These authors point out the high rates of radiographic glenoid loosening following anatomic total shoulder arthroplasty (TSA). They studied the association of radiolucent lines with shoulder function and patient-reported outcomes (PROs) in 492 primary TSAs performed between February 2005 and April 2016. Radiographs were evaluated for glenoid loosening according to the Lazarus grade at a mean of 5.3 years (range, 2-12 years) after surgery.
All-polyethylene keeled components (below left) were used in 186 shoulders All-polyethylene pegged glenoids (below right) were used in 306 shoulders.
At most recent follow-up, 308 glenoids (63%) showed no radiolucent lines (group 0) and 184 demonstrated peri-glenoid lucencies (group 1). The groups were similar regarding age, sex, body mass index, comorbidities, and prior surgery. At follow-up, group 1 with peri-glenoid lucency's demonstrated significantly lower improvements in forward elevation (P .02) and all PROs (P .005). The improvement in Simple Shoulder Test averaged 7.3 for the 308 shoulders without radiolucent lines and 5.6 for the 184 shoulders with radiolucent lines.
Subgroup analysis by radiolucency grade showed that forward elevation diminished with increasing radiolucent score and exceeded the minimal clinically important difference (MCID) above grade 2 lucencies. A similar decline in PROs was observed with increasing lucency grade; the differences exceeded the MCID for grade 5 lucencies.
Complications and reoperations were more common in group 1 (16% vs. 5% [P < .001] and 11% vs. 3% [P < .001], respectively). Glenoid component loosening was the most common cause of reoperation in group 1, representing the indication for revision in 14 of 21 reoperations.
Comment: These results again confirm that fixation of the glenoid component to bone is the weak link of total shoulder arthroplasty when smooth keeled or smooth pegged components are used. This observation has led to the exploration of other methods of fixation. However, as shown in the article below, new methods of fixation have their own problems.
These authors evaluated clinical and radiographic outcomes at a minimum 5-year followup in 45 shoulders that underwent total shoulder arthroplasty (TSA) using a glenoid with a central porous titanium post to augment the cemented peripheral pegs.
While the average clinical scores were improved, radiographs showed glenoid component radiolucency in 29 of 45 (64%) of the shoulders. Radiolucencies were confined to the area under the glenoid faceplate in 6 and were only around the central post in 13. Nine TSAs (20%) demonstrated 2 or more columns of involvement.
Some implants had secure fixation of the central peg, but evidence of stress-shielding in the bone beneath the face of the component (see below)
Some had incomplete bone healing to the central peg (see below)
One had fracture of the central peg
In contrast, our practice is to use all poly components with fluted central pegs that allow bone ingrowth without the potential risk of metal
Long term followup continues to be essential for evaluating the durability of glenoid component fixation.
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