No Differences in Early Results of a Hybrid Glenoid Compared With a Pegged Implant

Abstract

Background Glenoid component loosening after total shoulder arthroplasty is one of the most common causes of failure. A hybrid glenoid that uses peripherally cemented pegs and a central press-fit post may improve implant longevity. Questions/purposes We asked, compared with polyethylene pegged glenoid implants, do hybrid glenoid implants with a titanium post provide (1) better ingrowth with fewer radiolucencies, (2) better outcome and pain scores, and (3) lower risk of complications and revisions? Methods Between 2009 and 2010, 126 patients underwent primary total shoulder arthroplasty for osteoarthritis.Patients were included in this retrospective study if they consented for inclusion in a shoulder arthroplasty registry, had complete baseline and 2-year data, and had complete radiographs. Eighty-three (67%) were available at an average followup of 3.2 years (range, 24-45 months). Forty received a conventional all-polyethylene pegged glenoid and 43 received a hybrid component. During the period in question, four of the participating surgeons used only one implant, and four used only the other; there was one highvolume surgeon in each of the study groups. Radiographs were taken at the 2-year followup and analyzed for radiolucent lines. CT scans were obtained randomly for 10 patients with hybrid glenoid implants to assess bone ongrowth. American Shoulder and Elbow Surgeons score, VAS score, complications and revisions were recorded. Results At final followup, radiolucent lines between the two study groups were not different (hybrid, 1.0 ± 0.4; pegged, 1.6 ± 0.3; mean difference, 0.6; 95% CI, 0.85-1.72; p = 0.323). Final VAS pain scores were not different (hybrid, 1.2 ± 0.2; pegged, 1.5 ± 0.3; p = 0.056). Change in American Shoulder and Elbow Surgeons scores were not different (hybrid, 33.7 ± 7.3; pegged, 35.5 ± 8.2; p = 0.283). There were no differences in complication risk (hybrid, one of 43 [2.3%]; pegged, three of 40 [7.5%]; relative risk, 2.3; 95% CI, 0.82-3.12; p = 0.061). Conclusions With the numbers available and at early followup, there were no differences between the hybrid and pegged glenoids in terms of fixation, functional outcome, pain scores, and complications. CT scans confirmed bone ongrowth on the porous titanium post in a small subcohort of patients. Further studies are needed to determine how this new implant will perform with time. Until then, its use should be initiated with caution.

Retrieval Analysis of Porous Titanium Glenoid Posts: An Evaluation of Osteointegration

“…A previous study showed that this same implant had similar clinical and radiographic findings when compared with conventional all-polyethylene cemented pegged components at early follow-up. 14 These findings were particularly encouraging because bone was found to grow onto the central post on computed tomography scans of well-functioning implants, providing hope that long-term studies may show lower rates of loosening. 14 In the current study, specimens were analyzed from an explantation retrieval library.…”

“…14 These findings were particularly encouraging because bone was found to grow onto the central post on computed tomography scans of well-functioning implants, providing hope that long-term studies may show lower rates of loosening. 14 In the current study, specimens were analyzed from an explantation retrieval library. Three patients experienced postoperative subscapularis rupture and the other 3 patients had rotator cuff tears other than the subscapularis, which has been shown to contribute to instability and eccentric loading of the humeral component on the glenoid surface after primary TSR.…”

Hybrid Glenoid Designs in Anatomic Total Shoulder Arthroplasty: A Systematic Review

“…The indication for surgery was osteoarthritis in 445 Various hybrid glenoid components were used. Two studies with 362 shoulders used the Equinoxe Cage Glenoid (Exactech, Inc., Gainesville, Florida) [5,7], and 2 studies with 88 shoulders used the Comprehensive Shoulder System (Zimmer Biomet, Warsaw, Indiana) [8,18]. Two studies with 103 shoulders used the trabecular metal glenoid (Zimmer Biomet) [2,9], and 1 study with 40 shoulders used the second-generation trabecular tantalum glenoid (Zimmer Biomet) [14].…”

A comparison of pegged vs. keeled glenoid components regarding functional and radiographic outcomes in anatomic total shoulder arthroplasty: a systematic review and meta-analysis

“…A total of 25 studies were noncomparative. Of these studies, 9 examined keeled glenoid fixations9, 12, 15, 19, 23, 31, 50, 51, 54 and 16 examined pegged glenoid fixations5, 7, 14, 25, 26, 27, 28, 29, 35, 36, 38, 39, 42, 45, 49, 53 (Table I). Among these studies, 10 reported ASES scores, 16 reported Constant scores, 19 reported radiolucency rates, and 19 reported revision rates.…”

“…of participantsTotal no. of shoulders with radiolucency at final follow-upASES scoreConstant scoreRevision rateArnold et al, 5 2011PrimaryPegged351181.30Bell and Coghlan, 7 2014PrimaryPegged50892.58860.020Budge et al, 9 2013VariousKeeled19170.50.158Collin et al, 12 2011PrimaryKeeled5620630.054De Wilde et al, 14 2013VariousPegged34472Denard et al, 15 2013PrimaryKeeled502273.40.34Fox et al, 19 2013VariousKeeled1511020.046Gazielly and Scarlat, 23 2015PrimaryKeeled396730.026Greiner et al, 25 2013VariousPegged902484.20.075Groh, 26 2010VariousPegged8300Gulotta et al, 27 2015PrimaryPegged4080.10.05Ho et al, 28 2013Primary…”