Total shoulder arthroplasty for glenohumeral arthritis associated with posterior glenoid bone loss: results of an all-polyethylene, posteriorly augmented glenoid component.

Posterior glenoid bone loss is commonly encountered in total shoulder arthroplasty (TSA). The purpose of our study is to report the clinical and radiographic findings of patients with a minimum of 2 years' follow-up treated with an all-polyethylene, augmented glenoid component. Twenty-two shoulders with posterior glenoid bone loss were treated by a single surgeon. All underwent primary TSA using a posteriorly augmented, all-polyethylene, stepped glenoid component. Outcome data included visual analog scale, Western Ontario Osteoarthritis of the Shoulder index, and Short Form 36 scores. Radiographic analysis was performed to evaluate bone-cement interface lucency, implant seating, and osseous integration of the central peg. The mean follow-up period was 36 months. Average preoperative retroversion measured with computed tomography scan was 23.5°. In addition to statistically significant increases in forward flexion and external rotation, the visual analog scale score, Western Ontario Osteoarthritis of the Shoulder score, and Short Form 36 physical component summary score all improved significantly (P < .001). Twelve shoulders had osseous integration between the central-peg flanges, 6 had bone adjacent to the central-peg flanges but without identifiable osseous integration, and 1 showed osteolysis. The mean Lazarus score was 0.5. All glenoids had perfect seating scores. Two patients sustained a total of 3 episodes of prosthetic instability. Early results of a posteriorly augmented, all-polyethylene, stepped prosthetic glenoid component to address posterior glenoid loss in TSA are encouraging. Continued evaluation will determine prosthetic longevity and maintained clinical improvement.

Favorito PJ ，Freed RJ ，Passanise AM ，Brown MJ ... -  《-》

Radiographic results of augmented all-polyethylene glenoids in the presence of posterior glenoid bone loss during total shoulder arthroplasty.

Chronic osteoarthritis can result in glenohumeral subluxation and loss of posterior glenoid bone. This can alter normal glenohumeral biomechanics and affect the stress placed on the glenoid implant after total shoulder arthroplasty. This study evaluated the clinical and radiographic results of an augmented all-polyethylene glenoid for the treatment of glenoid osteoarthritis in the presence of posterior glenoid bone loss and determined whether any failures or complications occurred with short-term follow-up. During a 2-year period, 21 patients were treated with an augmented glenoid for an index diagnosis of osteoarthritis with a biconcave glenoid and average posterior glenoid bone loss of 4.7 mm. Clinical outcomes were recorded for the American Shoulder and Elbow Surgeons Shoulder Assessment, Simple Shoulder Test, and active motion. Radiographic analysis included glenoid version, humeral head subluxation, component seating, ingrowth, and loosening. Significant improvements were demonstrated for American Shoulder and Elbow Surgeons Shoulder Assessment (52.3), Simple Shoulder Test (8.1), forward flexion (50°), external rotation (32°), and pain. Radiographic improvements were found for glenoid version (12°), humeral scapular alignment (23%), and humeral glenoid alignment (8%). Central peg ingrowth was demonstrated in all patients, and complete component seating was achieved in 19 patients. No complications were encountered, and no clinical or radiographic failures were identified. Augmented polyethylene glenoid components demonstrated improved clinical outcome, without implant failure or complications, during short-term follow-up.

Stephens SP ，Spencer EE ，Wirth MA 《-》

Clinical and Radiographic Results of an All-Polyethylene Pegged Bone-Ingrowth Glenoid Component.

Loosening of the glenoid component continues to be the main cause of medium and long-term failure of shoulder replacements. The purpose of this study was to evaluate the early clinical and radiographic results following use of an all-polyethylene pegged glenoid component designed for hybrid (biological and cement) fixation. Eighty-three shoulders in 77 patients (mean age, 68.6 years) underwent total shoulder arthroplasty with a pegged hybrid-fixation component (bone-ingrowth glenoid and cemented peg). Outcomes were determined with the American Shoulder and Elbow Surgeons (ASES) score and the Oxford shoulder score. A detailed analysis of radiographs and fine-slice computed tomography (CT) images was performed to determine the extent of bone ingrowth between the flanges and the extent of radiolucent lines at the prosthesis-bone interface. The mean duration of follow-up was 46.7 months (range, 24 to 99 months). At the time of final follow-up, the median ASES score was 97 points (range, 43 to 100 points) and the median Oxford score was 48 points (range, 24 to 48 points). The median active forward elevation was 130° (range, 65° to 170°), median external rotation was 45° (range, 5° to 80°), and median internal rotation was to T11 (range, buttock to T4). Seventy-eight shoulders demonstrated a perfect Lazarus score for radiolucency (0, indicating no radiolucency). Sixty-eight shoulders demonstrated complete osseointegration, with bone ingrowth between all of the flanges seen on coronal CT; 5 demonstrated partial osseointegration; and 10 demonstrated osteolysis around the central peg. Most radiolucent lines were in the inferior Yian zones. There were no correlations between the Yian CT scores and either the ASES or Oxford score (rho = 0.13 and 0.07, respectively). Total shoulder arthroplasty with an all-polyethylene pegged glenoid component, utilizing hybrid fixation, demonstrated excellent clinical and radiographic results at the time of early follow-up. Radiolucent lines were seen most commonly around the inferior pegs of the prosthesis, and this may represent an incipient mode of failure. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Wijeratna M ，Taylor DM ，Lee S ，Hoy G ，Evans MC ... -  《-》

Clinical and Radiographic Outcomes of a Posteriorly Augmented Glenoid Component in Anatomic Total Shoulder Arthroplasty for Primary Osteoarthritis with Posterior Glenoid Bone Loss.

Ho JC ，Amini MH ，Entezari V ，Jun BJ ，Alolabi B ，Ricchetti ET ，Iannotti JP ... -  《-》

Preliminary Results of a Posterior Augmented Glenoid Compared to an all Polyethylene Standard Glenoid in Anatomic Total Shoulder Arthroplasty.

Wright TW ，Grey SG ，Roche CP ，Wright L ，Flurin PH ，Zuckerman JD ... -  《-》