Thursday, December 6, 2012

Results of Cemented Total Shoulder Replacement with a Minimum Follow-up of Ten Years JBJS

Results of Cemented Total Shoulder Replacement with a Minimum Follow-up of Ten Years JBJS

While most journals require a minimum of two years of followup for reconstructive procedures, patients are interested in knowing longer term outcomes as well. This study is a Level IV followup of 39 out of 60 arthroplasties performed between June 1995 and October 2000 at a minimum of 10 years after a 'third generation' Tornier total shoulder arthroplasty with keeled flat-back glenoid components.  Glenoid anatomy was characterized by standardized anteroposterior and axillary radiographs of the shoulders obtained preoperatively and postoperatively. The morphology of the glenoid was recorded according to the classification described by Walch. The glenoid was type A2 in eleven cases, type B1 in sixteen, type B2 in ten, and type C in two. Loosening was defined as a radiolucent line score of over 12 (out of a maximum of 18), tilting over 5 degrees or subsidence. The authors observed that some shoulders showed loosening only on the AP view, some only on the axillary and some on both. Over a third of the glenoid components were radiographically loose at the time of followup. The mean radiolucent line score for the B2 and C glenoids was significantly greater than that for the A2 and B1 glenoids.

Superior migration of the humeral component was observed in over two thirds of the cases. None of the glenoid components required revision and the Constant scores showed significant improvement.

The high radiographic loosening rates observed in this study for keeled components are consistent with two previous long term result reports, here and here.

So again, glenoid component fixation, especially when the glenoid is biconcave or retroverted, remains a challenge. While shoulders with loose glenoids may remain functional, this loosening remains a concern that has not been resolved by later generation prostheses.


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