Sunday, March 10, 2013

Radiographic survival in total shoulder arthroplasty

Radiographic survival in total shoulder arthroplasty

The authors reviewed 302 total shoulders with a cemented, keeled glenoid component at an average of 8.6 years after surgery. Of these 151 had preoperative, early postoperative, and most recent radiographs at a minimum 4 years. Fifty-two of 151 glenoid components (34%) showed a shift in position or a complete lucent line ≥1.5 mm. Component survival free from radiographic failure was 99% at 5 years but only 67% at 10 years. Among multiple factors, only late subluxation superiorly was associated with increased risk for radiographic failure, presumably via the 'rocking horse' effect. Glenoid component survivals free from revision at 5 and 10 years for the 302 shoulders were 99% and 93%.

Almost one-third of the glenoid components had a shift in component position between early postoperative and final radiographs and approximately one-third of all components were felt to be
radiographically at risk for clinical failure. These "at risk" changes began to appear at five years after surgery or later.

These results are similar to those of Kasten (Mid-term survivorship analysis of a shoulder replacement with a keeled glenoid and a modern cementing technique. J Bone Joint Surg Br 2010;92:387-92.), Young (A multicenter study of the long-term results of using a flat-back polyethylene glenoid component in shoulder replacement for primary osteoarthritis. J Bone Joint Surg Br 2011;93:210-6.), and Walch (Results of a convex-back cemented keeled glenoid component in primary osteoarthritis: multicenter study with a follow-up greater than 5 years. J Shoulder Elbow Surg 2011;20:385-94.) ( Patterns of loosening of polyethylene keeled glenoid components after shoulder arthroplasty for primary osteoarthritis. J Bone Joint Surgery Am 2012;94:145-50.).

Clearly fixation of the glenoid component remains a concern. It is also of interest that the revision rate lags substantially behind the rate of radiographic loosening.

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