These authors sought to evaluate the clinical and radiographic results of a fully uncemented all-polyethylene fluted central peg bone-ingrowth glenoid component at a minimum 5-year follow-up.
The study included 35 shoulders in 31 patients (mean age, 73 years) with a mean follow-up of 100 months (8.3 years). The study included patients presenting with avascular necrosis or primary osteoarthritis excluding patients with glenoid type C. The glenoid types for the included shoulders are not reported. Patients having an impaired functional outcome due to medical conditions were excluded. The components were inserted using an off-label technique without the cement fixation of the peripheral pegs as recommended by the manufacturer. The rationale for this technique was "potentially reducing heat-induced necrosis, having a shorter operating time, and potentially reducing cement-related difficulties in case of revision".
The mean Constant score improved from 40 preoperatively to 74 at early followup dropping to 66 at final followup. The drop in CS over time was attributed primarily to a decrease in strength at the later time points.
CT scans found an initial osseointegration rate of 81% at early follow-up that decreased to 71% at a mean follow-up of 8.4 years. 7 shoulders demonstrated isolated radiographic loosening around the central peg. 3 shoulders demonstrated isolated radiographic loosening around the peripheral pegs, and 1 shoulder with gross radiographic loosening demonstrating a combined loosening of all pegs. 74% (26 of 35) of the shoulders demonstrated progression of radiolucent lines. The radiographic loosening rate was 31%.
Of the 35 shoulders, 4 (12%) required revision. Two patients were revised because of symptomatic loosening, 1 patient underwent a revision because of a subscapularis insufficiency, and 1 patient was revised because of a Cutibacterium infection.
Comment: This is an interesting study with CT scans evaluating the glenoid component fixation at early and intermediate time points after total shoulder arthroplasty using an off-label technique.
The 12% revision rate at 8 years in this study can be compared to the 3% revision rate at 8 years for cemented all-polyethylene (cross linked) components reported by the Australian Orthopaedic Association (see below).
Comment: This is an interesting study with CT scans evaluating the glenoid component fixation at early and intermediate time points after total shoulder arthroplasty using an off-label technique.
The 12% revision rate at 8 years in this study can be compared to the 3% revision rate at 8 years for cemented all-polyethylene (cross linked) components reported by the Australian Orthopaedic Association (see below).
These results can also be compared to those of Noyes et al (see this link) with similar length of followup. In the Noyes study of 76 total shoulders using the same glenoid component as in this study, but inserted with cementing of the peripheral pegs as recommended by the manufacturer, there was 97% survivorship at 80 months. On radiographs, 81% of the central fluted pegs had complete incorporation with no lucent lines.
Cemented fixation of this component has shown great clinical utility in a large international study (see this link).
Thus it does not appear that using an off-label cementless insertion technique is an attractive method for glenoid arthroplasty.
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