Survival of the pegged glenoid component in shoulder arthroplasty: part II.

Loosening of the glenoid component is a primary reason for failure of an anatomic shoulder arthroplasty. Pegged glenoids were designed in an effort to outperform keeled components. This study evaluated the midterm clinical and radiographic survival of a single implant design with implantation of an in-line pegged glenoid component and identified risk factors for radiographic loosening and clinical failure. There were 330 total shoulder arthroplasties that had been implanted with a cemented, all-polyethylene, in-line pegged glenoid component evaluated with an average clinical follow-up of 7.2 years. Of these shoulders, 287 had presurgical, initial postsurgical, and late postsurgical radiographs (mean radiographic follow-up, 7.0 years). At most recent follow-up, 30 glenoid components had been revised for aseptic loosening. This translated to a rate of glenoid component survival free from revision for all 330 shoulders of 99% at 5 years and 83% at 10 years. Of 287 glenoid components, 120 were considered loose on the basis of radiographic evaluation. Four humeral components were considered loose. Component survival (Kaplan-Meier) free from radiographic failure at 5 and 10 years was 92% and 43%. Severe presurgical glenoid erosion (Walch A2, B2, C) and patient age <65 years were risk factors for radiographic failure. Late humeral head subluxation was associated with radiographic failure. Despite the predominant thinking that pegged glenoid components may be superior to keeled designs, midterm radiographic and clinical failure rates were high with this pegged component design, particularly after 5 years. Advanced presurgical glenoid erosion and younger patient age are risk factors for radiographic loosening. Revision rates underestimate radiographic glenoid loosening.

McLendon PB ，Schoch BS ，Sperling JW ，Sánchez-Sotelo J ，Schleck CD ，Cofield RH ... -  《-》

The association between glenoid component design and revision risk in anatomic total shoulder arthroplasty.

Anatomic total shoulder arthroplasty (TSA) is a proven treatment for glenohumeral joint osteoarthritis, with superior results compared with hemiarthroplasty. However, glenoid component loosening remains a problem and is one of the most common causes of failure in TSA. Multiple component designs have been developed in an attempt to reduce loosening rates. The purpose of this study was to evaluate risk of revision after anatomic TSA according to the glenoid component design. We conducted a cohort study including patients aged ≥18 years who underwent primary elective TSA for the diagnosis of osteoarthritis between 2010 and 2017. Patients with missing implant information, who received stemless humeral implants, or who received augmented glenoid implants, were excluded. Glenoid component designs used were categorized into 4 mutually exclusive treatment groups: polyethylene central-pegged ingrowth, polyethylene-metal hybrid, polyethylene all-cemented pegged, and polyethylene cemented keeled. Multivariable competing risk regression was used to evaluate the risk of glenoid loosening as a cause-specific revision by the glenoid component design. Of the 5566 TSA included in the final cohort, 39.2% of glenoid implants were polyethylene central-pegged ingrowth, 31.1% were polyethylene-metal hybrid, 26.0% were polyethylene all-cemented pegged, and 3.6% were polyethylene cemented keeled. At 6-year final follow-up, 4.1% of TSA were revised for any cause, and 1.4% for glenoid loosening. Compared with the polyethylene central-pegged ingrowth design, no difference in glenoid loosening revision risk was observed for the polyethylene-metal hybrid design (hazard ratio [HR] = 1.15, 95% confidence interval [CI] = 0.42-3.20). However, both the polyethylene all-cemented pegged (HR = 2.48, 95% CI = 1.08-5.66) and polyethylene cemented keeled (HR = 3.84, 95% CI = 1.13-13.00) designs had higher risks for revision due to glenoid loosening. We observed glenoid component designs to be associated with differential risks in revision due to glenoid loosening with polyethylene all-cemented pegged glenoids and polyethylene cemented keeled glenoids having higher risks when compared with polyethylene central-pegged ingrowth glenoids. Surgeons may want to consider the glenoid component design when performing anatomic TSA.

Dillon MT ，Chan PH ，Prentice HA ，Burfeind WE ，Yian EH ，Singh A ，Paxton EW ，Navarro RA ... -  《-》

Radiographic and clinical comparison of pegged and keeled glenoid components using modern cementing techniques: midterm results of a prospective randomized study.

Glenoid component loosening remains a significant issue after anatomic shoulder arthroplasty. Pegged glenoid components have shown better lucency rates than keeled components in the short term; however, midterm to long-term results have not fully been determined. We previously reported early outcomes of the current randomized controlled group of patients, with higher glenoid lucency rates in those with a keeled glenoid. The purpose of this study was to evaluate the radiographic and clinical outcomes of these components at minimum 5-year follow-up. Fifty-nine total shoulder arthroplasties were performed in patients with primary glenohumeral osteoarthritis. Patients were randomized to receive either a pegged or keeled glenoid component. Three raters graded radiographic glenoid lucencies. Clinical outcome scores and active mobility outcomes were collected preoperatively and at yearly postoperative appointments. Of the 46 shoulders meeting the inclusion criteria, 38 (82.6%) were available for minimum 5-year radiographic follow-up. After an average of 7.9 years, radiographic lucency was present in 100% of pegged and 91% of keeled components (P = .617). Grade 4 or 5 lucency was present in 44% of pegged and 36% of keeled components (P = .743). There were no differences in clinical outcome scores or active mobility outcomes between shoulders with pegged and keeled components at last follow-up. Within the initial cohort, 20% of the keeled shoulders (6 of 30) and 7% of the pegged shoulders (2 of 29) underwent revision surgery (P = .263). Kaplan-Meier analysis showed no significant difference in survival rates between groups (P = .560). At an average 7.9-year follow-up, non-ingrowth, all-polyethylene pegged glenoid implants are equivalent to keeled implants with respect to radiolucency, clinical outcomes, and need for revision surgery.

Kilian CM ，Press CM ，Smith KM ，O'Connor DP ，Morris BJ ，Elkousy HA ，Gartsman GM ，Edwards TB ... -  《-》

Radiographic comparison of finned, cementless central pegged glenoid component and conventional cemented pegged glenoid component in total shoulder arthroplasty: a prospective randomized study.

Radiographic lucency of the glenoid component remains a problem after cement fixation in primary total shoulder arthroplasty. Glenoid component design likely contributes to rates of glenoid lucency. The purpose of this study was to prospectively compare radiographic lucency between a finned, cementless central pegged glenoid component (CL component) and a conventional cemented pegged glenoid component (P component) on immediate postoperative and minimum 2-year follow-up radiographs. Fifty-four patients undergoing total shoulder arthroplasty were prospectively randomized to receive an all-polyethylene CL component or a conventional all-polyethylene P component. Three raters graded glenoid lucency and bone interdigitation on immediate postoperative and latest follow-up radiographs. Patients who had undergone revision surgery or had died before evaluation were excluded. Minimum 2-year follow-up was required for inclusion of radiographic evaluation. Fifty patients met inclusion criteria; 42 patients (84%; 20 CL and 22 P) were available for follow-up with the original glenoid implant in place. The mean follow-up duration was 35 months (24-64 months). There were no significant differences in glenoid radiolucency between CL (1/20 [5%]) and P (2/22 [9%]) components at last follow-up (P = .999). Five patients (25%) in the CL group had bone interdigitation. No instances of aseptic glenoid loosening occurred. There were no significant differences in the rate of glenoid lucency between the 2 groups at immediate or an average 35-month follow-up. Both techniques appear to be viable options for initial glenoid component fixation, with CL components allowing possible osseointegration, imparting potential long-term stability.

Kilian CM ，Morris BJ ，Sochacki KR ，Gombera MM ，Haigler RE ，O'Connor DP ，Edwards TB ... -  《-》

Clinical and radiographic comparison of a hybrid cage glenoid to a cemented polyethylene glenoid in anatomic total shoulder arthroplasty.

This study reports the clinical and radiographic outcomes of a hybrid cage glenoid compared with an age-matched, sex-matched, and follow-up-matched cohort of cemented all-polyethylene peg glenoids in patients undergoing anatomic total shoulder arthroplasty with 2 years' minimum follow-up. We reviewed 632 primary anatomic total shoulder arthroplasty patients from an international multi-institutional database; 316 patients received hybrid cage glenoids and were matched for age, sex, and follow-up with 316 patients with cemented all-polyethylene peg glenoids. Each cohort received the same humeral component. Scoring was performed in all patients preoperatively and at latest follow-up using 5 outcome scoring metrics and 4 active range-of-motion measurements. A Student 2-tailed unpaired t test identified differences in outcomes; P < .05 denoted a significant difference. Cage glenoid patients had significantly lower rates of radiolucent glenoid lines (9.0% vs. 37.6%, P < .0001) and radiolucent humeral lines (3.0% vs. 9.1%, P = .0088) than all-polyethylene peg glenoid patients. In the cage glenoid cohort, 4 cases of aseptic glenoid loosening (1.3%) and 4 cases of articular surface dissociation (1.3%) occurred. In the all-polyethylene peg cohort, 12 cases of aseptic loosening (3.8%) occurred. Cage glenoid patients had a significantly lower revision rate than all-polyethylene peg glenoid patients (2.5% vs. 6.9%, P = .0088). At 50 months' mean follow-up, cage glenoids demonstrated equally good clinical outcomes to all-polyethylene peg glenoids. Cage glenoids had significantly fewer radiolucent lines around both the glenoid and humeral components and a lower revision rate. Longer-term follow-up is required to confirm these promising short-term results.

Friedman RJ ，Cheung E ，Grey SG ，Flurin PH ，Wright TW ，Zuckerman JD ，Roche CP ... -  《-》