There is no question that survivorship of the glenoid component is the key to survivorship of a total shoulder arthroplasty. We have presented our approach to glenoid arthroplasty here.
This is an important study in that it seeks literature evidence on the cost-effectivenss of pegged vs. keeled glenoid components with particular emphasis on the risk of revision surgery. After a thorough analysis of the published data, they found that pooled risk ratio for revision was 0.27 (95% CI, 0.08 to 0.88) in favor of pegged components (p = 0.028). Their value analysis indicated that pegged glenoid designs were more cost-effective than keeled glenoid designs.
These results are consistent with what we published a decade ago, at which time we also factored in the importance of surgeon experience.
One of the key differences between a pegged and keeled component is that with a pegged component the geometry of the fit is more precisely controlled by the fact that concentric reaming takes place around the same axis as is used to fix the component.
Thus the risk of poor bony support for the component (shown below) is reduced.
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