Does the innovation of trabecular metal backed glenoid component improve 5 year total shoulder outcomes?

A Multi-Centre, Randomized Controlled Trial Comparing a Second-Generation Uncemented Trabecular Metal-backed versus Cemented Polyethylene Glenoid Component in Total Shoulder Arthroplasty: Five-year Results reports quality of life, clinical, patient-reported, and radiographic outcomes at five years from a randomized controlled trial comparing a second-generation uncemented trabecular metal-backed glenoid (TM, 46 patients, below right) versus a cemented non-ingrowth polyethylene glenoid (POLY, 47 patients, below left) in patients undergoing a total shoulder arthroplasty (TSA).

There were no preoperative differences between groups with respect to age, sex, or WOOS scores.
At followup, there were no statistical or clinically relevant differences in WOOS or patient-reported outcomes between the two groups.

Metal debris was observed in 11 (23.9%) of the TM shoulders without apparent impact on clinical outcomes.

One TM patient experienced glenoid loosening in the setting of an infection. 

One POLY patient had a minor intraoperative periprosthetic fracture of the glenoid which resolved non-operatively. 

Otherwise there was no radiographic evidence of glenoid loosening in either group.

Comment: This randomized clinical trial showed a minimal rate of glenoid component failure at five years after anatomic total shoulder arthroplasty for both the uncemented trabecular metal-backed glenoid and the cemented non-ingrowth polyethylene glenoid in patients undergoing a total shoulder arthroplasty. They noted no differences in outcome between the two glenoid components.

The authors point out that the osseous integration seen with the TM glenoid has the negative consequence that occurs in the revision setting where prosthesis removal can be extremely challenging and lead to extensive bone loss.

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