This Level I RCT compared pegged versus keeled cemented glenoid components in total shoulder arthroplasty for primary osteoarthritis. All implants used modern cementing (compaction and pressurization). The question: does modern cementing eliminate the fixation advantage of pegged designs on immediate and mid-term radiographs?
When choosing a glenoid component for total shoulder arthroplasty in primary osteoarthritis, this trial supports the pegged design. Even with optimal modern cementing (compaction of cancellous bone plus cement pressurization), keeled components accumulated three times the radiographic lucency at mid-term (46% vs 15%).
The mental model: radiolucent lines predict loosening, and progression of those lines is the strongest warning sign. Early parity between designs is misleading because the keel's mechanical disadvantage reappears with time. Watch for higher lucency in female and osteoporotic patients, and keep glenohumeral mismatch at 6 mm or greater to limit radiolucent line formation.
This is a single-surgeon, single-implant study with only 26-month follow-up and unblinded raters, so weight it as supportive rather than definitive on long-term survivorship.
This Level I RCT compared pegged versus keeled cemented glenoid components in total shoulder arthroplasty for primary osteoarthritis. All implants used modern cementing (compaction and pressurization). The question: does modern cementing eliminate the fixation advantage of pegged designs on immediate and mid-term radiographs?
When choosing a glenoid component for total shoulder arthroplasty in primary osteoarthritis, this trial supports the pegged design. Even with optimal modern cementing (compaction of cancellous bone plus cement pressurization), keeled components accumulated three times the radiographic lucency at mid-term (46% vs 15%).
The mental model: radiolucent lines predict loosening, and progression of those lines is the strongest warning sign. Early parity between designs is misleading because the keel's mechanical disadvantage reappears with time. Watch for higher lucency in female and osteoporotic patients, and keep glenohumeral mismatch at 6 mm or greater to limit radiolucent line formation.
This is a single-surgeon, single-implant study with only 26-month follow-up and unblinded raters, so weight it as supportive rather than definitive on long-term survivorship.