Saturday, August 8, 2015

Total shoulder arthroplasty with an all polyethylene glenoid component

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

These authors evaluated 42 total shoulder arthroplasties performed from 2003 to 2007 using an all polyethylene glenoid component.

Omitted from the study were 34 patients that were either deceased (n . 15 [19.7%]) or could not be contacted for final follow-up (n . 19 [25%]). The average follow-up was 80 months (63-114);

81% of the central fluted pegs had complete incorporation with no lucent lines. Lucent lines correlated with lower ASES scores.Vault penetration of the central fluted peg was found in 5 cases. Four of these went on to develop lucent lines (80%) compared with the average for the study, which was 19%.
Glenoid lucent lines strongly correlated with the grade of humeral calcar osteolysis.

Comment: Hopefully the authors will follow these patients along to see if the radiolucent lines are progressive with time. The relationship of glenoid lucent lines to humeral osteolysis suggests the possibilities of low grade infection from Propionibacterium or reaction to polyethylene debris.  This study had only 1 revision, and at the time of the surgery, 5 tissue culture specimens were obtained and held for 3 weeks in 3 different media including broth, and all were negative.

These are encouraging results with a system that avoids metal backing and removes a relatively small amount of humeral bone.


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