Radiographic comparison of pegged and keeled glenoid components using modern cementing techniques: A prospective randomized study

Edwards, T. Bradley; Labriola, Joanne E.; Stanley, Rodney J.; O’Connor, Daniel P.; Elkousy, Hussein; Gartsman, Gary M.

doi:10.1016/j.jse.2009.10.013

Cited by 113 publications

(55 citation statements)

References 33 publications

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“…In a review of nearly 3000 total shoulder arthroplasties, Bohsali et al [5] reported the incidence of aseptic loosening to be 39% after 5 years, with 83% of cases attributed to failure of the glenoid component. Shoulder arthroplasty in the setting of posterior glenoid bone loss is associated with a threefold increase in stress in the cement mantle and sevenfold increase in glenoid component micromotion [13,14,37]. Glenoid component retroversion decreases glenohumeral contact area, increases contact pressure, and may lead to eccentric loading with resultant glenoid component loosening [14,37].…”

Section: Introductionmentioning

confidence: 99%

Posterior Glenoid Wear in Total Shoulder Arthroplasty: Eccentric Anterior Reaming Is Superior to Posterior Augment

Wang

Abrams

Behn

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Uncorrected glenoid retroversion during total shoulder arthroplasty may lead to an increased likelihood of glenoid prosthetic loosening. Augmented glenoid components seek to correct retroversion to address posterior glenoid bone loss, but few biomechanical studies have evaluated their performance. Questions/purposes We compared the use of augmented glenoid components with eccentric reaming with standard glenoid components in a posterior glenoid wear model. The primary outcome for biomechanical stability in this model was assessed by (1) implant edge displacement in superior and inferior edge loading at intervals up to 100,000 cycles, with secondary outcomes including (2) implant edge load during superior and inferior translation at intervals up to 100,000 cycles, and (3) incidence of glenoid fracture during implant preparation and after cyclic loading. Methods A 12°-posterior glenoid defect was created in 12 composite scapulae, and the specimens were divided in two equal groups. In the posterior augment group, glenoid version was corrected to 8°and an 8°-augmented polyethylene glenoid component was placed. In the eccentric reaming group, anterior glenoid reaming was performed to neutral version and a standard polyethylene glenoid component was placed. Specimens were cyclically loaded in the superoinferior direction to 100,000 cycles. Superior and inferior glenoid edge displacements were recorded. Results Surviving specimens in the posterior augment group showed greater displacement than the eccentric reaming group of superior (1.01 ± 0.02 [95% CI, 0.89-1.13] versus 0. 83 ± 0.10 [95% CI,

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Section: Introductionmentioning

confidence: 99%

Posterior Glenoid Wear in Total Shoulder Arthroplasty: Eccentric Anterior Reaming Is Superior to Posterior Augment

Wang

Abrams

Behn

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Study recruitment was closed after 15 patients (16 shoulders), as the participating surgeon felt that continuing to randomize patients to receive the keeled implant was no longer appropriate based on clinical judgment and mounting published evidence indicating the keeled implant was not as successful as the pegged implant. 5,16,17,23 Of the 16 patients enrolled, 11 were included in the 12-month postoperative analysis and 9 were included in the 24-month analysis owing to missed examinations and loss to follow-up. Figure 1 summarizes patient recruitment, loss to follow-up, outcome scores, and RSA analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Although a small number of clinical studies of cemented TSA have shown no difference in micromotion or radiolucency between pegged and keeled glenoid components, 5,17 a recent review by Vavken and colleagues, 3 along with numerous other studies, 4,8,16,[23][24][25] showed that keeled glenoid components are inferior to pegged components in terms of fixation and patient outcomes. These findings are consistent with our study based on both the RSA and patient-reported outcome measures data.…”

Section: Discussionmentioning

confidence: 99%

Radiostereometric analysis of keeled versus pegged glenoid components in total shoulder arthroplasty: a randomized feasibility study

Gascoyne

McRae

Parashin

et al. 2017

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Radiostereometric analysis of keeled versus pegged glenoid components in total shoulder arthroplasty: a randomized feasibility study Background: This study aimed to assess differences in the fixation and functional outcomes between pegged and keeled all-polyethylene glenoid components for standard total shoulder arthroplasty. Methods:Patients were randomized to receive a keeled or pegged all-polyethylene glenoid component. We used model-based radiostereometric analysis (RSA) to assess glenoid fixation and subjective outcome measures to assess patient function. Followup examinations were completed at 6 weeks and 6, 12 and 24 months after surgery. Modifications to the RSA surgical, imaging and analytical techniques were required throughout the study to improve the viability of the data.Results: Stymied enrolment resulted in only 16 patients being included in our analyses. The RSA data indicated statistically greater coronal plane migration in the keeled glenoid group than in the pegged group at 12 and 24 months. Functional outcome scores did not differ significantly between the groups at any follow-up. One patient with a keeled glenoid showed high component migration after 24 months and subsequently required revision surgery 7 years postoperatively.

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“…Fox et al [10] reported that glenoid component survivorship can be as much as 99% at 5 years using all-polyethelene cemented components . Because frank loosening is a relatively rare occurrence, others have evaluated the early development of radiolucent lines to help predict eventual glenoid loosening [3,6,8,14,19,20,24,30,33]. Although it might be debatable whether early radiolucencies portend future loosening, they generally are regarded as something to be avoided if possible.…”

Section: Discussionmentioning

confidence: 99%

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

Gulotta

Chambers

Warren

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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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.

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Radiographic comparison of pegged and keeled glenoid components using modern cementing techniques: A prospective randomized study

Cited by 113 publications

References 33 publications

Posterior Glenoid Wear in Total Shoulder Arthroplasty: Eccentric Anterior Reaming Is Superior to Posterior Augment

Posterior Glenoid Wear in Total Shoulder Arthroplasty: Eccentric Anterior Reaming Is Superior to Posterior Augment

Radiostereometric analysis of keeled versus pegged glenoid components in total shoulder arthroplasty: a randomized feasibility study

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

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