Radiographic and clinical outcomes of total shoulder arthroplasty with an all-polyethylene pegged bone ingrowth glenoid component: prospective short- to medium-term follow-up

Background: Hybrid glenoid components in total shoulder arthroplasty (TSA) utilize both polyethylene and metal components to provide short-term stability and long-term biologic fixation through bone ingrowth. Questions/Purpose: We sought to systematically review the literature for studies that assessed outcomes of TSA performed using hybrid glenoid components. Methods: PubMed, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase were searched systematically for articles measuring clinical and patient-reported outcomes and rates of complication and revision following TSA using a hybrid glenoid component. Results: Seven studies with 593 shoulders were included in this review. The mean age of patients was 65 ± 1 years, and 46% of the population was male. Mean follow-up was 50 months (4.2 years). The overall complication rate was 7% and rate of revision was 2.5%; glenoid radiolucency was present in 33% of shoulders at mean follow-up of 50 months. Mean improvements in forward elevation, external rotation, internal rotation score, and abduction were 49°, 28°, 2 points, and 42°, respectively. Mean improvements in Constant, American Shoulder and Elbow Surgeons (ASES), and University of California, Los Angeles (UCLA) scores were 36 points, 52 points, and 17 points, respectively. Conclusion: Our review found that TSA using hybrid glenoid components results in low rates of complication and revision at early follow-up. Long-term studies are warranted to understand more fully the role of hybrid glenoid components in TSA.

Download Full-text

Medium-term rates of radiolucency after primary total shoulder arthroplasty using a cementless metal-backed pegged polyethylene glenoid

Shoulder & Elbow ◽

10.1177/1758573219901122 ◽

2020 ◽

pp. 175857321990112

Author(s):

Nicholas J Murray ◽

Khalid Al-Hourani ◽

Mark AA Crowther ◽

Partha P Sarangi ◽

Philip A McCann

Keyword(s):

Retrospective Study ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Glenoid Component ◽

Medium Term ◽

Single Centre ◽

Primary Indication ◽

Cause Of Failure ◽

Established Treatment

Background Total shoulder arthroplasty is an established treatment with the commonest cause of failure loosening of the glenoid component. Hydroxyapatite metal-backed glenoid components could offer better survivorship due to improved fixation. The aim of this study was to investigate periprosthetic radiolucency rates associated with an uncemented, metal-backed polyethylene glenoid component with medium-term results. Methods A single centre retrospective study examining radiological outcomes of the Epoca metal-backed glenoid component. Radiographs were analysed for post-operative adequacy of glenoid seating and radiographs at follow-up assessed for periprosthetic lucencies and any revision procedures were recorded. Results Forty-one patients were followed up with a mean follow-up time of 5.5 years (3–8 years). Primary indication for total shoulder arthroplasty was osteoarthritis (80%). Mean age was 69 years (53–86 years). Ninety-five per cent of glenoid components were completely seated. At follow-up six patients had undergone revision (14.6%). Thirty of the remaining patients (86%) did not demonstrate any radiolucency on follow-up radiographs. Complete glenoid seating post-operatively was associated with lower rate of subsequent radiolucency and revision (P < 0.01). Conclusion Low rates of radiolucency at medium-term follow-up with an uncemented metal-backed glenoid, however significant rates of revision. Complete seating of the glenoid component was associated with lower rates of radiolucency and revision.

Download Full-text

Clinical Use of a Computer Assisted Anatomic Total Shoulder Arthroplasty System: An Analysis of 574 Cases

10.29007/kld9 ◽

2019 ◽

Author(s):

Alexander Greene ◽

Sandrine Polakovic ◽

Christopher Roche ◽

Yifei Dai

Keyword(s):

Clinical Outcomes ◽

Shoulder Arthroplasty ◽

Preoperative Planning ◽

Total Shoulder Arthroplasty ◽

Computer Assisted Surgery ◽

Computer Assisted ◽

Glenoid Component ◽

Implant Placement ◽

Implant Selection

Accurate reproduction of glenohumeral anatomy during anatomic total shoulder arthroplasty (aTSA) has been shown to correlate with positive clinical outcomes. Preoperative planning and computer assisted surgery (CAS) can improve upon glenoid placement, but such systems for aTSA have experienced limited commercial success. Postoperative surgical reports from the first 574 clinical cases of a commercially available CAS aTSA system were collected and analyzed for implant selection, implant placement, and incision start to incision close operative time, and compared to similar date cohorts for non-navigated cases. Navigated aTSA cases had a significantly longer incision time than non-navigated cases. Augmented glenoid components were used in a much higher percentage of navigated cases than non-navigated cases, suggesting that augmented glenoid components provide utility for correcting pathologic glenoid wear. The average resultant version of the implanted component increased with the size of augment used, suggesting there may not be a clear consensus on optimal retroversion. term clinical follow up will need to be collected to determine if preoperative planning combined with more precise and accurate glenoid component positioning leads to improved clinical outcomes and implant longevity.

Download Full-text

Mid-term outcomes of bony increased offset-reverse total shoulder arthroplasty in the Asian population

Clinics in Shoulder and Elbow ◽

10.5397/cise.2021.00087 ◽

2021 ◽

Vol 24 (3) ◽

pp. 125-134

Author(s):

Kirtan Tankshali ◽

Dong-Whan Suh ◽

Jong-Hun Ji ◽

Chang-Yeon Kim

Keyword(s):

Los Angeles ◽

Clinical Outcomes ◽

Shoulder Arthroplasty ◽

Intraoperative Complications ◽

Total Shoulder Arthroplasty ◽

Asian Population ◽

Reverse Total Shoulder Arthroplasty ◽

Scapular Notching ◽

Reverse Total Shoulder

Background: To evaluate clinical and radiological outcomes of bony increased offset-reverse total shoulder arthroplasty (BIO-RSA) in the Asian population at mid-term follow-up.Methods: From June 2012 to August 2017 at a single center, 43 patients underwent BIO-RSA, and 38 patients with a minimum of 2 years of follow-up were enrolled. We evaluated the preoperative and postoperative clinical outcomes, radiological outcomes (notching and loosening), and complications of BIO-RSA at the last follow-up. In addition, we divided these patients into notching and not-notching groups and compared the demographics, preoperative, and postoperative characteristics of patients between the two groups.Results: Visual analog scale, American Shoulder and Elbow Surgeons, University of California-Los Angeles, and Simple Shoulder Test scores improved significantly from preoperative (average: 5, 39.43, 16.22, 3.94) to postoperative (average: 1.71, 78.91, 28.34, 7.8; p<0.05) outcomes. All range of motion except internal rotation improved significantly at the final follow-up (p<0.05), and the bone graft was well-incorporated with the native glenoid in all patients (100%). However, scapular notching was observed in 20/38 patients (53%). In the comparison between notching and not-notching groups (18 vs. 20 patients), there were no significant differences in demographics, radiological parameters, and clinical outcomes except acromion-greater tuberosity (AT) distance (p=0.003). Intraoperative complications were three metaphyseal fractures and one inferior screw malposition. Postoperative complications included one heterotopic ossification, one scapula neck stress fracture, one humeral stem loosening, and one late infection.Conclusions: BIO-RSA resulted in improved clinical outcomes at mid-term follow-up in the Asian population. Although better cosmesis and advantages of glenoid lateralization were observed, we observed higher rates of scapular notching compared to previously reported rates in BIO-RSA studies. In addition, adequate glenoid lateralization with appropriate humeral lengthening (AT distance) might reduce scapular notching.

Download Full-text

Total Shoulder Arthroplasty with a Metal-Backed, Bone-Ingrowth Glenoid Component: Medium to Long-Term Results

Yearbook of Hand and Upper Limb Surgery ◽

10.1016/s1551-7977(09)79281-7 ◽

2009 ◽

Vol 2009 ◽

pp. 25-26

Author(s):

G.S. Athwal

Keyword(s):

Shoulder Arthroplasty ◽

Bone Ingrowth ◽

Total Shoulder Arthroplasty ◽

Long Term Results ◽

Glenoid Component

Download Full-text

Anatomic total shoulder arthroplasty with an inlay glenoid component: clinical outcomes and return to activity

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2019.10.003 ◽

2020 ◽

Vol 29 (6) ◽

pp. 1188-1196 ◽

Cited By ~ 2

Author(s):

Gregory L. Cvetanovich ◽

Amanda J. Naylor ◽

Michael C. O'Brien ◽

Brian R. Waterman ◽

Grant H. Garcia ◽

...

Keyword(s):

Clinical Outcomes ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Glenoid Component ◽

Return To Activity

Download Full-text

Radiographic and clinical outcomes of second generation Trabecular Metal™ glenoid components in total shoulder arthroplasty

Shoulder & Elbow ◽

10.1177/1758573220909981 ◽

2020 ◽

pp. 175857322090998

Author(s):

Raymond E Chen ◽

Alexander M Brown ◽

Alexander S Greenstein ◽

Sandeep Mannava ◽

Ilya Voloshin

Keyword(s):

Clinical Outcomes ◽

Shoulder Arthroplasty ◽

Second Generation ◽

Total Shoulder Arthroplasty ◽

Implant Survival ◽

Trabecular Metal ◽

Metal Debris ◽

Shoulder Range Of Motion ◽

Shoulder Range

Background Total shoulder arthroplasty with second generation porous tantalum glenoid implants (Trabecular Metal™) has shown good short-term outcomes, but mid-term outcomes are unknown. This study describes the clinical, radiographic, and patient-rated mid-term outcomes of total shoulder arthroplasty utilizing cemented Trabecular Metal™ glenoid components. Methods Patients who underwent anatomic total shoulder arthroplasty with cemented Trabecular Metal™ glenoid components for primary osteoarthritis were identified for minimum five-year follow-up. The primary outcome measure was implant survival; secondary outcome measures included patient-rated outcome scores, shoulder range of motion findings, and radiographic analysis. Results Twenty-seven patients were enrolled in the study. Twenty-one patients had full radiographic follow-up. Mean follow-up was 6.6 years. There was 100% implant survival. Shoulder range of motion significantly improved and the mean American Shoulder and Elbow Society score was 89.8. There was presence of metal debris radiographically in 24% of patients. Twenty-nine percent of patients had evidence of radiolucency. Fourteen percent of patients had moderate superior subluxation. Conclusion Total shoulder arthroplasty with second generation cemented Trabecular Metal™ glenoid components yielded good outcomes at mean 6.6-year follow-up. Metal debris incidence and clinical outcomes were similar to short-term findings. The presence of metal debris did not significantly affect clinical outcomes. Continued observation of these patients will elucidate longer-term implant survival.

Download Full-text

Bilateral total shoulder arthroplasty: A systematic review of clinical outcomes

Shoulder & Elbow ◽

10.1177/1758573220916822 ◽

2020 ◽

pp. 175857322091682

Author(s):

John-Rudolph H Smith ◽

Darby A Houck ◽

Jessica A Hart ◽

Jonathan T Bravman ◽

Rachel M Frank ◽

...

Keyword(s):

Patient Satisfaction ◽

Clinical Outcomes ◽

Shoulder Arthroplasty ◽

English Language ◽

External Rotation ◽

Total Shoulder Arthroplasty ◽

Cochrane Library ◽

Level Of Evidence ◽

Patient Reported

Background The purpose of this study was to describe the clinical outcomes following bilateral total shoulder arthroplasty (TSA). Methods A systematic search of the PubMed, Embase, and Cochrane Library databases following PRISMA guidelines was performed. English-language literature published from 2010 to 2018 analyzing bilateral TSA (anatomic and/or reverse) with a minimum one-year follow-up was reviewed by two independent reviewers. Study quality was evaluated with the Modified Coleman Methodology Score and the methodological index for non-randomized studies score. Results Eleven studies (1 Level II, 3 Level III, 7 Level IV) with 292 patients were included. Two studies reported on bilateral anatomic TSA ( n = 54), six reported on bilateral reverse TSA (RTSA; n = 168), two reported on anatomic TSA with contralateral RTSA (TSA/RTSA; n = 31), and one compared bilateral anatomic TSA ( n = 26) and bilateral RTSA ( n = 13). Among studies, mean revision rate ranged from 0% to 10.53% and mean complication rate ranged from 4.9% to 31.3%. At final follow-up, patients experienced significant overall improvements in range of motion and patient-reported outcome score measurements. However, bilateral anatomic TSA resulted in greater improvements in external rotation compared to bilateral RTSA. Overall patient satisfaction was 91.0%. Conclusion The available data indicate that bilateral TSA allows for functional and pain improvements and result in high patient satisfaction. Level of evidence IV.

Download Full-text

Anatomic Total Shoulder Arthroplasty Using a Self-Pressurizing Pegged Bone-Preserving Cemented Glenoid Component: A 2- to 5-Year Follow-up Study

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/2471549217750478 ◽

2018 ◽

Vol 2 ◽

pp. 247154921775047

Author(s):

Joaquin Sanchez-Sotelo ◽

Ngoc Tram V Nguyen ◽

Mark Morrey

Keyword(s):

Shoulder Arthroplasty ◽

External Rotation ◽

Total Shoulder Arthroplasty ◽

Loose Body ◽

Deep Infection ◽

Glenoid Component ◽

Total Shoulder Arthroplasties ◽

Shoulder Arthroplasties ◽

And Function

Background: High rates of radiographic loosening have been reported with various glenoid designs. Many available designs sacrifice most of the bone at the central portion of the glenoid vault, creating large areas of deficiency when revision becomes necessary. The purpose of this study was to report the 2- to 5-year outcome of shoulder arthroplasty using a bone-preserving all-polyethylene glenoid components with self-pressurizing pegs. Methods: Between August 2011 and December 2014, 202 consecutive anatomic total shoulder arthroplasties (TSAs) were performed by a single surgeon with implantation of a self-pressurizing cemented pegged glenoid component in 190 patients (12 patients had both shoulders replaced). Patients were followed up prospectively and evaluated for pain, motion, strength, American Shoulder and Elbow Surgeons (ASES) scores, and radiographic changes. The mean follow-up time was 2.7 (2–5) years. Results: TSA improved pain and function reliably. At the most recent follow-up, 94% of the shoulders had no or mild pain. Motion included 154 ± 25° of elevation, 68 ± 18° of external rotation, and median internal rotation to T10 (range, iliac crest to T4). The most recent average ASES score was 82 ± 15 points. Early postoperative radiographs showed no radiolucent lines. No humeral or glenoid component was considered radiographically loose at the most recent follow-up. Complications requiring reoperation included subscapularis insufficiency (4), posterior instability (2), deep infection (1), stiffness (1), and a painful loose body (1). No components were revised for loosening. Conclusions: Anatomic TSA using a cemented bone-preserving all-polyethylene pegged self-pressurizing glenoid component provided satisfactory clinical outcomes and survival at 2 to 5 years.

Download Full-text