Stemmed pyrocarbon hemiarthroplasty for glenohumeral arthropathy: a systematic review and meta-analysis
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Background Stemmed pyrocarbon hemiarthroplasty (PyC-HA) has emerged as a glenoid-preserving option for young, active patients with glenohumeral arthropathy. Prior reviews have included mixed pyrocarbon implant types and have generally summarized outcomes descriptively. No prior systematic review and meta-analysis has focused exclusively on stemmed PyC-HA with quantitative pooled analysis of clinical and survivorship outcomes. Methods A systematic review and meta-analysis was performed in accordance with PRISMA guidelines. MEDLINE, Scopus, and Google Scholar were searched through February 2026. Eligible studies reported outcomes of stemmed PyC-HA for glenohumeral arthropathy or related indications. Overlapping institutional cohorts were identified and managed to avoid repetitive counting of patient data. Revision rate were pooled using random-effects models with Freeman-Tukey double-arcsine transformation. Continuous outcomes were pooled using inverse-variance weighted random-effects models with Hartung-Knapp confidence intervals. Methodological quality was assessed using the MINORS criteria. Results Seventeen studies met the inclusion criteria for qualitative review. Of these, 10 unique studies comprising 789 shoulders at a mean age of 52.9 years with a mean follow-up of 38 months were included in the meta-analysis. The pooled all-cause revision rate was 5.0% (95% CI 3.3%-7.4%; I 2 = 24.1%), and the pooled atraumatic revision rate was 4.5% (95% CI 3.1%-6.6%; I 2 = 15.7%). The pooled final absolute Constant score was 77.5 points (95% CI 67.6-87.4; I 2 = 77.7%), with a mean improvement of 42.5 points (95% CI 29.5-55.5; I 2 = 90.3%) at final follow-up. Pooled final forward flexion was 149.7° (95% CI 135.9°-163.5°; I 2 = 86.5%), with a mean improvement of 45.3° (95% CI 28.7°-62.0°). The pooled improvement in VAS/NRS pain score was -5.08 points (95% CI -5.98 to -4.17; I 2 = 60.7%). Among studies reporting Kaplan-Meier survivorship, revision-free survival ranged from 92.2% at 3 years to 89.4% at 10 years. Across multiple independent cohorts, radiographic glenoid erosion progression was not associated with functional outcomes. Humeral head oversizing was consistently noted as the most modifiable factor associated with glenoid erosion and revision. Conclusions Stemmed PyC-HA is associated with low pooled revision rates, improved functional outcomes, and encouraging survivorship data at short- to mid-term follow-up. Oversizing of the humeral head is associated with a higher revision rate, and intraoperative humeral head size choice is a modifiable surgical factor. Long-term survivorship remains uncertain, and continued follow-up is needed before sPyC-HA can be established as a viable alternative to both aTSA and conventional CoCr-HA in this challenging patient population. Level of Evidence Level IV, Systematic Review Meta Analysis
Institution: University of Massachusetts Chan Medical School
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,000
OpenAlex ID: W7214901778