Saturday, January 7, 2012

Glenoid component lucent lines and loosening, JSES December 2011

Collin et al have provided a ten year follow-up on all polyethylene glenoid components in total shoulder arthroplasty. The authors state "Glenoid component loosening remains the most common reason for failure and revision surgery."

The shoulder arthroplasties in this study were performed by surgeons with a very high level of expertise, Gilles Walch and Pascal Boileau. While the principal purpose was to compare the track record of flat-backed versus concave backed cemented components, no significant differences were found. At 10 year followup, 20% of the glenoid components had possible loosening and 35% had definite loosening. The presence of glenoid loosening was associated with lower shoulder comfort and function by the Constant score. The authors noted that when radiolucent lines were present on the immediate post-operative films, these lucencies tended to progress. Younger patients (<60 years) tended to have a greater rate of progression than older patients. Glenoid components placed in the dominant shoulder had a greater tendency to have progressive lucencies than those in non-dominant shoulders.

This report suggests that active use and surgical technique are major factors determining the longevity of glenoid components. There was no mention of the results of cultures taken at the time of revision. The cases shown in Figures 6 &  7 (reproduced below) would seem suspect for the presence of an organism such as P. acnes.

 Note loss of alignment of metal markers in the glenoid and fragmentation of cement with osteolysis

Note massive osteolysis and fragmentation of cement.

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