for stem subsidence in RSA with on-lay press-fit short stems, hypothesizing that a lower filling ratio (FR) would correlate with subsidence. Materials and Methods: This retrospective analysis included patients who underwent RSA using on-lay press-fit short stems between 2017 and 2023, with a minimum follow-up of 2 years. Subsidence was defined as a ≥5 mm reduction in the distance from the tip of the greater tuberosity to the distal end of the stem on anteroposterior radiographs between the immediate postoperative and final follow-up evaluations. FR was assessed at the metaphyseal (FRmet) and diaphyseal (FRdia) levels. Neutral alignment was defined as a stem–shaft angle within 5°. Clinical outcomes included range of motion, Constant score, and American Shoulder and Elbow Surgeons score. Results: This study enrolled 151 patients: 65 with cuff tear arthropathy, 54 with massive rotator cuff tears, 29 with glenohumeral osteoarthritis, and three with shoulder dislocations. Osteoporosis was identified in 37 patients. Subsidence occurred in 20 patients (13.2%). The mean FRmet was significantly lower in the subsidence ≥5 mm group (67.7% ± 6.2) than the <5 mm group (71.5% ±8.0, p=0.01). Logistic regression identified low FRmet (OR: 0.90, 95% CI: 0.82–0.99, p=0.03) and osteoporosis (OR: 3.2, 95% CI: 1.05–9.96, p=0.04) as significant risk factors. There was no significant difference in clinical outcomes with subsidence. Conclusions: Subsidence occurred in 13.2% of patients following RSA with press-fit short stems. A lower FRmet (<70%) and osteoporosis were significant predictors of subsidence. Achieving an FRmet ≥70% may reduce this risk, while cemented stems could be preferable for patients with osteoporosis. Level of Evidence: Level Ⅲ; Retrospective study; Retrospective comparative study; Diagnostic Studies Diagnostic studies Filling ratio Osteoporosis Retrospective comparative studies Reverse shoulder arthroplasty Subsidence Full Text Additional Declarations No competing interests reported. Table 1 to 8 are available in the Supplementary Files section. Supplementary Files Table1.pptx Table 1. Radiological outcomes Table2.pptx Table 2. Demographic outcomes: Comparison between subsidence <5 mm and subsidence ≥5 mm Table3.pptx Table 3. Radiographic evaluation: Comparison between subsidence <5 mm and subsidence ≥5 mm Table4.pptx Table 4. Correlation between subsidence and FRmet ≥70% Table5.pptx Table 5. Correlation between subsidence and FRdia ≥60% Table6.pptx Table 6. Risk factors for subsidence Table7.pptx Table 7. Pre- and postoperative clinical outcomes by subsidence <5 mm and subsidence ≥5 mm Table8.pptx Table 8. MCID for CS and ASES Cite Share Download PDF Status: Published Journal Publication published 28 Mar, 2026 Read the published version in Archives of Orthopaedic and Trauma Surgery → Version 1 posted Editorial decision: Revision requested 03 Feb, 2026 Reviews received at journal 03 Feb, 2026 Reviewers agreed at journal 05 Jan, 2026 Reviews received at journal 30 Sep, 2025 Reviewers agreed at journal 30 Sep, 2025 Reviewers invited by journal 30 Sep, 2025 Editor assigned by journal 29 Sep, 2025 Submission checks completed at journal 29 Sep, 2025 First submitted to journal 26 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7717771","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":525428845,"identity":"ab7efb2f-2b55-42c3-bc11-e17842831ed5","order_by":0,"name":"Rei Nishiura","email":"","orcid":"","institution":"Osaka Metropolitan University Graduate of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Rei","middleName":"","lastName":"Nishiura","suffix":""},{"id":525428846,"identity":"27f2a438-f8b3-4be7-a1ec-3ce011e78f46","order_by":1,"name":"katusumasa 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Radiological outcomes\u003c/p\u003e","description":"","filename":"Table1.pptx","url":"https://assets-eu.researchsquare.com/files/rs-7717771/v1/4ffdec4a950523e0143553d6.pptx"},{"id":93409516,"identity":"394f2c73-4d88-4e5b-bf2e-f15d76c810e5","added_by":"auto","created_at":"2025-10-13 14:22:47","extension":"pptx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":45861,"visible":true,"origin":"","legend":"\u003cp\u003eTable 2. Demographic outcomes: Comparison between subsidence \u0026lt;5 mm and subsidence ≥5 mm\u003c/p\u003e","description":"","filename":"Table2.pptx","url":"https://assets-eu.researchsquare.com/files/rs-7717771/v1/b30305eee1a755f5a5b4eeb9.pptx"},{"id":93409515,"identity":"fc9fa89c-7634-430f-894f-5d2a26ba8373","added_by":"auto","created_at":"2025-10-13 14:22:47","extension":"pptx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":44077,"visible":true,"origin":"","legend":"\u003cp\u003eTable 3. Radiographic evaluation: Comparison between subsidence \u0026lt;5 mm and subsidence ≥5 mm\u003c/p\u003e","description":"","filename":"Table3.pptx","url":"https://assets-eu.researchsquare.com/files/rs-7717771/v1/6964f723b9c14c3be65e468f.pptx"},{"id":93408914,"identity":"8c8f19be-81d4-489a-9b65-7618be997450","added_by":"auto","created_at":"2025-10-13 14:14:47","extension":"pptx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":43961,"visible":true,"origin":"","legend":"\u003cp\u003eTable 4. Correlation between subsidence and FRmet ≥70%\u003c/p\u003e","description":"","filename":"Table4.pptx","url":"https://assets-eu.researchsquare.com/files/rs-7717771/v1/37f77c3ff785ae158c1943b0.pptx"},{"id":93408916,"identity":"869c3d3a-3b99-4d7f-b0a0-06bd973548d2","added_by":"auto","created_at":"2025-10-13 14:14:47","extension":"pptx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":42711,"visible":true,"origin":"","legend":"\u003cp\u003eTable 5. Correlation between subsidence and FRdia ≥60%\u003c/p\u003e","description":"","filename":"Table5.pptx","url":"https://assets-eu.researchsquare.com/files/rs-7717771/v1/515077c9aeb03dc4017d7927.pptx"},{"id":93408920,"identity":"8bb9c756-1330-4402-9dda-c2cf887594ec","added_by":"auto","created_at":"2025-10-13 14:14:47","extension":"pptx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":45533,"visible":true,"origin":"","legend":"\u003cp\u003eTable 6. Risk factors for subsidence\u003c/p\u003e","description":"","filename":"Table6.pptx","url":"https://assets-eu.researchsquare.com/files/rs-7717771/v1/380c93ec6a4873dab4218a20.pptx"},{"id":93408922,"identity":"46c5753f-ace3-46d4-9188-9e2082166812","added_by":"auto","created_at":"2025-10-13 14:14:47","extension":"pptx","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":45572,"visible":true,"origin":"","legend":"\u003cp\u003eTable 7. Pre- and postoperative clinical outcomes by subsidence \u0026lt;5 mm and subsidence ≥5 mm\u003c/p\u003e","description":"","filename":"Table7.pptx","url":"https://assets-eu.researchsquare.com/files/rs-7717771/v1/c29f82d8f17fcf46b9f27cb6.pptx"},{"id":93408918,"identity":"f5d6784e-f1e9-48ab-b251-9eb1786e4a70","added_by":"auto","created_at":"2025-10-13 14:14:47","extension":"pptx","order_by":8,"title":"","display":"","copyAsset":false,"role":"supplement","size":39340,"visible":true,"origin":"","legend":"\u003cp\u003eTable 8. MCID for CS and ASES\u003c/p\u003e","description":"","filename":"Table8.pptx","url":"https://assets-eu.researchsquare.com/files/rs-7717771/v1/9ba7062eb2305f3da030178b.pptx"}],"financialInterests":"\u003cp\u003eNo competing interests reported.\u003c/p\u003e\n\u003cp\u003eTable 1 to 8 are available in the Supplementary Files section.\u003c/p\u003e","formattedTitle":"Prevalence and risk factors for stem subsidence following reverse shoulder arthroplasty using on-lay press-fit short stems","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-orthopaedic-and-trauma-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aots","sideBox":"Learn more about [Archives of Orthopaedic and Trauma Surgery](http://link.springer.com/journal/402)","snPcode":"402","submissionUrl":"https://submission.springernature.com/new-submission/402/3","title":"Archives of Orthopaedic and Trauma Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Diagnostic studies, Filling ratio, Osteoporosis, Retrospective comparative studies, Reverse shoulder arthroplasty, Subsidence","lastPublishedDoi":"10.21203/rs.3.rs-7717771/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7717771/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e In reverse shoulder arthroplasty (RSA), press-fit short stems offer benefits such as reduced operative time and bone preservation. However, stem subsidence has been reported, although the risk factors remain unclear. This study aimed to determine the prevalence and risk factors for stem subsidence in RSA with on-lay press-fit short stems, hypothesizing that a lower filling ratio (FR) would correlate with subsidence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e This retrospective analysis included patients who underwent RSA using on-lay press-fit short stems between 2017 and 2023, with a minimum follow-up of 2 years. Subsidence was defined as a ≥5 mm reduction in the distance from the tip of the greater tuberosity to the distal end of the stem on anteroposterior radiographs between the immediate postoperative and final follow-up evaluations. FR was assessed at the metaphyseal (FRmet) and diaphyseal (FRdia) levels. Neutral alignment was defined as a stem–shaft angle within 5°. Clinical outcomes included range of motion, Constant score, and American Shoulder and Elbow Surgeons score.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e This study enrolled 151 patients: 65 with cuff tear arthropathy, 54 with massive rotator cuff tears, 29 with glenohumeral osteoarthritis, and three with shoulder dislocations. Osteoporosis was identified in 37 patients. Subsidence occurred in 20 patients (13.2%). The mean FRmet was significantly lower in the subsidence ≥5 mm group (67.7% ± 6.2) than the \u0026lt;5 mm group (71.5% ±8.0, p=0.01). Logistic regression identified low FRmet (OR: 0.90, 95% CI: 0.82–0.99, p=0.03) and osteoporosis (OR: 3.2, 95% CI: 1.05–9.96, p=0.04) as significant risk factors. There was no significant difference in clinical outcomes with subsidence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubsidence occurred in 13.2% of patients following RSA with press-fit short stems. A lower FRmet (\u0026lt;70%) and osteoporosis were significant predictors of subsidence. Achieving an FRmet ≥70% may reduce this risk, while cemented stems could be preferable for patients with osteoporosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLevel of Evidence:\u003c/strong\u003e Level Ⅲ; Retrospective study; Retrospective comparative study; Diagnostic Studies\u003c/p\u003e","manuscriptTitle":"Prevalence and risk factors for stem subsidence following reverse shoulder arthroplasty using on-lay press-fit short stems","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-13 14:14:42","doi":"10.21203/rs.3.rs-7717771/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-03T15:30:20+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-03T15:11:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"58237927052067254927140013332658290377","date":"2026-01-05T15:12:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-30T12:17:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62258318361945780691192731003714706116","date":"2025-09-30T12:09:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-30T10:29:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-29T06:37:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-29T06:36:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Orthopaedic and Trauma Surgery","date":"2025-09-26T04:53:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-orthopaedic-and-trauma-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aots","sideBox":"Learn more about [Archives of Orthopaedic and Trauma Surgery](http://link.springer.com/journal/402)","snPcode":"402","submissionUrl":"https://submission.springernature.com/new-submission/402/3","title":"Archives of Orthopaedic and Trauma Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"719ba76f-7835-4a9a-962d-da036dafe27e","owner":[],"postedDate":"October 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T16:17:25+00:00","versionOfRecord":{"articleIdentity":"rs-7717771","link":"https://doi.org/10.1007/s00402-026-06253-z","journal":{"identity":"archives-of-orthopaedic-and-trauma-surgery","isVorOnly":false,"title":"Archives of Orthopaedic and Trauma Surgery"},"publishedOn":"2026-03-28 16:09:46","publishedOnDateReadable":"March 28th, 2026"},"versionCreatedAt":"2025-10-13 14:14:42","video":"","vorDoi":"10.1007/s00402-026-06253-z","vorDoiUrl":"https://doi.org/10.1007/s00402-026-06253-z","workflowStages":[]},"version":"v1","identity":"rs-7717771","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7717771","identity":"rs-7717771","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}