These authors prospectively compare radiographic lucency between a finned, cementless central pegged glenoid component
and a conventional cemented pegged glenoid component
on immediate postoperative and minimum 2-year follow-up radiographs.
Fifty-four patients undergoing total shoulder arthroplasty were prospectively randomized to receive one of the two glenoid components.
Patients who had undergone revision surgery or had died before evaluation were excluded.
Fifty patients met inclusion criteria; 42 were available for followup with the original glenoid implant in place. The mean follow-up duration was 35 months (24-64 months).
At a mean of 35 months after surgery, there were no significant differences in glenoid radiolucency between the two components.
At a mean of 35 months after surgery, there were no significant differences in glenoid radiolucency between the two components.
Comment: This is an important randomized control trial with short term radiographic followup without clinical outcome data.
It is recognized that glenoid component failure is often delayed, usually appearing 10 years after surgery. A recent study of 333 patients, Results of a convex-back cemented keeled glenoid component in primary osteoarthritis: multicenter study with a follow-up greater than 5 years, found radiologic loosening of 0.3% at 5 years and 48.5% at 10 years.
It is hoped that these authors will be able to follow this cohort for another eight years to assess the radiographic and clinical status of the shoulders. To that point it is of interest that some of the shoulders in this series showed early glenoid loosening
It is recognized that glenoid component failure is often delayed, usually appearing 10 years after surgery. A recent study of 333 patients, Results of a convex-back cemented keeled glenoid component in primary osteoarthritis: multicenter study with a follow-up greater than 5 years, found radiologic loosening of 0.3% at 5 years and 48.5% at 10 years.
It is hoped that these authors will be able to follow this cohort for another eight years to assess the radiographic and clinical status of the shoulders. To that point it is of interest that some of the shoulders in this series showed early glenoid loosening
while others showed superior displacement of the humeral component relative to the glenoid - a situation known to risk subsequent rocking horse loosening of the glenoid component.
It is of interest that the great majority of these cases were done for glenoid type A pathology:
79% type A 21% type B
This distribution of pathoanatomy is different from that in most reports. For example in the above referenced study of 333 shoulders, there were
54% type A, 42% type B, 4% other
Seven complications (13%) occurred in the 54 patients initially enrolled in the study:
79% type A 21% type B
This distribution of pathoanatomy is different from that in most reports. For example in the above referenced study of 333 shoulders, there were
54% type A, 42% type B, 4% other
In type A pathoanatomy, shown below, the humerus is centered in the glenoid.
Many believe that type B glenoids (shown below) are at higher risk for glenoid component failure.
It seems likely that these authors treated many of their type B glenoids with another type of arthroplasty.
one intraoperative proximal humerus metaphyseal fracture
one postoperative traumatic rupture of the subscapularis tendon
one intraoperative nondisplaced greater tuberosity fracture
two glenohumeral dislocations (1 anterior and 1 posterior)
one postoperative infection
one small anterior glenoid fracture that occurred during glenoid reaming
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