Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Budge MD, Nolan EM, Heisey MH, Baker K, Wiater JM. Results of total shoulder arthroplasty with a monoblock porous tantalum glenoid component: a prospective minimum 2-year follow-up study. J Shoulder Elbow Surg 2013;22:535-41. [PMID: 22959525 DOI: 10.1016/j.jse.2012.06.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 06/03/2012] [Accepted: 06/11/2012] [Indexed: 02/01/2023]

For:	Budge MD, Nolan EM, Heisey MH, Baker K, Wiater JM. Results of total shoulder arthroplasty with a monoblock porous tantalum glenoid component: a prospective minimum 2-year follow-up study. J Shoulder Elbow Surg 2013;22:535-41. [PMID: 22959525 DOI: 10.1016/j.jse.2012.06.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 06/03/2012] [Accepted: 06/11/2012] [Indexed: 02/01/2023]

Number

Cited by Other Article(s)

Dupley L, Briggs S, Trail IA. Future advances in shoulder arthroplasty surgery. J Clin Orthop Trauma 2025;63:102880. [PMID: 39916736 PMCID: PMC11795138 DOI: 10.1016/j.jcot.2024.102880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Accepted: 12/21/2024] [Indexed: 02/09/2025] Open

Barret H, Tiercelin J, Godenèche A, Charousset C, Audebert S, Lefebvre Y, Gallinet D, Barth J, Bonnevialle N. Bony integration of a hybrid glenoid component in anatomical shoulder arthroplasty : short-term CT scan analysis. Bone Joint J 2025;107-B:181-187. [PMID: 39889755 DOI: 10.1302/0301-620x.107b2.bjj-2024-1123.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2025]

Abstract

Aims

Loosening of the glenoid component in the long term remains an important complication of the anatomical total shoulder arthroplasty (aTSA). The aim of this study was to explore the bony integration of a hybrid glenoid component based on an analysis of CT scans.

Methods

In a prospective multicentre study, patients who underwent primary aTSA, whose hybrid design of glenoid component included a fully-polyethylene flanged upper peg and a porous-coated titanium lower peg, and who were reviewed with CT scans between 12 and 24 months postoperatively, were included. Two independent observers reviewed the scans. Bony integration of the upper peg was scored as described by Arnold et al, and integration of the lower peg was scored as described by Gulotta et al. Perforation of the glenoid vault in any plane was also assessed.

Results

From an initial group of 120 aTSAs in 116 patients, 104 CT scans were analyzed in 100 patients (four bilateral shoulders, mean age 66 years (SD 11), 62 female and 38 male). Osteolysis around the upper peg was found in 32 patients (32 aTSAs; 31%). Of the remaining patients, 72 had a mean Arnold score of 5.6 points (SD 0.9), and 70 (67%) had perfect integration. The lower peg had a mean Gulotta score of 6.5 points (SD 1.4). There was perfect integration of the lower peg in 70 patients (70 aTSAs; 67%). A total of nine patients (nine aTSAs; 9%) had no bony integration at either peg. There was perforation of the glenoid in an anterior or posterior direction at the level of the upper peg in three and 28 patients, respectively. This occurred at the level of the lower peg in 11 and 18 patients, respectively. The inter- and intraobserver reliability was good (k = 0.782 and 0.86, respectively). No implant breakage occurred at a mean follow-up of 16 months (12 to 24). The clinical outcome was satisfactory at a mean follow-up of 32 months (24 to 35), as assessed by a visual analogue scale score for pain, the Constant-Murley score, Subjective Shoulder Value, and American Shoulder and Elbow Surgeons score.

Conclusion

Short-term CT scan analysis of a new hybrid anatomical glenoid component found perfect bony integration around the lower porous coated titanium peg in 90% of patients. The upper polyethylene flanged peg had bony integration in 70 patients (70 aTSAs; 67%). Longer follow-up is needed to analyze the rate of survival of this component. The short-term clinical outcome was satisfactory.

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Habermeyer P, Rapaport J, Raiss P, Magosch P. Convertible glenoid replacement in the anatomical total shoulder arthroplasty: medium-term results. Arch Orthop Trauma Surg 2024;144:4365-4374. [PMID: 39361059 DOI: 10.1007/s00402-024-05536-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 09/02/2024] [Indexed: 11/15/2024]

Abstract

INTRODUCTION

The older generation of high thickness metal-backed glenoid prostheses had a high failure rate. The goal of our study was to analyze the medium-term clinical and radiological results of a technically modified generation of metal backed glenoids with 35% decrease in thickness.

METHODS

Thirty-nine patients (43 shoulders) with a mean age of 66.5 years at surgery were examined from two to ten years (mean 71.2 months) using the Constant-Score, Subjective Shoulder Value and X-ray in a.p. and axial view. Indication for surgery included patients with glenoid types B1, B2, or B3 and/or posterior subluxation but intact rotator cuff, or patients who did not want a reverse prosthesis and had high functional demands. Inclusion criteria comprised participation in a clinical and radiological follow-up examination, along with a minimum follow-up duration of 24 months. Additionally, in all cases, the Constant Score and the Subjective Shoulder Value (PROM) had to be determined. Exclusion criteria were an incomplete dataset, implantation of a different prosthesis type, and failure to meet the minimum follow-up time.

RESULTS

The absolute Constant Score (CS) improved significantly (p < 0.0001) from 43 ± 13 (range: 20-69) points before to 80 ± 13 (range: 46-98) points after surgery. The only preoperative negative influencing factor on the result was the glenoid protrusion according to Lévigne (p = 0.0150). No significant differences in functional outcomes were found between glenoid types A2, B1, B2 and B3. Radiolucent lines at the interface were observed in a total of four patients (13%). Radiological signs of glenoid osteolysis were seen in six patients (20%). Humeral upward migration was observed in four patients (13%) and posterior shoulder joint decentering occurred in one patient (3%). Implant-specific complications occurred in three cases (7%). Due to a massive rotator cuff tear, two cases (4.7%) had to be converted to a reversed implant, with the primary metal component remaining in place. If the implant-specific and rotator cuff-associated complications are summarized, the rate is 11.7%. All components that required conversion to an reverse implant have so far remained free of complications.

CONCLUSION

Favorable clinical results can be achieved, especially in patients with an eccentric glenoid type. Severe preoperative glenoid erosion (Walch A2, B2, B3) does not appear to have any influence on postoperative functional results. The complication and revision rates are significantly better than in previous studies with conventional metal-backed glenoid components. Conversion of the anatomical glenoid component to a reverse system was always possible and good clinical results were achieved.

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Twomey-Kozak J, Adu-Kwarteng K, Lunn K, Briggs DV, Hurley E, Anakwenze OA, Klifto CS. Recent Advances in the Design and Application of Shoulder Arthroplasty Implant Systems and Their Impact on Clinical Outcomes: A Comprehensive Review. Orthop Res Rev 2024;16:205-220. [PMID: 39081796 PMCID: PMC11288362 DOI: 10.2147/orr.s312870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024] Open

Chin PYK, Regan W, Plausinis D, Zarzour Z, Leung F, Johnston K, Lim B, Sasyniuk T. A multicenter, randomized controlled trial comparing a second-generation uncemented trabecular metal-backed vs. cemented polyethylene glenoid component in total shoulder arthroplasty: 5-year results. J Shoulder Elbow Surg 2024;33:1004-1016. [PMID: 38286183 DOI: 10.1016/j.jse.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 01/31/2024]

Abstract

BACKGROUND

Previously, we reported early (2-year) findings from a randomized controlled trial comparing a second-generation uncemented trabecular metal-backed (TM) glenoid vs. cemented polyethylene glenoid (POLY) in patients undergoing a total shoulder arthroplasty. The purpose of the current study is to report disease-specific quality of life, clinical, patient-reported, and radiographic outcomes at midterm (5-year) from this trial.

METHODS

Five surgeons from 3 centers participated. Patients 18-79 years with a primary diagnosis of glenohumeral osteoarthritis were screened for eligibility. Randomization to an uncemented TM or cemented POLY glenoid was performed intra-operatively after adequate bone stock was confirmed. Study intervals were baseline, 2- and 5-year postoperative. The primary outcome was the Western Ontario Osteoarthritis Shoulder (WOOS) quality of life score. Secondary outcomes included the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, EuroQol-5 Dimensions, and 12-Item Short Form Health Survey scores and clinical and radiographic examinations. Radiographic images were reviewed for metal debris according to Endrizzi. Mixed effects repeated measures analysis of variance for within- and between-group comparisons were performed.

RESULTS

Of the 104 patients who consented, 93 were randomized (46 TM; 47 POLY). There were no differences between groups at baseline (TM: mean age 66.5 years [standard deviation (SD) 6.4], 24 male and 22 female; and POLY: mean age 68.4 years [SD 5.5], 23 male / 24 female). Mean (SD) WOOS scores at baseline and 2 and 5 years were as follows: TM, 32 (21), 92 (13), and 93 (11); POLY, 27 (15), 93 (11), and 93 (10), respectively. No statistical or clinically relevant differences were noted with patient-reported outcomes between groups. Metal debris was observed in 11 (23.9%) patients, but outcomes were not negatively impacted, and debris severity was minor (grades 1 and 2). Complication rates were similar between groups (TM: 7 of 46 [15.2%], and POLY: 8 of 47 [17.0%]; P = .813). No aseptic glenoid failures were reported, but 1 patient in the TM group required revision because of infection.

CONCLUSIONS

Our short-term (2-year) findings were maintained with longer follow-up. At 5 years postoperation, there were no statistically or clinically significant differences between an uncemented second-generation TM glenoid and a cemented polyethylene glenoid with respect to disease-specific quality of life or patient-reported outcomes. No glenoid implant failures were reported, and complication rates were similar between groups. Only one complication was glenoid related (1 infection in the TM group). Metal debris was observed in 23.9% of patients with a TM glenoid but did not negatively influence implant survival, patient-reported outcomes, or shoulder function.

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Liebhauser M, Hohenberger G, Lohberger B, Hauer G, Deluca A, Sadoghi P. Implant breakage after shoulder arthroplasty: a systematic review of data from worldwide arthroplasty registries and clinical trials. BMC Musculoskelet Disord 2023;24:804. [PMID: 37821859 PMCID: PMC10565962 DOI: 10.1186/s12891-023-06922-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023] Open

Abstract

BACKGROUND

Implant breakage after shoulder arthroplasty is a rare complication after aseptic loosening, infection or persistent pain, resulting in malfunction of the components requiring revision surgery. This correlates with a high burden for the patient and increasing costs. Specific data of complication rates and implant breakage are available in detailed arthroplasty registries, but due to the rare occurrence and possibly underestimated value rarely described in published studies. The aim of this systematic review was to point out the frequency of implant breakage after shoulder arthroplasty. We hypothesized that worldwide arthroplasty registry datasets record higher rates of implant breakage than clinical trials.

METHODS

PubMed, MEDLINE, EMBASE, CINHAL, and the Cochrane Central Register of Controlled Trials database were utilized for this systematic review using the items "(implant fracture/complication/breakage) OR (glenoid/baseplate complication/breakage) AND (shoulder arthroplasty)" according to the PRISMA guidelines on July 3rd, 2023. Study selection, quality assessment, and data extraction were conducted according to the Cochrane standards. Case reports and experimental studies were excluded to reduce bias. The breakage rate per 100,000 observed component years was used to compare data from national arthroplasty registries and clinical trials, published in peer-reviewed journals. Relevant types of shoulder prosthetics were analyzed and differences in implant breakage were considered.

RESULTS

Data of 5 registries and 15 studies were included. Rates of implant breakage after shoulder arthroplasty were reported with 0.06-0.86% in registries versus 0.01-6.65% in clinical studies. The breakage rate per 100,000 observed component years was 10 in clinical studies and 9 in registries. There was a revision rate of 0.09% for registry data and 0.1% for clinical studies within a 10-year period. The most frequently affected component in connection with implant fracture was the glenoid insert.

CONCLUSION

Clinical studies revealed a similar incidence of implant failure compared to data of worldwide arthroplasty registries. These complications arise mainly due to breakage of screws and glenospheres and there seems to be a direct correlation to loosening. Periprosthetic joint infection might be associated with loosening of the prosthesis and subsequent material breakage. We believe that this analysis can help physicians to advise patients on potential risks after shoulder arthroplasty.

LEVEL OF EVIDENCE

III.

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Italia K, Jomaa M, Pareyon R, Hollman F, Cutbush K, Gupta A. Outcomes and survivorship of anatomic total shoulder arthroplasty: current concepts. J ISAKOS 2023;8:284-288. [PMID: 37100117 DOI: 10.1016/j.jisako.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/28/2023]

Kim MS, Ahn YS, Lee SH, Jeong HJ, Kim YK, Oh JH. Can convertible metal-backed glenoid components replace cemented polyethylene glenoid components in anatomical total shoulder arthroplasty? BMC Surg 2023;23:193. [PMID: 37407984 DOI: 10.1186/s12893-023-02092-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 06/25/2023] [Indexed: 07/07/2023] Open

Abstract

BACKGROUND

Anatomical total shoulder arthroplasty (aTSA) has been used to manage degenerative diseases such as primary osteoarthritis. An increase in the use of this procedure has led to several developments in humeral and glenoid components to improve patient outcomes. This study aimed to compare clinical and radiological outcomes of the newly-introduced convertible metal-backed glenoid components with cemented polyethylene glenoid components in aTSA, and to determine whether the new component would be comparable to a conventional one for reducing the burden of future revision or conversion surgeries.

METHODS

Medical records of fifty patients who underwent aTSA with at least two years of follow-up were retrospectively reviewed. Eighteen patients received convertible metal-backed glenoid components with vitamin E1-coated liner (MB group), while thirty-two patients received conventional cemented polyethylene glenoid components (PE group). Pre- and postoperative clinical and radiological outcomes (acromion-greater tuberosity angle [AGA] and humeral lateral offset [LO]) at final follow-up were assessed. Radiolucent lines (RLLs) and loosening around the humeral and glenoid components were also evaluated.

RESULTS

Clinical outcomes improved after surgery in both groups (all p < 0.001). The arc of rotation measured by AGA improved postoperatively in both groups (all p < 0.001), and AGA and LO were not different according to the type of glenoid components (all p > 0.05). Overall complication rates including RLLs of PE and MB groups were 43.8% (14/32) and 16.7% (3/18), respectively (p = 0.031). Although the PE group had more RLLs than did the MB group (p < 0.05), related symptoms and/or glenoid implant loosening were not observed in both groups. Subscapularis failure occurred in two patients in the PE group and in one in the MB group.

CONCLUSION

The convertible metal-backed glenoid implant with vitamin E1-coated liner may be a good alternative for considering the potential for an easier conversion to reverse total shoulder arthroplasty.

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Friedman RJ, Boettcher ML, Grey S, Flurin PH, Wright TW, Zuckerman JD, Eichinger JK, Roche C. 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. Bone Joint J 2023;105-B:668-678. [PMID: 37259565 DOI: 10.1302/0301-620x.105b6.bjj-2022-1033.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]

Abstract

Aims

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.

Methods

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).

Results

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%).

Conclusion

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.

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Clinical and radiographic outcomes following anatomic total shoulder arthroplasty utilizing an inset glenoid component at 2-year minimum follow-up: a dual center study. J Shoulder Elbow Surg 2022;32:1222-1230. [PMID: 36584872 DOI: 10.1016/j.jse.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 12/29/2022]

Abstract

BACKGROUND

Anatomic total shoulder arthroplasty (aTSA) is a successful and reproducible treatment for patients with painful glenohumeral arthritis. However, long-term outcomes using traditional onlay glenoid components have been tempered by glenoid loosening. Inset components have been proposed to minimize glenoid loosening by reducing edge-loading and opposite-edge lift-off forces with humeral translation. Successful short- and long-term outcomes have been reported while using inset glenoid implants. The current study is the largest study presenting a minimum of 2-year follow-up data following aTSA with an all-polyethylene inset glenoid component (Shoulder Innovations, Holland, MI, USA).

METHODS

A dual center, retrospective review of patients undergoing aTSA using an Inset glenoid component by 2 fellowship-trained shoulder surgeons at 2 separate institutions from August, 2016, to August, 2019, was performed. Minimum follow-up was 2 years. Range of motion (ROM), visual analog scale (VAS) pain scores, Single Assessment Numeric Evaluation (SANE), and American Shoulder and Elbow Surgeons (ASES) scores were obtained. Radiographic outcomes, including central peg lucency and glenoid loosening, were assessed by 3 independent reviewers on the postoperative Grashey and axillary radiographs obtained at the final follow-up.

RESULTS

Seventy-five shoulders were included for the final analysis. The mean age of the entire cohort was 64 (±11.4) years. Twenty-one (28%) glenoids were type A1, 10 (13.3%) were type A2, 13 (17.3%) were type B1, 22 (29.3%) were type B2, 6 (8%) were type B3, and 3 (4%) were type D. At a minimum follow-up of 24 months (mean: 28.7 months), a significant improvement in ROM in all planes was observed. Significant improvements in VAS (5.1-0.9, P < .001), SANE (39.5-91.2, P < .001), and ASES (43.7-86.6, P < .001) scores were observed. There were 4 (5.3%) cases of central peg lucency about the inset glenoid component and one (1.3%) case of glenoid loosening. No revisions were performed for glenoid loosening.

CONCLUSION

At a minimum of 2 years postoperatively, there were significant improvements in ROM, VAS, SANE, and ASES scores with very low rates of central peg lucency and glenoid loosening in patients undergoing aTSA with an inset glenoid component. Further work is needed to determine the long-term benefit of this novel implant.

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Liu C, Shi L, Amirouche F. Glenoid Prosthesis Design Considerations in Anatomic Total Shoulder Arthroplasty. J Shoulder Elb Arthroplast 2022;6:24715492221142856. [PMCID: PMC9742691 DOI: 10.1177/24715492221142856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/16/2022] [Indexed: 12/13/2022] Open

Marigi EM, Lenartowicz KA, Jennewine B, Throckmorton TW, Sperling JW. Clinical and radiographic outcomes of hybrid glenoid fixation with a central porous titanium post: analysis of 713 consecutive shoulders. J Shoulder Elbow Surg 2022;31:1524-1532. [PMID: 35093521 DOI: 10.1016/j.jse.2021.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/13/2021] [Accepted: 12/19/2021] [Indexed: 02/01/2023]

Abstract

BACKGROUND

Hybrid glenoid component fixation represents an emerging technology in total shoulder arthroplasty (TSA) design. However, there is a paucity of larger-scale studies reporting the outcomes following implantation of these components. This study aimed to determine the outcomes following primary TSA using hybrid glenoid component fixation with a central porous titanium post.

METHODS

A retrospective review of 2 institutional databases identified patients aged ≥ 18 years who underwent primary elective hybrid TSA between 2009 and 2018 with a minimum of 2 years of follow-up. Outcomes evaluated included the visual analog scale pain score, range of motion, American Shoulder and Elbow Surgeons (ASES) score, complications, and implant survivorship free from reoperation or revision. Postoperative imaging was assessed for glenoid radiolucent lines and evidence of aseptic glenoid component loosening (AGL).

RESULTS

A total of 713 shoulders in 666 patients with a mean age of 61 ± 6 years were included in the study at a mean follow-up period of 4.3 years (range, 2.0-9.1 years); male shoulders comprised 50.9% of shoulders. Notable clinical improvements were observed with respect to the visual analog scale pain score (7.0 to 1.4, P < .001), active forward elevation (91° to 155°, P < .001), active external rotation (21° to 50°, P < .001), and the ASES score (38.6 to 82.7, P < .001), with all exceeding the substantial clinical benefit threshold for TSA. The active internal rotation score also showed significant improvement (3.1 to 5.7, P < .001). Glenoid radiolucent lines were identified in 57 TSAs (8.2%), with 1 radiographically loose glenoid component (0.1%). There were 54 complications (7.6%), with postoperative rotator cuff tear as the most common complication (n = 15, 2.1%); only 4 cases (0.6%) of glenoid-related complications (AGL) were observed. The Kaplan-Meier rate of survival free from revision surgery was 98.7% at 1 year, 98.5% at 2 years, and 96.7% at 5 years.

CONCLUSIONS

Hybrid glenoid component fixation of anatomic TSA with a central porous titanium post demonstrated statistically significant and clinically meaningful improvements in pain, range of motion, and ASES scores. Although AGL remains a concern, only 0.6% of TSAs sustained glenoid-related complications at a mean follow-up period of 4.3 years and the rate of survivorship free from revision was 96.7% at 5 years. These favorable clinical findings support the theoretical advantages of hybrid glenoid fixation; however, large comparative investigations with long-term follow-up are needed to validate these results.

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Bola M, Simões J, Ramos A. Finite element analysis to predict short and medium-term performance of the anatomical Comprehensive® Total Shoulder System. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022;219:106751. [PMID: 35306286 DOI: 10.1016/j.cmpb.2022.106751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 06/14/2023]

Murphy J, Todd E, Wright MA, Murthi AM. Evaluation of clinical and radiographic outcomes after total shoulder arthroplasty with inset Trabecular Metal-backed glenoid. J Shoulder Elbow Surg 2022;31:971-977. [PMID: 34774775 DOI: 10.1016/j.jse.2021.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/01/2021] [Accepted: 10/11/2021] [Indexed: 02/01/2023]

Abstract

BACKGROUND

Trabecular Metal (TM)-backed glenoid implants were introduced for their theoretical ability to increase osseointegration while minimizing wear and the risk of loosening in total shoulder arthroplasty (TSA). Initial follow-up studies of TM-backed glenoids demonstrated high rates of metallic debris formation around the implant site, raising concerns about longevity. More recent data suggest that metallic debris formation may be less prevalent than previously reported and that the implants may have positive long-term outcomes regardless of debris. The goal of our study was to assess the clinical and radiographic outcomes at mid-term follow-up of TSA using a TM-backed glenoid implant placed with full backside support using an inset technique. We hypothesized that our clinical and radiographic outcomes would be good using this technique.

METHODS

We retrospectively reviewed the charts of 39 patients who underwent 41 TSA procedures with a Zimmer Biomet TM-backed glenoid component performed by a single surgeon between January 2010 and March 2016. After exclusions for death unrelated to surgery and loss to follow-up, 35 patients (37 shoulders) with minimum 2-year clinical follow-up were included in the study. The glenoids were all placed in an inset fashion with full backside support. Clinical, patient-reported, and radiographic outcomes were analyzed.

RESULTS

The average follow-up period was 7.2 years (range, 2-11 years). At final follow-up, average shoulder elevation was 153° ± 22° and average external rotation was 53° ± 12°. The average American Shoulder and Elbow Surgeons score was 86.8 ± 19.0, and the average visual analog scale score was 1.3 ± 2.4. Metallic debris was found in 9 shoulders (27%), and radiolucency was observed around the glenoid components in 13 shoulders (39%) on the final postoperative radiographs. Metallic debris and radiolucency findings were low in severity, with average grades of 0.32 (standard deviation, 0.54) and 0.39 (standard deviation, 0.50), respectively. There were no reoperations.

CONCLUSION

This study of 37 shoulders undergoing TSA with a TM-backed glenoid demonstrated 100% implant survivorship at an average follow-up of 7 years. Clinical outcomes were excellent despite the occurrence of some metallic debris formation. The findings suggest that a TM-backed glenoid component implanted in an inset fashion to achieve full backside support can provide good clinical and patient-reported outcomes in TSA patients at mid-term follow-up and suggest that continued consideration of the role of TM-backed glenoids and the optimal technique for implantation may be warranted.

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Haleem A, Sedrak P, Gohal C, Athwal GS, Khan M, Alolabi B. Hybrid Glenoid Designs in Anatomic Total Shoulder Arthroplasty: A Systematic Review. HSS J 2022;18:219-228. [PMID: 35645649 PMCID: PMC9096999 DOI: 10.1177/15563316211040829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]

Chin PYK, Regan WD, Plausinis D, Zarzour ZD, Leung F, Sasyniuk TM, Lim B, Sayre EC. Two-year results of a multi-centre, randomized controlled trial comparing a second-generation uncemented trabecular metal-backed versus cemented polyethylene glenoid component in total shoulder arthroplasty. Bone Jt Open 2021;2:728-736. [PMID: 34488426 PMCID: PMC8479846 DOI: 10.1302/2633-1462.29.bjo-2021-0073.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open

Abstract

Aims

To report early (two-year) postoperative findings from a randomized controlled trial (RCT) investigating disease-specific quality of life (QOL), clinical, patient-reported, and radiological outcomes in patients undergoing a total shoulder arthroplasty (TSA) with a second-generation uncemented trabecular metal (TM) glenoid versus a cemented polyethylene glenoid (POLY) component.

Methods

Five fellowship-trained surgeons from three centres participated. Patients aged between 18 and 79 years with a primary diagnosis of glenohumeral osteoarthritis were screened for eligibility. Patients were randomized intraoperatively to either a TM or POLY glenoid component. Study intervals were: baseline, six weeks, six-, 12-, and 24 months postoperatively. The primary outcome was the Western Ontario Osteoarthritis Shoulder QOL score. Radiological images were reviewed for metal debris. Mixed effects repeated measures analysis of variance for within and between group comparisons were performed.

Results

A total of 93 patients were randomized (46 TM; 47 POLY). No significant or clinically important differences were found with patient-reported outcomes at 24-month follow-up. Regarding the glenoid components, there were no complications or revision surgeries in either group. Grade 1 metal debris was observed in three (6.5%) patients with TM glenoids at 24 months but outcomes were not negatively impacted.

Conclusion

Early results from this RCT showed no differences in disease-specific QOL, radiographs, complication rates, or shoulder function between uncemented second-generation TM and cemented POLY glenoids at 24 months postoperatively. Revision surgeries and reoperations were reported in both groups, but none attributed to glenoid implant failure. At 24 months postoperatively, Grade 1 metal debris was found in 6.5% of patients with a TM glenoid but did not negatively influence patient-reported outcomes. Longer-term follow-up is needed and is underway.

Cite this article: Bone Jt Open 2021;2(9):728–736.

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Chen RE, Brown AM, Greenstein AS, Mannava S, Voloshin I. Radiographic and clinical outcomes of second generation Trabecular Metal™ glenoid components in total shoulder arthroplasty. Shoulder Elbow 2021;13:416-425. [PMID: 34394739 PMCID: PMC8355655 DOI: 10.1177/1758573220909981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/28/2020] [Accepted: 02/10/2020] [Indexed: 01/21/2023]

Huang G, Pan ST, Qiu JX. The Clinical Application of Porous Tantalum and Its New Development for Bone Tissue Engineering. MATERIALS (BASEL, SWITZERLAND) 2021;14:2647. [PMID: 34070153 PMCID: PMC8158527 DOI: 10.3390/ma14102647] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022]

Chen RE, Brown AM, Greenstein AS, Miller RJ, Mannava S, Voloshin I. Cemented versus uncemented fixation of second-generation Trabecular Metal glenoid components: minimum 5-year outcomes. J Shoulder Elbow Surg 2021;30:e147-e156. [PMID: 32750528 DOI: 10.1016/j.jse.2020.07.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/09/2020] [Accepted: 07/19/2020] [Indexed: 02/01/2023]

Abstract

BACKGROUND

Total shoulder arthroplasty (TSA) with second-generation Trabecular Metal™ implants (Zimmer, Warsaw, IN, USA) has shown good short-term outcomes. Differences in outcomes between cemented and uncemented fixation are unknown. This study compared the clinical, radiographic, and patient-rated outcomes of TSA with cemented vs. uncemented TM glenoids at minimum 5-year follow-up.

METHODS

Patients who underwent anatomic TSA with second-generation TM glenoid components for primary osteoarthritis were identified for minimum 5-year follow-up. The patients were divided into 2 groups: cemented and uncemented glenoid fixation. Outcome measures included implant survival, patient-rated outcome scores (Patient-Reported Outcomes Measurement Information System [PROMIS] and American Shoulder and Elbow Surgeons scores), shoulder range of motion, and radiographic analysis. Findings were compared between groups.

RESULTS

The study included 55 shoulders: 27 in the cemented group (21 with full radiographic follow-up) and 28 in the uncemented group (22 with full radiographic follow-up). Both groups had similar follow-up times (6.6 years in cemented group vs. 6.7 years in uncemented group, P = .60). Moreover, the groups did not differ significantly in sex composition, age at the time of surgery, or preoperative Walch glenoid grade distribution. No patients required revision surgery. The 2 groups had similar preoperative range of motion, but patients in the uncemented group had greater follow-up forward flexion (P = .03), external rotation (P < .01), and lateral elevation (P = .03) than did patients in the cemented group. PROMIS scores were not significantly different between groups. American Shoulder and Elbow Surgeons scores were similar (89.8 in cemented group vs. 94.1 in uncemented group, P = .21). Mid-term radiographs showed a metal debris rate of 24% in the cemented group and 27% in the uncemented group. Although these values were not significantly different (P = .90), the frequency of mild metal debris (grade 1-2), when present, was greater in the uncemented group (grade 2 in 6 shoulders) than in the cemented group (grade 1 in 4 and grade 2 in 1, P = .02). There was a greater presence of mild (grade 1) radiolucent lines in the uncemented group (64%) than in the cemented group (29%, P < .01). No glenoid had evidence of loosening (defined by a change in position or radiolucent lines > 2 mm). The presence of metal debris and radiolucent lines did not have a significant effect on clinical outcomes.

CONCLUSION

At minimum 5-year follow-up, TSA patients with TM glenoids demonstrated excellent clinical and patient-reported outcomes with a 100% implant survival rate, regardless of cemented vs. uncemented fixation. However, the uncemented group showed a significantly higher rate of radiolucent lines and a higher frequency of mild metal debris. These radiographic findings did not affect the clinical outcomes, and their implications for long-term outcomes and prosthesis survival is unknown.

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Malahias MA, Chytas D, Kostretzis L, Trellopoulos A, Brilakis E, Antonogiannakis E. Modern trabecular metal-backed glenoid components in total shoulder arthroplasty: What is the evidence? A systematic review. Shoulder Elbow 2021;13:29-37. [PMID: 33717216 PMCID: PMC7905522 DOI: 10.1177/1758573220914277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 02/28/2020] [Accepted: 02/29/2020] [Indexed: 11/17/2022]

Trivedi NN, Shimberg JL, Sivasundaram L, Mengers S, Salata MJ, Voos JE, Gillespie RJ. Advances in Glenoid Design in Anatomic Total Shoulder Arthroplasty. J Bone Joint Surg Am 2020;102:1825-1835. [PMID: 33086353 DOI: 10.2106/jbjs.19.01294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]

Kim DM, Alabdullatif F, Aldeghaither M, Shin MJ, Kim H, Park D, Kholinne E, Jeon IH, Koh KH. Do Modern Designs of Metal-Backed Glenoid Components Show Improved Clinical Results in Total Shoulder Arthroplasty? A Systematic Review of the Literature. Orthop J Sports Med 2020;8:2325967120950307. [PMID: 33062762 PMCID: PMC7536381 DOI: 10.1177/2325967120950307] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/10/2020] [Indexed: 11/16/2022] Open

Abstract

Background:

Despite the increased popularity of reverse total shoulder arthroplasty, total shoulder arthroplasty is the standard treatment for advanced shoulder arthritis in young adult patients. Conventional metal-backed glenoid (MBG) designs result in more loosening and revision surgery compared with cemented polyethylene glenoid components. However, modern MBG designs have been recently devised to overcome such drawbacks.

Purpose:

To compare the radiolucency, loosening, and failure rates of modern MBG designs with those of conventional designs.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A search for relevant articles was carried out using the PubMed, Cochrane Library, and Embase databases using MeSH (Medical Subject Headings) terms and natural keywords. A total of 362 articles were screened. We descriptively analyzed numerical data between the groups and statistically analyzed categorical data, such as the presence of loosening, failure, and revision surgery. The main outcome was the rate of revision surgery or failure. Subgroup analysis according to follow-up duration was performed to reduce heterogeneity.

Results:

A total of 25 articles (2036 shoulders) were included; 15 articles (1579 shoulders) involved a conventional MBG design, and 10 (457 shoulders) involved a modern design. The mean age of the patients was 64.2 and 66.5 years in the conventional and modern design groups, respectively, with a mean follow-up duration of 102.0 and 56.1 months, a mean gain of forward elevation of 35.1° and 61.7°, and a mean gain of external rotation of 24.2° and 39.2°. The rate of radiolucency was 48.0% and 16.7%, the rate of loosening was 11.2% and 4.9%, and the rate of revision was 15.9% and 2.4%, for the conventional and modern design groups, respectively. Subgroup analysis according to follow-up duration showed that the rates of loosening and revision were significantly lower in the modern design group (P < .001).

Conclusion:

Our findings suggest that modern MBG designs showed significantly lower loosening and failure rates than conventional designs. The overall results of the comparison, including loosening, failure, change in range of motion, and clinical scores, indicate that modern MBG designs are promising. More long-term follow-up studies on modern MBGs should be conducted.

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Dillon MT, Chan PH, Prentice HA, Burfeind WE, Yian EH, Singh A, Paxton EW, Navarro RA. The association between glenoid component design and revision risk in anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2020;29:2089-2096. [PMID: 32507730 DOI: 10.1016/j.jse.2020.02.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/10/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023]

Abstract

INTRODUCTION

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

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Malahias MA, Kostretzis L, Gkiatas I, Chronopoulos E, Brilakis E, Antonogiannakis E. Total shoulder arthroplasty with hybrid fixation of glenoid components consisting of cementless porous metal pegs or cage along with cemented backside polyethylene surface: a systematic review. Musculoskelet Surg 2020;104:229-236. [PMID: 32529404 DOI: 10.1007/s12306-020-00670-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/04/2020] [Indexed: 11/26/2022]

Schoch BS, Zarezadeh A, Priddy M, King JJ, Wright TW. Uncemented fixation of a monoblock ingrowth polyethylene glenoid: early follow-up. J Shoulder Elbow Surg 2020;29:968-975. [PMID: 31812586 DOI: 10.1016/j.jse.2019.09.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/03/2019] [Accepted: 09/12/2019] [Indexed: 02/01/2023]

Kim DM, Aldeghaither M, Alabdullatif F, Shin MJ, Kholinne E, Kim H, Jeon IH, Koh KH. Loosening and revision rates after total shoulder arthroplasty: a systematic review of cemented all-polyethylene glenoid and three modern designs of metal-backed glenoid. BMC Musculoskelet Disord 2020;21:114. [PMID: 32085766 PMCID: PMC7035638 DOI: 10.1186/s12891-020-3135-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/12/2020] [Indexed: 11/10/2022] Open

Abstract

BACKGROUND

Several modern designs of metal-backed glenoids (MBG) have been devised to overcome flaws such as loosening and a high failure rate. This review aimed to compare rates of complications and revision surgeries between cemented polyethylene glenoid (PEG) and three examples of modern MBG designs.

METHODS

Literature search was carried out using PubMed, Cochrane Library, EMBASE, and Google Scholar using MeSH terms and natural keywords. A total of 1186 articles were screened. We descriptively analyzed numerical data between the groups and statistically analyzed the categorical data, such as the presence of radiolucent line, loosening, and revision surgery (failure). Articles were divided into three groups based on follow-up duration: < 36-month, 36-72-month, and > 72-month subgroups.

RESULTS

This study included 35 articles (3769 shoulders); 25 on cemented PEG and ten on the modern MBG. Mean age was 66.4 (21-93) and 66.5 years (31-88). The mean duration of follow-up was 73.1 (12-211) and 56.1 months (24-100). Overall, the rate of the radiolucent line was 354/1302 (27%) and 47/282 (17%), the loosening rate was 465/3185 (15%) and 22/449 (5%), and the failure rate was 189/3316 (6%) and 11/457 (2%), for PEG and MBG, respectively. The results of < 36-month and 36-72-month subgroups showed lower rates of radiolucency and loosening in the cemented PEG group, but there was no significant difference in failure rate (P = 0.754 and 0.829, respectively). In the > 72-month subgroup, MBG was better in terms of loosening (P < 0.001) and failure rates (P = 0.006).

CONCLUSIONS

The modern MBG component, especially TM glenoid, seems to be a promising alternative to cemented PEGs, based on subgroup revision rates according to the follow-up duration and overall results of ROM and clinical scores. All polyethylene glenoids tend to increase loosening and failure over time. Three modern MBG designs seem to have no difference in failure, at least in the < 36-month and 36-72-month subgroups compared to the cemented PEG. More long-term follow-up studies on modern MBG should be ultimately conducted.

LEVEL OF EVIDENCE

Level IV, systematic review.

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Friedman RJ, Cheung E, Grey SG, Flurin PH, Wright TW, Zuckerman JD, Roche CP. Clinical and radiographic comparison of a hybrid cage glenoid to a cemented polyethylene glenoid in anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2019;28:2308-2316. [PMID: 31324502 DOI: 10.1016/j.jse.2019.04.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/16/2019] [Accepted: 04/24/2019] [Indexed: 02/01/2023]

Welsher A, Gohal C, Madden K, Miller B, Bedi A, Alolabi B, Khan M. A comparison of pegged vs. keeled glenoid components regarding functional and radiographic outcomes in anatomic total shoulder arthroplasty: a systematic review and meta-analysis. JSES OPEN ACCESS 2019;3:136-144.e1. [PMID: 31709353 PMCID: PMC6835032 DOI: 10.1016/j.jses.2019.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]

Nelson CG, Brolin TJ, Ford MC, Smith RA, Azar FM, Throckmorton TW. Five-year minimum clinical and radiographic outcomes of total shoulder arthroplasty using a hybrid glenoid component with a central porous titanium post. J Shoulder Elbow Surg 2018. [PMID: 29526600 DOI: 10.1016/j.jse.2018.01.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]

Watson ST, Gudger GK, Long CD, Tokish JM, Tolan SJ. Outcomes of Trabecular Metal-backed glenoid components in anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2018;27:493-498. [PMID: 29433646 DOI: 10.1016/j.jse.2017.09.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/22/2017] [Accepted: 09/30/2017] [Indexed: 02/01/2023]

Geraldes DM, Hansen U, Jeffers J, Amis AA. Stability of small pegs for cementless implant fixation. J Orthop Res 2017;35:2765-2772. [PMID: 28387966 PMCID: PMC5763372 DOI: 10.1002/jor.23572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 04/03/2017] [Indexed: 02/04/2023]

von Engelhardt LV, Manzke M, Breil-Wirth A, Filler TJ, Jerosch J. Restoration of the joint geometry and outcome after stemless TESS shoulder arthroplasty. World J Orthop 2017;8:790-797. [PMID: 29094010 PMCID: PMC5656495 DOI: 10.5312/wjo.v8.i10.790] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/14/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open

McLendon PB, Schoch BS, Sperling JW, Sánchez-Sotelo J, Schleck CD, Cofield RH. Survival of the pegged glenoid component in shoulder arthroplasty: part II. J Shoulder Elbow Surg 2017;26:1469-1476. [PMID: 28161240 DOI: 10.1016/j.jse.2016.12.068] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/12/2016] [Accepted: 12/26/2016] [Indexed: 02/01/2023]

Abstract

BACKGROUND

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.

MATERIALS AND METHODS

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).

RESULTS

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.

CONCLUSION

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.

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Two-year Clinical and Radiographic Outcomes of Total Shoulder Arthroplasty Using a Hybrid Glenoid Component With a Central Porous Titanium Post. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2017. [DOI: 10.1097/bte.0000000000000094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]

Survivorship of Trabecular Metal Anchored Glenoid Total Shoulder Arthroplasties. Tech Hand Up Extrem Surg 2017;20:113-6. [PMID: 27328424 DOI: 10.1097/bth.0000000000000127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]

Geraldes DM, Hansen U, Amis AA. Parametric analysis of glenoid implant design and fixation type. J Orthop Res 2017;35:775-784. [PMID: 27219615 DOI: 10.1002/jor.23309] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 05/06/2016] [Indexed: 02/04/2023]

Abstract

Common post-operative problems in shoulder arthroplasty such as glenoid loosening and joint instability may be reduced by improvements in glenoid design, shape, material choice, and fixation method. A framework for parametric analysis of different implant fixation configurations was developed in order to efficiently sift through potential glenoid component designs. We investigated the influence of design factors such as fixation type, component thickness, and peg position, number, diameter, and length in a multi-factorial design investigation. The proposed method allowed for simultaneous comparison of the mechanical performance of 344 different parametric variations of 10 different reference geometries with either large central fixation features or small peripheral pegs, undergoing four different worst-case scenario loading conditions, and averaging 64.7 s per model. The impact of design parameters were assessed for different factors responsible for post-operative problems in shoulder arthroplasty, such as bone volume preservation, stresses in the implant, central displacement or fixation stability, and the worst performing geometries all relied on conventional central fixation. Of the remaining geometries, four peripheral fixation configurations produced von Mises stresses comfortably below the material's yield strength. We show that the developed method allows for simple, direct, rapid, and repeatable comparison of different design features, material choices, or fixation methods by analyzing how they influence the bone-implant mechanical environment. The proposed method can provide valuable insight in implant design optimization by screening through multiple potential design modifications at an early design evaluation stage and highlighting the best performing combinations according to the failure mechanism to mitigate. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:775-784, 2017.

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Bohsali KI, Bois AJ, Wirth MA. Complications of Shoulder Arthroplasty. J Bone Joint Surg Am 2017;99:256-269. [PMID: 28145957 DOI: 10.2106/jbjs.16.00935] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]

Clinical and radiologic outcomes of the second-generation Trabecular Metal™ glenoid for total shoulder replacements after 2-6 years follow-up. Arch Orthop Trauma Surg 2016;136:1637-1645. [PMID: 27566616 DOI: 10.1007/s00402-016-2562-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Indexed: 10/21/2022]

Endrizzi DP, Mackenzie JA, Henry PDG. Early Debris Formation with a Porous Tantalum Glenoid Component: Radiographic Analysis with 2-Year Minimum Follow-up. J Bone Joint Surg Am 2016;98:1023-9. [PMID: 27307363 DOI: 10.2106/jbjs.15.00410] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]

Abstract

BACKGROUND

Porous tantalum has been used effectively in hip, knee, and reverse shoulder arthroplasty implants. However, a first-generation porous tantalum glenoid component for use in anatomic shoulder arthroplasty previously demonstrated failure, with failure usually preceded by the appearance of intra-articular metallic debris. After redesign, the component was reintroduced in 2009. The purpose of the current study was to evaluate the radiographic and clinical outcomes of the redesigned glenoid component.

METHODS

Sixty-eight patients undergoing total shoulder arthroplasty received a Trabecular Metal porous tantalum glenoid component (73 components; 5 patients underwent staged bilateral procedures). No polymethylmethacrylate cement was used (off-label usage in the U.S.). A grading system to assess metallic debris formation was developed using radiographs of the previous generation of porous tantalum glenoid components that failed. Radiographs from the current series were independently reviewed by 2 shoulder arthroplasty specialists, and their results were compared. Glenoid components were evaluated for signs of bone ingrowth and metallic debris formation.

RESULTS

Sixty-six (90%) of the 73 components were evaluated at a minimum of 2 years of follow-up (mean radiographic follow-up of 50.8 months; range, 24 to 68 months). Of these, 92.4% demonstrated minimal or no glenoid radiolucency. Overall, the prevalence of metallic tantalum debris formation was 44% (29 of 66). Sequential radiograph review demonstrated that the incidence of metallic debris formation increased for each year of follow-up, with radiographs from 2, 3, 4, and ≥5 years of follow-up demonstrating a metallic debris incidence of 23%, 36%, 49%, and 52%, respectively. Additionally, the severity of metallic debris formation increased with follow-up duration. There was no component dissociation or revision due to implant breakage in this series.

CONCLUSIONS

The porous tantalum glenoid component studied had excellent short-term component fixation. However, the development of metallic debris, increasing in both overall incidence and degree of severity over time, raises concern for potential failure of this glenoid component. Longer follow-up is required.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Wei X, Zhao D, Wang B, Wang W, Kang K, Xie H, Liu B, Zhang X, Zhang J, Yang Z. Tantalum coating of porous carbon scaffold supplemented with autologous bone marrow stromal stem cells for bone regeneration in vitro and in vivo. Exp Biol Med (Maywood) 2016;241:592-602. [PMID: 26843518 DOI: 10.1177/1535370216629578] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/04/2016] [Indexed: 01/23/2023] Open

Vuillermin CB, Trump ME, Barwood SA, Hoy GA. Catastrophic failure of a low profile metal-backed glenoid component after total shoulder arthroplasty. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2015;9:121-7. [PMID: 26622128 PMCID: PMC4640001 DOI: 10.4103/0973-6042.167952] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]

Metal-backed glenoid implant with polyethylene insert is not a viable long-term therapeutic option. J Shoulder Elbow Surg 2015;24:1534-43. [PMID: 26227769 DOI: 10.1016/j.jse.2015.02.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/07/2015] [Accepted: 02/16/2015] [Indexed: 02/01/2023]

Abstract

BACKGROUND

The aims of this study were to determine the survival of anatomic total shoulder arthroplasty with uncemented metal-backed (MB) glenoid components with a polyethylene (PE) insert in primary osteoarthritis, to assess the reasons for revision surgery, and to identify patients and diagnostic factors that influence failure rates.

METHODS

Between 1994 and 1999, 165 patients (mean age, 68 years) with primary osteoarthritis were treated with anatomic total shoulder arthroplasty using an uncemented MB/PE glenoid component. Outcomes were assessed both clinically and radiologically with a minimum of 2 years of follow-up. A prosthetic survival curve was constructed with the end point defined as either partial or complete revision, using 100% confidence intervals.

RESULTS

Survival rate free of revision was 46% (100% confidence interval, 32%-54%) at 12 years. At a mean follow-up of 8.5 years (range, 2-16 years), revision was required in 61 patients (37%); 80% of shoulders undergoing revision (49 of 61) had evidence of PE wear. Glenoid loosening (because of osteolysis secondary to wear debris), soft tissue deficiency, and prosthetic instability were the most common modes of failure. Younger patients and biconcave glenoids (with posterior humeral subluxation) have a negative effect on implant survival. Proximal humerus osteolysis was significantly more frequent in shoulders with PE wear. Exchange of the PE insert (with conservation of the MB tray) was possible in only 3% of the revised shoulders.

CONCLUSION

Uncemented MB glenoid resurfacing is not a viable long-term therapeutic option because of accelerated PE wear leading to early revision surgery. Conservation of the MB tray with reinsertion of a new PE insert is rarely possible because of glenoid bone loss, implant loosening, soft tissue deficiency, and prosthetic instability. Younger patients and biconcave glenoids have a negative effect on implant survival.

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Five- to ten-year follow-up with a partially cemented all-polyethylene bone-ingrowth glenoid component. J Shoulder Elbow Surg 2015;24:1458-62. [PMID: 25842027 DOI: 10.1016/j.jse.2015.02.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/12/2015] [Accepted: 02/16/2015] [Indexed: 02/01/2023]

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Posterior augmented glenoid designs preserve more bone in biconcave glenoids. J Shoulder Elbow Surg 2015;24:1135-41. [PMID: 25618465 DOI: 10.1016/j.jse.2014.12.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 11/17/2014] [Accepted: 12/06/2014] [Indexed: 02/01/2023]

The glenoid component in anatomic shoulder arthroplasty. J Am Acad Orthop Surg 2015;23:317-26. [PMID: 25829449 DOI: 10.5435/jaaos-d-13-00208] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open

Eichinger JK, Galvin JW. Management of complications after total shoulder arthroplasty. Curr Rev Musculoskelet Med 2015;8:83-91. [PMID: 25672497 PMCID: PMC4596192 DOI: 10.1007/s12178-014-9251-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]

Papadonikolakis A, Matsen FA. Metal-Backed Glenoid Components Have a Higher Rate of Failure and Fail by Different Modes in Comparison with All-Polyethylene Components: A Systematic Review. J Bone Joint Surg Am 2014;96:1041-1047. [PMID: 24951741 DOI: 10.2106/jbjs.m.00674] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]