Thursday, May 3, 2018

Glenoid failure in total shoulder - do cysts play a role?

Total shoulder arthroplasty with minimum 5-year follow-up: does the presence of subchondral cysts in the glenoid increase risk of failure?

These authors state "In our patient population, we found a high prevalence of radiographic loosening (41%) after 5 years".

They evaluated the effect of preoperative cystic changes in the glenoid  (determined by CT) on postoperative outcomes and implant survival after total shoulder arthroplasty (TSA) for 75 patients having TSA for primary osteoarthritis with minimum 5-year follow-up. 

8 shoulders had no cysts, 27 shoulders had small cyst formation, 19 had medium cysts, and 21 had large cysts. 

The overall revision rate was 7% (5 of 75). All revised patients were in the groups with medium or large cysts. There were no statistical differences in American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment scores or presence of radiographic loosening among the study groups. 

The authors did not note an increased failure rate for the type B2 gleonoids.

Comment: The authors do not suggest how the cystic glenoid might be managed to avoid the apparent increased risk of glenoid component failure. In our practice, we use an all polyethylene glenoid component with a fluted central peg. 
If glenoid cysts are present, these are autografted using bone from the humeral head.
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