Wednesday, October 21, 2015

Total shoulder arthroplasty, glenoid seating and glenoid radiolucencies

The association of incomplete glenoid component seating and periprosthetic glenoid radiolucencies after total shoulder arthroplasty.

These authors evaluated the minimum 2-year follow-up for 36 total shoulder arthroplasties performed for primary glenohumeral osteoarthritis with a partially cemented all-polyethylene glenoid prosthesis.

At a mean of 43 months after surgery, neither Lazarus plain film radiolucency scores nor Yian CT radiolucency scores were associated with Lazarus plain film seating scores. Neither Lazarus plain film radiolucency scores nor Yian CT radiolucency scores were associated with modified Lazarus CT scan seating scores.

Comment: The authors concluded that "Radiolucencies around a partially cemented glenoid component were not associated with the degree of component seating. Complete seating of the glenoid component is not necessary to achieve radiographic implant stability". These statements are not correct.  The surgeon performing these total shoulders is a high volume shoulder surgeon with a great degree of expertise. This is evidence by the observation that of the 210 images, 111 (51%) were graded as ‘‘A,’’ 88 (41%) were graded as ‘‘B,’’ and 7 (3%) were given a grade of ‘‘D.’’ None were graded as ‘‘E.’’ 92% of the glenoids had 'good' seating. Because of the very small number of cases with 'poor seating' this study provides insufficient evidence to state that the degree of component seating is unimportant in the fixation of the glenoid component. It would be unfortunate if this article was used to detract from the need to achieve the best possible seating for the glenoid component. A more appropriate conclusion is the one buried in the Discussion section "a small degree of incomplete glenoid seating is not associated with loosening at a mean of nearly 4 years after surgery."


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