Sunday, December 28, 2014

Radiolucent lines correlate with poorer outcomes after shoulder arthroplasty

Long-term survival of the glenoid components in total shoulder replacement for arthritis

These authors present 5 to 12 year follow-up on 39 total shoulders for osteoarthritis using a keeled, polyethylene, convex-backed component implanted with minimal reaming, compaction bone grafting of the glenoid and minimal addition of cement.

The glenoid morphology was A1 in 25 shoulders, A2 in ten, B1 in four and no B2 or C.

The glenoid preparation included limited reaming, creation of a central keel slot, impaction of cancellous bone chips harvested from the humeral head into the keel slot with a glenoid punch, and insertion of a convex backed polyethylene with low viscosity cement at the keel.

Radiolucent lines were assessed on anteroposterior radiographs.

Constant scores, active elevation, and comfort were improved.

Radiolucency around the components increased with time. 16% had definite radiological glenoid loosening at last followup.

Constant scores deteriorated with the progression of glenoid radiolucency.

The rate of revision surgery for glenoid loosening was 2.5 %.

Comment: This is an interesting single surgeon study of the use of a keeled glenoid component in shoulders with relatively benign glenoid pathoanatomy (35 of 39 type A glenoids). Emphasis was placed on preservation of the glenoid bone stock.

The authors showed that increased glenoid radiolucency was associated with poorer shoulder comfort and function.

One of the cases shown (figure 2f) shows a substantial amount of glenoid osteolysis - similar to that seen with Propionibacterium, but culture results are not presented.

A final observation is that many patients apparently would rather accept the symptoms of a loose glenoid rather than having a revision.


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