Advances in Glenoid Design in Anatomic Total Shoulder Arthroplasty
The "bullet points" of this article are presented as
1. Rotator cuff imbalance, soft-tissue and capsular repair defects, and improper component sizing, positioning, and orientation can result in a high-stress environment at the periphery of the glenoid component-bone interface.
2. The optimal position and orientation of the glenoid for a given individual is currently unknown.
3. There have been advancements in glenoid design, with the advent of contemporary metal-backed and hybrid components, but their long-term efficacy has not been proven. Inset glenoid components have shown promising short- and mid-term results.
4. The augmented glenoid, which has shown satisfactory short-term results in the setting of posterior glenoid loss is a potential option for glenoid bone loss that is too severe for eccentric reaming. It may be technically easier than bone-grafting, does not require union, and is not at risk of collapse or bone graft resorption.
5. Advances in surgical technique, including patient-specific instrumentation, may provide additional accuracy, especially in dysplastic and eccentrically worn glenoids; however, evidence for clinical benefit is still lacking.
Taken together this list of "Advances" seems to be a list of technologies the benefits of which are "currently unknown", "not been proven", "potential options", and "evidence of clinical benefit is still lacking".
When considering these technologies, we need to be mindful that the long term survival of cemented all-cross-linked polyethylene components is excellent, this figure from a very large (10,929 cases) population based study by the Australian Orthopaedic Association (see this link) provides a reference against which the benefit and cost-effectiveness of new technologies should be measured.
With respected to patient specific instrumentation (PSI), the authors report, "Although PSI shows improvements in 3D accuracy in the setting of knee arthroplasty, subsequent studies have failed to demonstrate improvements in long-term clinical outcomes. In light of this finding, evaluation of the cost, long-term postoperative functional outcomes, and implant survivorship associated with PSI in shoulder arthroplasty is necessary before widespread adoption is warranted."
The authors conclude that "Advances in surgical technique and modifications in implant design have attempted to address this shortcoming, but evidence of improved long-term survival following these modifications is lacking."
New technologies and techniques commonly bring with them new costs. Particularly at this time when our health care system is dealing with a hugely expensive pandemic, we must be thoughtful about spending our health care collars on approaches for which the benefits to the patient remain to be demonstrated. See this related post.
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How you can support research in shoulder surgery Click on this link.
We have a new set of shoulder youtubes about the shoulder, check them out at this link.
Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
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