Saturday, November 29, 2014

Is glenoid peg perforation a problem?

Glenoid perforation with pegged components during total shoulder arthroplasty.

These authors sought to determine if glenoid peg perforation was associated with an increased rate of glenoid component loosening and whether glenoid peg perforation was associated with inferior clinical outcomes. They performed a case-control retrospective review comparing 25 total shoulder arthroplasties (TSAs) in which one or multiple pegs perforated the medial glenoid vault (uncontained group) with 25 TSAs without peg perforation (contained group). Average clinical follow-up was more than 5 years.

Initially the authors had intended to obtain radiographs at two or more years after surgery. However, a large number of patients were unable to obtain satisfactory x-rays and this aspect of the study was abandoned.

No patient in either group was known to have had revision for glenoid loosening. 

Two (8%) patients in the uncontained group required revision for rotator cuff tears. The glenoid components were secure in both.

Penn and ASES scores were significantly lower in the unconfined group. Pain and satisfaction subscores were similar between the groups, but function subscores were significantly lower in the unconfined group.

Comment: Readers may be interested in a previous post discussing glenoid perforation and its possible consequences.

As the authors point out, shoulders with severe glenoid erosion accompanied by eccentric posterior glenoid wear and anterior soft tissue contractors have more severe forms of glenohumeral arthritis than those with small amounts of medial erosion. On one hand, it is not surprising that thin glenoids are more likely to be perforated. On the other hand, it is not surprising that shoulder arthroplasty for these severely deformed glenohumeral joints will have poorer results than those with minimal deformity. In this regard it would be of interest to know the pre surgery Penn scores and the radiographic pathoanatomy prior to surgery for each of the two groups.

It seems likely that the poorer functional results in the 25 TSAs with peg penetration were due to disease severity and not to the peg penetration. This view is somewhat reinforced by the observation that both shoulders requiring revision for cuff failure were in the penetration (uncontained) group.


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