These authors point out that one of the goals of computer 3D simulation and computer-generated guides is to minimize perforation of the glenoid vault by glenoid pegs in shoulder arthroplasty, based on assumptions that perforation leads to worse outcomes because of component loosening and potential failure.
They evaluated outcomes of glenoid peg perforation testing the assumption that perforation produces worse results. Eighty-three shoulders underwent shoulder arthroplasty with pegged hybrid fixation (bone-ingrowth flanged central glenoid peg and peripheral cemented pegs) without the use of computer generated guides or 3D planning software.
Outcomes were determined by American Shoulder and Elbow Score and Oxford Shoulder Score. Fine slice CT determined the presence of vault perforation and the extent of lucent lines at the prosthesis–bone interface and bony morphology of the vault perforation. Follow-up was 46.7 months (24–99). Seven shoulders (8%) demonstrated perforation of glenoid vault. Bony ingrowth and cortical overgrowth occurred despite perforation, with no clinically significant differences in clinical or radiological outcomes in shoulders with and without glenoid vault perforation. None of these patients underwent revision surgery.
The presence of lucent lines around the glenoid component was classified on CT according to the scoring system of Yian et al. Yian described assessing six zones with the amount of lucency around pegs given a score of 1, 2 or 3 if there was lucency of 1, 2 or 3 mm. Possible Yian scores ranged from 0 to 18. They defined an abnormal Yian score as being > 0. Implants with a Yian scores of 6–12 or > 12 are defined as being possibly loose and definitely loose, respectively.
The presence of lucent lines around the glenoid component was classified on CT according to the scoring system of Yian et al. Yian described assessing six zones with the amount of lucency around pegs given a score of 1, 2 or 3 if there was lucency of 1, 2 or 3 mm. Possible Yian scores ranged from 0 to 18. They defined an abnormal Yian score as being > 0. Implants with a Yian scores of 6–12 or > 12 are defined as being possibly loose and definitely loose, respectively.
Comment: In our experience with the same glenoid component
we have also found that central peg perforation is consistent with excellent clinical and radiographic outcomes.
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