These authors sought to identify surgeon-controlled factors contribute to glenoid component failure.
They reviewed the clinical and radiographic features of 215 total shoulder arthroplasties that they revised for symptomatic glenoid component failure. These patients had poor patient self-assessed shoulder function (mean Simple Shoulder Test score, 3.0 ± 2.7).
These shoulders often showed multiple failure modes; 72% had glenoid component loosening, 69% had polyethylene wear, 51% had glenohumeral decentering, and 25% had humeral component loosening. Metal-backed/hybrid and keeled glenoid designs were more likely to demonstrate loosening, malposition, dislocation, and early failure in comparison to pegged designs.
Glenoid components with cement on the backside were more prevalent among those having revisions within five years of the index arthroplasty.
Some of the identified failure modes are exemplified in these figures
The authors suggest that the occurrence of severe glenoid component failure might be reduced by paying attention to glenoid component design (all polyethylene, pegged fixation) and insertion technique (excellent seating without backside cement), restoring the normal balance of the humeral head in the center of the glenoid (soft tissue balancing and proper component placement), and considering a reverse total shoulder when the shoulder is unstable because of soft tissue deficiency.
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