Failure rates and outcomes after anatomic total shoulder arthroplasty are equivalent irrespective of subscapularis repair technique

Background: Despite the increased popularity of reverse total shoulder arthroplasty, total shoulder arthroplasty is the standard treatment for advanced shoulder arthritis in young adult patients. Conventional metal-backed glenoid (MBG) designs result in more loosening and revision surgery compared with cemented polyethylene glenoid components. However, modern MBG designs have been recently devised to overcome such drawbacks. Purpose: To compare the radiolucency, loosening, and failure rates of modern MBG designs with those of conventional designs. Study Design: Systematic review; Level of evidence, 4. Methods: A search for relevant articles was carried out using the PubMed, Cochrane Library, and Embase databases using MeSH (Medical Subject Headings) terms and natural keywords. A total of 362 articles were screened. We descriptively analyzed numerical data between the groups and statistically analyzed categorical data, such as the presence of loosening, failure, and revision surgery. The main outcome was the rate of revision surgery or failure. Subgroup analysis according to follow-up duration was performed to reduce heterogeneity. Results: A total of 25 articles (2036 shoulders) were included; 15 articles (1579 shoulders) involved a conventional MBG design, and 10 (457 shoulders) involved a modern design. The mean age of the patients was 64.2 and 66.5 years in the conventional and modern design groups, respectively, with a mean follow-up duration of 102.0 and 56.1 months, a mean gain of forward elevation of 35.1° and 61.7°, and a mean gain of external rotation of 24.2° and 39.2°. The rate of radiolucency was 48.0% and 16.7%, the rate of loosening was 11.2% and 4.9%, and the rate of revision was 15.9% and 2.4%, for the conventional and modern design groups, respectively. Subgroup analysis according to follow-up duration showed that the rates of loosening and revision were significantly lower in the modern design group ( P < .001). Conclusion: Our findings suggest that modern MBG designs showed significantly lower loosening and failure rates than conventional designs. The overall results of the comparison, including loosening, failure, change in range of motion, and clinical scores, indicate that modern MBG designs are promising. More long-term follow-up studies on modern MBGs should be conducted.

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Subscapularis Peel in Anatomic Total Shoulder Arthroplasty

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/2471549218813409 ◽

2018 ◽

Vol 2 ◽

pp. 247154921881340

Author(s):

Corey T Clyde ◽

Thomas W Throckmorton ◽

Thomas R Duquin

Keyword(s):

Rotator Cuff ◽

Shoulder Arthroplasty ◽

Clinical Studies ◽

Total Shoulder Arthroplasty ◽

Subscapularis Tendon ◽

Lesser Tuberosity ◽

Repair Method ◽

Advantages And Disadvantages ◽

Repair Technique ◽

Viable Treatment

Background Anatomic total shoulder arthroplasty is a viable treatment option for patients with glenohumeral arthritis and an intact rotator cuff with successful outcomes. However, one complication is rupture of the subscapularis tendon postoperatively. Controversy exists regarding the optimal technique of subscapularis tendon management. The purpose of the present article is to review subscapularis peel repair method. Methods The current literature on anatomic total shoulder arthroplasty and subscapularis peel was reviewed to determine the viability of the repair technique. Results Both biomechanical and clinical studies have demonstrated advantages and disadvantages of the subscapularis peel technique, most often by way of direct comparison with lesser tuberosity osteotomy, without consensus as to a superior repair method. Discussion The subscapularis peel repair in anatomic total shoulder arthroplasty when performed correctly may yield successful biomechanical and clinical outcomes for patients.

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