Glenoid Loosening in Total Shoulder Arthroplasty

Abstract Purpose We aimed to compare the outcomes and complications of anatomical shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) for primary glenohumeral osteoarthritis with intact cuff tissue. Materials and methods The MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before March 2, 2021 using the PRISMA guidelines. Studies were included if they directly compared aTSA and rTSA for treating primary glenohumeral arthritis. A meta-analysis was performed using six studies that compared radiologic outcomes, functional scores, and range of motion (ROM). All the data were pooled using a random-effects model. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated as dichotomous data, while continuous data were analyzed using mean differences with 95% CIs. Results Two independent researchers reviewed 1,061 studies. Six studies met the inclusion criteria. The range of motion, especially external rotation, was better for aTSA than for rTSA (MD = − 10.28, 95% CI: − 16.69 to − 3.88, P = 0.002). Functional scores showed no difference between aTSA and rTSA. Glenoid loosening (OR = 0.17, 95% CI: 0.06–0.50, P = 0.001) was more common with aTSA, and scapula notching (OR = 10.63, 95% CI: 1.73–65.27, P = 0.01) with rTSA. In the mid-term follow-up, the overall revision rate showed no difference between aTSA and rTSA, with a pooled OR of 0.33 (95% CI: 0.07–1.57, P = 0.16). Conclusion A better ROM was achieved after aTSA than after rTSA. There was no difference in the revision rate at mid-term follow-up between aTSA and rTSA. Glenoid loosening was more common with aTSA, and scapula notching with rTSA. Level of evidence: Level IV, Meta-analysis.

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Anatomical total shoulder arthroplasty in young patients with osteoarthritis

The Bone & Joint Journal ◽

10.1302/0301-620x.100b4.bjj-2017-0495.r2 ◽

2018 ◽

Vol 100-B (4) ◽

pp. 485-492 ◽

Cited By ~ 15

Author(s):

M. O. Gauci ◽

N. Bonnevialle ◽

G. Moineau ◽

M. Baba ◽

G. Walch ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Polyethylene Wear ◽

Total Shoulder Arthroplasty ◽

Young Patients ◽

Glenoid Component ◽

Implant Survival ◽

Survivorship Analysis ◽

Kaplan Meier ◽

Glenoid Loosening

Aims Controversy about the use of an anatomical total shoulder arthroplasty (aTSA) in young arthritic patients relates to which is the ideal form of fixation for the glenoid component: cemented or cementless. This study aimed to evaluate implant survival of aTSA when used in patients aged < 60 years with primary glenohumeral osteoarthritis (OA), and to compare the survival of cemented all-polyethylene and cementless metal-backed glenoid components. Materials and Methods A total of 69 consecutive aTSAs were performed in 67 patients aged < 60 years with primary glenohumeral OA. Their mean age at the time of surgery was 54 years (35 to 60). Of these aTSAs, 46 were undertaken using a cemented polyethylene component and 23 were undertaken using a cementless metal-backed component. The age, gender, preoperative function, mobility, premorbid glenoid erosion, and length of follow-up were comparable in the two groups. The patients were reviewed clinically and radiographically at a mean of 10.3 years (5 to 12, sd 26) postoperatively. Kaplan–Meier survivorship analysis was performed with revision as the endpoint. Results A total of 26 shoulders (38%) underwent revision surgery: ten (22%) in the polyethylene group and 16 (70%) in the metal-backed group (p < 0.0001). At 12 years’ follow-up, the rate of implant survival was 74% (sd 0.09) for polyethylene components and 24% (sd 0.10) for metal-backed components (p < 0.0002). Glenoid loosening or failure was the indication for revision in the polyethylene group, whereas polyethylene wear with metal-on-metal contact, instability, and insufficiency of the rotator cuff were the indications for revision in the metal-backed group. Preoperative posterior subluxation of the humeral head with a biconcave/retroverted glenoid (Walch B2) had an adverse effect on the survival of a metal-backed component. Conclusion The survival of a cemented polyethylene glenoid component is three times higher than that of a cementless metal-backed glenoid component ten years after aTSA in patients aged < 60 years with primary glenohumeral OA. Patients with a biconcave (B2) glenoid have the highest risk of failure. Cite this article: Bone Joint J 2018;100-B:485–92.

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Symptomatic Glenoid Loosening Complicating Total Shoulder Arthroplasty

HSS Journal ® ◽

10.1007/s11420-009-9148-1 ◽

2010 ◽

Vol 6 (1) ◽

pp. 52-56 ◽

Cited By ~ 14

Author(s):

Bradley S. Raphael ◽

Joshua S. Dines ◽

Russell F. Warren ◽

Mark Figgie ◽

Edward V. Craig ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Glenoid Loosening

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Experimental Validation of Computer-Simulated Glenoid Preparation for Total Shoulder Arthroplasty

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53506 ◽

2011 ◽

Cited By ~ 1

Author(s):

Charlie Yongpravat ◽

Jonathan D. Lester ◽

Alen Trubelja ◽

R. Michael Greiwe ◽

Comron Saifi ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Experimental Validation ◽

Total Shoulder Arthroplasty ◽

Three Dimensional ◽

Surface Preparation ◽

The Past ◽

Implant Placement ◽

Operative Planning ◽

Glenoid Surface ◽

Glenoid Loosening

The use of three-dimensional (3D) computer simulations for pre-operative planning of total shoulder arthroplasty (TSA) has greatly increased in the past decade [1,2]. These studies have primarily focused on optimizing glenoid resurfacing to elucidate the factors involved in glenoid loosening, the most common cause of TSA failure [3,4]. While finite element analyses have investigated the effects of glenoid resurfacing parameters such as implant placement and depth of reaming on the stresses associated with the glenoid/cement/implant construct, none have determined if their method for simulating glenoid surface preparation is physically representative or accurate. In TSA, the first step in glenoid resurfacing is reaming the glenoid surface in preparation for the placement of the glenoid implant. The purpose of this study was to validate the volume removed as determined by computer simulated reaming against the volume removed by ream of cadaveric scapulae.

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Arthroscopic assessment of glenoid loosening following total shoulder arthroplasty

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/0749-8063(91)90150-v ◽

1991 ◽

Vol 7 (3) ◽

pp. 317

Keyword(s):

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Glenoid Loosening

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Does the cement mantle thickness influence the glenoid loosening in anatomic total shoulder arthroplasty? An experimental study

Journal of Orthopaedic Science ◽

10.1016/j.jos.2018.07.009 ◽

2019 ◽

Vol 24 (1) ◽

pp. 81-86 ◽

Cited By ~ 1

Author(s):

Philippe Clavert ◽

Julia Bouchaïb ◽

Agathe Kling ◽

Jean-François Kempf

Keyword(s):

Experimental Study ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Cement Mantle ◽

Glenoid Loosening ◽

Mantle Thickness

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Is preoperative glenoid bone mineral density associated with aseptic glenoid implant loosening in anatomic total shoulder arthroplasty?

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03892-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Sandrine Mariaux ◽

Raphaël Obrist ◽

Alain Farron ◽

Fabio Becce ◽

Alexandre Terrier

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Medium Effect ◽

Implant Survival ◽

Implant Loosening ◽

Mineral Density ◽

Glenoid Loosening ◽

The Impact

Abstract Background Aseptic loosening of glenoid implants is the primary revision cause in anatomic total shoulder arthroplasty (aTSA). While supported by biomechanical studies, the impact of glenoid bone quality, more specifically bone mineral density (BMD), on aseptic glenoid loosening remains unclear. We hypothesized that lower preoperative glenoid BMD was associated with aseptic glenoid implant loosening in aTSA. Methods We retrospectively included 93 patients (69 females and 24 males; mean age, 69.2 years) who underwent preoperative non-arthrographic shoulder computed tomography (CT) scans and aTSA between 2002 and 2014. Preoperative glenoid BMD (CT numbers in Hounsfield unit) was measured in 3D using a reliable semi-automated quantitative method, in the following six contiguous volumes of interest (VOI): cortical, subchondral cortical plate (SC), subchondral trabecular, and three successive adjacent layers of trabecular bone. Univariate Cox regression was used to estimate the impact of preoperative glenoid BMD on aseptic glenoid implant loosening. We further compared 26 aseptic glenoid loosening patients with 56 matched control patients. Results Glenoid implant survival rates were 89% (95% confidence interval CI, 81–96%) and 57% (41–74%) at 5 and 10 years, respectively. Hazard ratios for the different glenoid VOIs ranged between 0.998 and 1.004 (95% CI [0.996, 1.007], p≥0.121). Only the SC VOI showed significantly lower CTn in the loosening group (622±104 HU) compared with the control group (658±88 HU) (p=0.048), though with a medium effect size (d=0.42). There were no significant differences in preoperative glenoid BMD in any other VOI between patients from the loosening and control groups. Conclusions Although the preoperative glenoid BMD was statistically significantly lower in the SC region of patients with aseptic glenoid implant loosening compared with controls, this single-VOI difference was only moderate. We are thus unable to prove that lower preoperative glenoid BMD is clearly associated with aseptic glenoid implant loosening in aTSA. However, due to its proven biomechanical role in glenoid implant survival, we recommend extending this study to larger CT datasets to further assess and better understand the impact of preoperative glenoid BMD on glenoid implant loosening/survival and aTSA outcome.

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