Monday, August 24, 2015

Total shoulder arthroplasty - use of a partially cemented all-polyethylene bone-ingrowth glenoid

Five- to ten-year follow-up with a partially cemented all-polyethylene bone-ingrowth glenoid component

This study, funded by the manufacturer of the prosthesis (DePuy (Johnson & Johnson)), included 42 of the 76 total shoulder arthroplasties performed by a single surgeon from 2003 to 2007. 34 patients were not included in the analysis because they were either deceased (n . 15 [19.7%]) or could not be contacted for final follow-up (n . 19 [25%]).

81% of the central fluted pegs had complete incorporation with no lucent lines. The survivorship was 97% at 80 months. Shoulders with penetration of the central peg through the glenoid had a greater incidence of radiolucency around this peg. Shoulders with central peg radiolucencies tended to have lower ASES scores and higher rates of humeral osteolysis.

Comment: This study that included 55% of the implanted components demonstrates that an all polyethylene component can have good survivorship. It also points to a possible association between central peg penetration, lucencies around the central peg, inferior ASES scores and humeral osteolysis.

A number of important variables were not included in the analysis: sex, age, diagnosis, glenoid version, glenoid type, posterior humeral displacement and the adequacy of the glenoid seating. Central peg penetration is more likely in glenoids that are substantially retroverted or medially eroded. Shoulder arthritis with substantial retroversion or medial erosion have a more severe form of the disease and create additional challenges for the surgeon in achieving proper seating of the component. In the severely diseased glenoid below, perforation by the central peg is inevitable.

 So it is difficult to know whether perforation itself was a factor in the inferior results or whether it was but a marker of more severe disease.

See this related post.


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