In this study the authors attempt to model clinical glenoid arthroplasty by the simulated implantation of standard 'onset' glenoid components and their 'novel inset' implant into a homogeneous block of polyurethane foam. The fixation strength and stress distributions of the implantations were analyzed using mechanical cyclical loading and by 3-D finite element analysis.
None of the components showed signs of loosening, but the inset glenoid showed less rocking horse distraction of the edge with eccentric loading.
While this is an interesting concept, we recognize that the model system does not replicate the clinical situation where there is often erosion and heterogenous bone density of the glenoid bone. The inset prosthesis relies on the bone surrounding the inset, rather than a substantial set of pegs for fixation. A small amount of bone resorption (which could not be modeled in their system) may substantially reduce the quality of the fixation.
We will await long term clinical results of this prosthesis, ideally in the form of a prospective randomized trial comparing it to more standard approaches.
We do agree with the authors that glenoid component loosening continues to be the most common delayed complication of total shoulder arthroplasty, resulting in our interest in the ream and run procedure.
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