Keeled glenoid survivorship in young patients

Mid- to long-term follow-up of total shoulder arthroplasty using a keeled glenoid in young adults with primary glenohumeral arthritis.

The purpose of this study was to examine the mid- to long-term functional outcome and implant survival of total shoulder arthroplasty in patients under the age of 56 years with primary glenohumeral arthritis. Between 1992 and 2004, surgeons in 8 centers performed 52 such arthroplasties. Minimum follow-up of 5 years was available in 50 patients at a mean of 115.5 months postoperatively.

At a mean of 115.5 months, 37.5% of glenoids showed no loosening, 18.8% showed possible loosening, and 43.8% had definite radiologic loosening. Survivorship of the glenoid component with the endpoint being revision surgery for glenoid loosening was 98% at 5 years but declined to 62.5% at 10 years. When the humeral head was not positioned anatomically, the glenoid was 6.6 times more likely to require removal. The 10-year survival rate was 87.5% for glenoids that were concentric before surgery (A1 and A2) and only 50% for non-concentric glenoids (B1 and B2). All of the revisions were in the dominant arm.

Comment: The management of the arthritic shoulder, especially those with type B glenoids in individuals under the age of 56 years remains a challenge. While total shoulder is one option, the ream and run has also been used in this age group with encouraging results, especially in patients without prior surgical procedures on that shoulder.

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