This is the only Level I randomized trial comparing an uncemented second-generation trabecular metal-backed glenoid against a cemented all-polyethylene glenoid in anatomic total shoulder arthroplasty. It reports 5-year disease-specific quality of life, patient-reported, clinical, and radiographic outcomes in 93 patients with primary glenohumeral osteoarthritis. The primary outcome was the WOOS quality-of-life index.
When you counsel a patient for anatomic TSA, this trial says the fixation debate (uncemented trabecular metal vs. cemented polyethylene) does not change disease-specific quality of life at 5 years. Both implants gave WOOS scores in the low 90s with equal function and pain relief. Choose based on bone stock and your revision philosophy, not expected patient-reported outcome.
Do not over-read metal debris on TM glenoid follow-up films. Debris appeared in nearly a quarter of patients but was Endrizzi grade 1 or 2 and did not predict failure. Keep watching it, since rates rise over time, but low-grade debris alone is not a reason to revise.
Separate the two failure stories. The recalled first-generation TM glenoid failed early from fracture; the second-generation design in this trial had no fractures and no aseptic glenoid failures. Remember that most TSA revisions come from non-glenoid problems: rotator cuff deficiency, instability, and humeral loosening, which matches large registry data.
This is the only Level I randomized trial comparing an uncemented second-generation trabecular metal-backed glenoid against a cemented all-polyethylene glenoid in anatomic total shoulder arthroplasty. It reports 5-year disease-specific quality of life, patient-reported, clinical, and radiographic outcomes in 93 patients with primary glenohumeral osteoarthritis. The primary outcome was the WOOS quality-of-life index.
When you counsel a patient for anatomic TSA, this trial says the fixation debate (uncemented trabecular metal vs. cemented polyethylene) does not change disease-specific quality of life at 5 years. Both implants gave WOOS scores in the low 90s with equal function and pain relief. Choose based on bone stock and your revision philosophy, not expected patient-reported outcome.
Do not over-read metal debris on TM glenoid follow-up films. Debris appeared in nearly a quarter of patients but was Endrizzi grade 1 or 2 and did not predict failure. Keep watching it, since rates rise over time, but low-grade debris alone is not a reason to revise.
Separate the two failure stories. The recalled first-generation TM glenoid failed early from fracture; the second-generation design in this trial had no fractures and no aseptic glenoid failures. Remember that most TSA revisions come from non-glenoid problems: rotator cuff deficiency, instability, and humeral loosening, which matches large registry data.