Survival of the Aequalis total shoulder replacement at a minimum 20-year follow-up: a clinical and radiographic study

Evans, Jonathan P; Batten, Timothy; Bird, J.; Thomas, William J.; Kitson, J.; Smith, Christopher D.

doi:10.1016/j.jse.2021.01.038

Cited by 18 publications

(15 citation statements)

References 18 publications

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“… 2 , 6 A recent study showed 100% glenoid loosening at 20 years, suggesting that a cemented all-polyethylene glenoid may not be the best choice in younger patients. 7 Various glenoid constructs were developed to provide adequate long-term fixation, often with little success. Metal-backed glenoid components were used for a brief period, but this transition was short lived as poor outcomes and complications arose.…”

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confidence: 99%

Comparison of press-fit versus peripherally cemented hybrid glenoid components in anatomic total shoulder arthroplasty: minimum 5-year follow-up

Goodloe¹,

Oldenburg²,

Toner³

et al. 2022

JSES International

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Background A common complication of anatomic total shoulder arthroplasty (aTSA) is aseptic glenoid loosening. Monoblock polyethylene glenoid components with backside ingrowth or on-growth utilize hybrid fixation, with cementation of the peripheral pegs and central ingrowth or on-growth of bone have been designed to decrease glenoid loosening. However, there is a paucity of midterm data comparing cementation of the peripheral peg holes versus all press-fit implantation for hybrid glenoid constructs. The purpose of this study is to compare the minimum five-year clinical and radiographic outcomes of a press-fit hybrid glenoid component with a peripherally cemented hybrid glenoid component in aTSA. Methods Between years 2013-2015, we reviewed a total of 169 patients who underwent primary aTSA, with follow-up data spanning a minimum of five years, from an international multi-institutional database. There were 61 press-fit and 108 peripherally cemented glenoids. Shoulders were evaluated for outcome measures, which included clinical outcome scores, radiographic outcomes, and complication rates. Results Postoperatively, there were no statistically significant differences in patient satisfaction, shoulder function, pain scoring, the Simple Shoulder Test, the Constant score, the American Shoulder and Elbow Surgeons score, the University of California–Los Angeles score, nor the Shoulder Pain and Disability Index, between the two cohorts. There were no significant differences in adverse events ( P = .791) or revision rates ( P = .592). At the final radiographic follow-up, there were no significant differences between the two groups with regard to the incidence of radiolucent lines on the glenoid ( P = .210) or humeral side ( P = .282). Conclusion At a minimum of 5-year follow-up, aTSA with a press-fit glenoid implant demonstrates no difference in clinical or radiographic outcomes when compared with a glenoid cohort where the peripheral pegs are cemented. In addition, there is no increased rate of aseptic glenoid loosening or need for revision surgery between the two groups with a lower rate of radiolucency detected than prior midterm data studies. Uncemented press-fit glenoid fixation with a cage component appears to be a safe and effective treatment option for patients undergoing primary aTSA at a minimum of 5-year follow-up.

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confidence: 99%

Comparison of press-fit versus peripherally cemented hybrid glenoid components in anatomic total shoulder arthroplasty: minimum 5-year follow-up

Goodloe¹,

Oldenburg²,

Toner³

et al. 2022

JSES International

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“…All patients had significant postoperative improvement in ROM, shoulder function (SST [Simple Shoulder Test] scores improved from a preoperative average of 2.0 to 7.4 at 2 years), and even general health status. In a 20-year follow-up of the Aequalis aTSA, Evans et al noted that 72% of patients had died with the prosthesis in situ and acknowledged that older patients undergoing aTSA are unlikely to require revision of their prosthesis in their lifetime [25].…”

Section: Outcomes Of Tsa In Older Patientsmentioning

confidence: 99%

Anatomic total shoulder arthroplasty in patients under 50 and over 80 years of age. Part 2

2022

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Anatomic total shoulder arthroplasty is a widely used definitive surgical solution for end-stage glenohumeral joint osteoarthritis and is associated with good clinical outcomes. Anatomic total shoulder arthroplasty has a role for patients under 50 years of age who have exhausted nonoperative management and for patients over 80 years of age with an intact rotator cuff. Patients younger than 50 place greater demands on their replaced shoulders, raising concerns about implant survivorship and in particular the failure of the glenoid component. There are limited data on the long-term survivorship of anatomic total shoulder arthroplasty in patients under the age of 50 years in the literature. Modern bone-preserving designs utilizing newer materials may contribute to improved outcomes and survivorship. Achieving comparable functional outcomes in patients over 80 years of age remains a challenge with concerns related to rotator cuff failure. However, in appropriately selected patients over the age of 80 years, an anatomic total shoulder arthroplasty provides better pain relief and function than a reverse total shoulder arthroplasty.

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“…2,5,6 A recent 20-year minimum review reported rates of radiological glenoid loosening of 75% at 15 years, 80% at 19 years, and 100% at 20 years’ follow-up. 7…”

Section: Introductionmentioning

confidence: 99%

“…2,5,6 A recent 20-year minimum review reported rates of radiological glenoid loosening of 75% at 15 years, 80% at 19 years, and 100% at 20 years' follow-up. 7 In order to address the fixation of the glenoid component of an aTSA, multiple manufacturers have developed novel glenoid designs with hybrid press-fit and cemented fixation. Several recent studies have shown promising results for hybrid glenoids.…”

Section: Introductionmentioning

confidence: 99%

Comparison of long-term clinical and radiological outcomes for cemented keel, cemented peg, and hybrid cage glenoids with anatomical total shoulder arthroplasty using the same humeral component

Friedman

Boettcher

Grey³

et al. 2023

Bone Joint J

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AimsThe aim of this study was to longitudinally compare the clinical and radiological outcomes of anatomical total shoulder arthroplasty (aTSA) up to long-term follow-up, when using cemented keel, cemented peg, and hybrid cage peg glenoid components and the same humeral system.MethodsWe retrospectively analyzed a multicentre, international clinical database of a single platform shoulder system to compare the short-, mid-, and long-term clinical outcomes associated with three designs of aTSA glenoid components: 294 cemented keel, 527 cemented peg, and 981 hybrid cage glenoids. Outcomes were evaluated at 4,746 postoperative timepoints for 1,802 primary aTSA, with a mean follow-up of 65 months (24 to 217).ResultsRelative to their preoperative condition, each glenoid cohort had significant improvements in clinical outcomes from two years to ten years after surgery. Patients with cage glenoids had significantly better clinical outcomes, with higher patient-reported outcome scores and significantly increased active range of motion, compared with those with keel and peg glenoids. Those with cage glenoids also had significantly fewer complications (keel: 13.3%, peg: 13.1%, cage: 7.4%), revisions (keel: 7.1%, peg 9.7%, cage 3.5%), and aseptic glenoid loosening and failure (keel: 4.7%, peg: 5.8%, cage: 2.5%). Regarding radiological outcomes, 70 patients (11.2%) with cage glenoids had glenoid radiolucent lines (RLLs). The cage glenoid RLL rate was 3.3-times (p < 0.001) less than those with keel glenoids (37.3%) and 4.6-times (p < 0.001) less than those with peg glenoids (51.2%).ConclusionThese findings show that good long-term clinical and radiological outcomes can be achieved with each of the three aTSA designs of glenoid component analyzed in this study. However, there were some differences in clinical and radiological outcomes: generally, cage glenoids performed best, followed by cemented keel glenoids, and finally cemented peg glenoids.Cite this article: Bone Joint J 2023;105-B(6):668–678.

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Survival of the Aequalis total shoulder replacement at a minimum 20-year follow-up: a clinical and radiographic study

Cited by 18 publications

References 18 publications

Comparison of press-fit versus peripherally cemented hybrid glenoid components in anatomic total shoulder arthroplasty: minimum 5-year follow-up

Comparison of press-fit versus peripherally cemented hybrid glenoid components in anatomic total shoulder arthroplasty: minimum 5-year follow-up

Anatomic total shoulder arthroplasty in patients under 50 and over 80 years of age. Part 2

Comparison of long-term clinical and radiological outcomes for cemented keel, cemented peg, and hybrid cage glenoids with anatomical total shoulder arthroplasty using the same humeral component

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