Uncemented fixation of a monoblock ingrowth polyethylene glenoid: early follow-up

Schoch, Bradley S.; Zarezadeh, Ali; Priddy, Michael; King, Joseph J.; Wright, Thomas W.

doi:10.1016/j.jse.2019.09.034

Cited by 10 publications

(7 citation statements)

References 23 publications

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“…Cage glenoids had complication and revision rates of 7.4% and 3.5%, respectively, very similar to the 7.6% and 3.8%, respectively, reported by Marigi et al 8 However, the indications for revision differed, as cage glenoids had a unique mode of failure of articular surface disassociation, which does not occur with monolithic or non-modular designs. This modular junction failure has been previously reported, 9,12,13,15,17 and occurs due to malalignment or malpositioning when preparing the central and peripheral holes for the pegs. Any angular divergence and/or positional deviation between the drilled holes and the pegs, during impaction of the press-fit central peg, can cause the peripheral pegs to bend or splay as the component is seated, which can lead to failure of the locking mechanism and disassociation.…”

Section: Discussionsupporting

confidence: 53%

“…8,9 Other authors have also shown high survivorship and low rates of glenoid-related complications with hybrid components; however, the length of follow-up in these studies is short, and unique but rare modes of failure associated with these modular devices have been reported. [8][9][10][11][12][13][14][15][16][17][18][19] Therefore, the aim of this study was to analyze and longitudinally compare the outcomes of aTSAs with cemented keel, cemented peg, and hybrid cage peg glenoid components using the same humeral system.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 53%

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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“…They concluded that press-fit fixation is a safe option for those undergoing TSA. 17 However, their study did not included a comparative group, and the mean follow-up was only 3 years, whereas the present study contains a cemented control cohort and a minimum follow-up of 5 years…”

Section: Discussionmentioning

confidence: 87%

“…More recently, surgeons used a modified technique in which aTSA is performed with implantation of a monoblock hybrid glenoid without the use of peripheral cementation of the peripheral pegs. 9 , 11 , 17 The theoretical advantages of this technique include less operative time, reduction in possible heat-induced necrosis, and potentially reduced complications in the revision setting. However, there are limited data regarding the clinical and radiographic outcomes when using a press-fit uncemented technique.…”

mentioning

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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“…Churchill did not place bone paste between the flanges of the central peg and found evidence of glenoid lucency in 25% of shoulders at a 5-year minimum follow-up. Schoch et al 41 reported radiolucent lines in 24% of shoulders following uncemented fixation of a hybrid ingrowth cage PE glenoid component at minimum 2 years follow-up. On the other hand, Jacxsens et al 42 studied a fully-uncemented central peg bony-ingrowth glenoid component and found progressive radiolucent lines in 74% of shoulders with a revision rate of 12% at minimum 5 years follow-up.…”

Section: The Use Of Bone Cementmentioning

confidence: 99%

Glenoid Prosthesis Design Considerations in Anatomic Total Shoulder Arthroplasty

Liu

Shi

Amirouche

2022

Journal of Shoulder and Elbow Arthroplasty

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Total shoulder arthroplasty is an increasingly popular option for the treatment of glenohumeral arthritis. Historically, the effectiveness of the procedure has largely been determined by the long-term stability of the glenoid component. Glenoid component loosening can lead to clinically concerning complications including pain with movement, loss of function, and accumulation of debris which may require surgery to revise. In response, there has been a push to optimize the design of the glenoid prosthesis. Traditional contemporary glenoid components use pegs for fixation and are made entirely of polyethylene. Variations on the standard implant include keeled, metal-backed, hybrid, augmented, and inlay designs. There is a wealth of biomechanical and clinical studies that report on the effectiveness of these different designs. The purpose of this review is to summarize existing literature regarding glenoid component design and identify key areas for future research. Knowledge of the rationale underlying glenoid design will help surgeons select the best component for their patients and optimize outcomes following TSA.

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Uncemented fixation of a monoblock ingrowth polyethylene glenoid: early follow-up

Cited by 10 publications

References 23 publications

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

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

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

Glenoid Prosthesis Design Considerations in Anatomic Total Shoulder Arthroplasty

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