Radiologic midterm results of cemented and uncemented glenoid components in primary osteoarthritis of the shoulder: a matched pair analysis.

Cemented all-polyethylene glenoid components are considered the gold standard in anatomic shoulder arthroplasty. New designs of cementless metal backed glenoid components showed promising early and midterm results. The aim of this matched-pair analysis was to compare the radiologic results of two cemented glenoid components and a cementless glenoid component in patients with primary osteoarthritis (OA). Sixty shoulders were clinically and radiologically evaluated after a mean follow-up of 59 months. Mean patient age was 70.4 years at surgery. Based on the design of the glenoid component (keel, peg, MB), 3 groups with, respectively, 20 shoulders were formed according to the matching criteria time of follow-up, patient age and gender. RLL and osteolysis in anteroposterior and axillary X-ray images were quantified and combined in a radiologic score (R-Score). Higher scores expressed worse radiologic outcomes. Further radiological parameters such as lateral glenohumeral offset (LGHO) and subluxation index were measured according to Walch. The functional results were documented using the age and gender normalized Constant-Murley score. Postoperative R-Score was highest in pegged components (peg: 5.7, keel: 2.4, MB: 1.6; p < 0.001) when combining both radiographs and after separate analysis of anteroposterior radiographs. MB glenoids had the lowest R-score in axillary radiographs (peg: 2.2, keel: 1.4, MB: 0.6; MB vs. keel: p = 0.004, MB vs peg: p < 0.001). RLL were more common (p = 0.004) and severe (p = 0.005) in pegged glenoids (RLL incidence: 77.8%, RLL-score: 2.5) than in MB glenoids (RLL incidence: 30%, RLL-score 0.7) and tended (p = 0.084) to have a higher RLL-score than keeled glenoids (RLL incidence: 63.2%, RLL-score:1.4). Both the osteolysis score (keel vs. peg: p < 0.001, MB vs. peg p < 0.001) and the incidence of osteolysis (keel vs. peg: p = 0.008, MB vs peg: p = 0.003) were significant higher in pegged glenoids (peg: osteolysis score: 3.2, osteolysis incidence: 100%; keel: osteolysis score: 1.0, osteolysis incidence: 63.2%, MB: osteolysis score: 0.9, osteolysis incidence: 60%), while the osteolysis score in axillary images was lowest for MB glenoids (peg: 1.2, keel: 0.9, MB: 0.4; peg vs. MB: p = 0.009, keel vs. MB: p = 0.047). Osteolysis in the central axillary zone was least common in MB glenoids (peg: 50%, keel: 47.4%, MB: 15%; peg vs. MB p = 0.035, keel vs. MB p = 0.041). LGHO was highest in MB glenoids (peg: 54.1, keel: 54.5, MB: 57.8; p < 0.001) but did not increase radiographic loosening (r = 0.007; p = 0.958). Preoperative posterior humeral head subluxation seemed to affect incidence of RLL negatively (pre-op posterior decentered 64.3%, pre-op centered 31.9%; p = 0.201) but did not reach statistical significance. Pegged glenoid components had a concerning rate of RLL and osteolysis. MB glenoid components had a better outcome in axillary radiographs concerning RLL and osteolysis. Increased LGHO did not increase radiographic loosening. Retrospective comperative treatment study Level III.

Magosch P ，Habermeyer P ，Vetter P 《-》

Comparison of long-term clinical and radiological outcomes for cemented keel, cemented peg, and hybrid cage glenoids with anatomical total shoulder arthroplasty using the same humeral component.

The aim of this study was to longitudinally compare the clinical and radiological outcomes of anatomical total shoulder arthroplasty (aTSA) up to long-term follow-up, when using cemented keel, cemented peg, and hybrid cage peg glenoid components and the same humeral system. We retrospectively analyzed a multicentre, international clinical database of a single platform shoulder system to compare the short-, mid-, and long-term clinical outcomes associated with three designs of aTSA glenoid components: 294 cemented keel, 527 cemented peg, and 981 hybrid cage glenoids. Outcomes were evaluated at 4,746 postoperative timepoints for 1,802 primary aTSA, with a mean follow-up of 65 months (24 to 217). Relative to their preoperative condition, each glenoid cohort had significant improvements in clinical outcomes from two years to ten years after surgery. Patients with cage glenoids had significantly better clinical outcomes, with higher patient-reported outcome scores and significantly increased active range of motion, compared with those with keel and peg glenoids. Those with cage glenoids also had significantly fewer complications (keel: 13.3%, peg: 13.1%, cage: 7.4%), revisions (keel: 7.1%, peg 9.7%, cage 3.5%), and aseptic glenoid loosening and failure (keel: 4.7%, peg: 5.8%, cage: 2.5%). Regarding radiological outcomes, 70 patients (11.2%) with cage glenoids had glenoid radiolucent lines (RLLs). The cage glenoid RLL rate was 3.3-times (p < 0.001) less than those with keel glenoids (37.3%) and 4.6-times (p < 0.001) less than those with peg glenoids (51.2%). These findings show that good long-term clinical and radiological outcomes can be achieved with each of the three aTSA designs of glenoid component analyzed in this study. However, there were some differences in clinical and radiological outcomes: generally, cage glenoids performed best, followed by cemented keel glenoids, and finally cemented peg glenoids.

Friedman RJ ，Boettcher ML ，Grey S ，Flurin PH ，Wright TW ，Zuckerman JD ，Eichinger JK ，Roche C ... -  《-》

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 changes around humeral components in shoulder arthroplasty.

Raiss P ，Edwards TB ，Deutsch A ，Shah A ，Bruckner T ，Loew M ，Boileau P ，Walch G ... -  《-》

Cemented polyethylene versus uncemented metal-backed glenoid components in total shoulder arthroplasty: a prospective, double-blind, randomized study.

Boileau P ，Avidor C ，Krishnan SG ，Walch G ，Kempf JF ，Molé D ... -  《JOURNAL OF SHOULDER AND ELBOW SURGERY》