These authors report the clinical and radiographic outcomes of 316 Exactech hybrid cage glenoids below left) to an age-matched, sex-matched, and follow-up–matched cohort of 316 Exactech cemented all polyethylene glenoid (below right) in patients undergoing anatomic total shoulder arthroplasty with 2 years’ minimum follow-up.
The Exactech cage glenoid patients had significantly lower rates of radiolucent glenoid lines (9.0% vs. 37.6%, P < .0001) and radiolucent humeral lines (3.0% vs. 9.1%, P . .0088) than the Exactech all-polyethylene peg glenoid patients. In the cage glenoid cohort, 4 cases of aseptic glenoid loosening (1.3%) and 4 cases of articular surface dissociation (1.3%) occurred as shown below.
In the all-polyethylene peg cohort, 12 cases of aseptic loosening (3.8%) occurred. Cage glenoid patients had a significantly lower revision rate than all-polyethylene peg glenoid patients (2.5% vs. 6.9%, P . .0088).
Comment: These authors point out the importance of exact alignment of the drilled holes and the direction of impaction required by the metal-coated pegs.
In contrast to the all-polyethylene component with smooth pegs used in this study, we prefer a component with a fluted central peg.
Comment: These authors point out the importance of exact alignment of the drilled holes and the direction of impaction required by the metal-coated pegs.
The required direction and accuracy may be difficult to achieve because of challenges with exposure, especially in retroverted glenoids.
Failure to achieve the desired alignment of the holes with the reamed bony surface can result in failure of the component as shown below.
In contrast to the all-polyethylene component with smooth pegs used in this study, we prefer a component with a fluted central peg.
This component has several advantages, including (1) the flexibility of the pegs that can better accommodate minor degrees of malalignment in comparison to the more rigid hybrid pegs and (2) the fluted central peg that allows bone ingrowth which cannot occur with the smooth pegs used in this study.
To see a YouTube of our technique for total shoulder arthroplasty, click on this link.
To see a YouTube of our technique for total shoulder arthroplasty, click on this link.
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