Early outcomes of augmented glenoid components in anatomic total shoulder arthroplasty: a systematic review

Abstract

Background The objective was to evaluate the short-term clinical and radiological outcomes following augmented anatomic total shoulder arthroplasty in patients with posterior glenoid deficiency. Methods An electronic search of EMBASE, MEDLINE, and PubMed identified studies reporting clinical and radiographic outcomes following augmented anatomic total shoulder arthroplasty among patients with posterior glenoid deficiency. Results Nine studies including 312 shoulders underwent anatomic total shoulder arthroplasty using an augmented glenoid implant between 2015 and 2020. A statistically significant improvement in range of motion (ROM), visual analog scale (VAS), American Shoulder & Elbow Surgeons (ASES), Constant, University of California - Los Angeles and Simple Shoulder Test (SST) scores was demonstrated at mean follow-up of 37.1 months. Glenoid retroversion improved from 21.8° to 9.5°. At final follow-up, radiolucency was reported in 35.1% of shoulders. The 16° full-wedge augment led to higher and more severe radiographic lucency, while high peg perforation rates (44%) were observed among 5-mm augment stepped implants. The overall rate of complication was 2.6%. Rate of revision surgery was 1.9%. Conclusions Overall, early- to mid-term outcomes following augmented anatomic total shoulder arthroplasty for posterior glenoid deficiency demonstrate good to excellent overall clinical results. More radiographic and clinical failures were reported in larger full wedge (16°) augments and stepped augments (5 mm). Prospective studies examining mid- and long-term outcomes will help further elucidate safety and efficacy of these relatively new implants.

Shoulder arthroplasty in patients with glenohumeral osteoarthritis, glenoid bone loss and an intact rotator cuff: an algorithmic approach and review of the literature

“…Glenoid component augmentation is an additional method that has been described as a method of addressing glenoid bony defects during both anatomic TSA and RTSA. Augmented components include polyethylene designs utilized for anatomic TSA and are made of metal in baseplate components used in RTSA ( 22 - 24 ). Various augmented glenoid component designs have been described for anatomic TSA including all-polyethylene monoblock with full-wedge (Equinoxe; Exactech, Gainesville, FL, USA) ( 22 ), half-wedge augmented glenoid (Aequalis Perform+; Wright Medical Group, Memphis, TN, USA) ( 22 ), or step-cut design (Global StepTech; DePuy Synthes, Warsaw, IN, USA) ( 22 , 23 ) ( Figure 3 ).…”

“…There are a number of clinical studies evaluating augmented glenoid components and augmented baseplates used in RTSA. A recent systematic review included nine studies (312 patients total) which used augmented glenoid components at a mean follow-up of 37 months (range, 2.3–72 months) ( 24 ). Overall, they found that 35% of patients had reported radiolucency surrounding the components with 44% rate of peg perforation in 5 mm augment stepped implants ( 24 ).…”

“…A recent systematic review included nine studies (312 patients total) which used augmented glenoid components at a mean follow-up of 37 months (range, 2.3–72 months) ( 24 ). Overall, they found that 35% of patients had reported radiolucency surrounding the components with 44% rate of peg perforation in 5 mm augment stepped implants ( 24 ). While glenoid component augmentation is still developing a long-term track-record, larger studies are needed before widespread adoption in dealing with patients who have glenoid bone loss and an intact rotator cuff.…”

Treatment of Glenoid Wear with the Use of Augmented Glenoid Components in Total Shoulder Arthroplasty

“…In another study, Priddy et al 46 showed significantly higher degree of radiolucency around 16-degree augmented glenoids compared with 8-degree augments (p = 0.03), demonstrating there may be a limit to the degree of achievable augmentation without compromising implant stability. More recently, Sheth et al 50 published a systematic review and analysis of the available clinical literature. This included 9 studies with 312 shoulders who underwent TSA with an augmented glenoid component between 2015 and 2020.…”

“…The pooled complication rate was 2.6%, and the revision rate was 1.9% at short-term follow-up. It is important to note that all studies to date are retrospective in nature representing Level III or IV evidence 50 . Although these outcomes are promising and short-term complication rates are low, high-level studies with long-term follow-up are warranted.…”