Hsu, J Shoulder Elbow Surg 2018 - What Can Be Learned from an Analysis of 215 Glenoid Component Failures?

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What Can Be Learned from an Analysis of 215 Glenoid Component Failures?

Hsu, Matsen, et al.·J Shoulder Elbow Surg·2018·54 citations·Case series

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Background

Glenoid component failure is a prevalent mechanical complication of anatomic total shoulder arthroplasty. The objective of this study was to identify surgeon-controlled factors that may be addressed to reduce the rate of glenoid component failure that is sufficiently symptomatic to merit surgical revision.

Methods

We reviewed the clinical and radiographic features of 215 total shoulder arthroplasties that we revised for symptomatic glenoid component failure.

Results

Glenoid component failure was associated with poor patient self-assessed shoulder function (mean Simple Shoulder Test score, 3.0 ± 2.7).
These shoulders often showed multiple failure modes; 72% had glenoid component loosening, 69% had polyethylene wear, 51% had glenohumeral decentering, and 25% had humeral component loosening.
Metal-backed/hybrid and keeled glenoid designs had higher rates of loosening (P = .010), malposition (P = .007), dislocation (P < .001), and early failure (P = .044) in comparison to pegged designs.
Glenoid components with cement on the backside were more prevalent among those revised sooner than 5 years after the index surgery (P < .001).

Conclusions

Glenoid component failure remains a major cause of poor patient outcomes after total shoulder arthroplasty. The occurrence of severe glenoid component failure might be reduced by paying attention to glenoid component design and insertion technique, restoring the normal balance of the humeral head in the center of the glenoid, and considering a reverse total shoulder when the shoulder is unstable because of soft tissue deficiency.

Level of evidence: Level IV; Case Series; Treatment Study. Copyright remains with the authors and publisher.

What Can Be Learned from an Analysis of 215 Glenoid Component Failures?

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What Can Be Learned from an Analysis of 215 Glenoid Component Failures?

Hsu, Matsen, et al.·J Shoulder Elbow Surg·2018·54 citations·Case series

|

Background

Glenoid component failure is a prevalent mechanical complication of anatomic total shoulder arthroplasty. The objective of this study was to identify surgeon-controlled factors that may be addressed to reduce the rate of glenoid component failure that is sufficiently symptomatic to merit surgical revision.

Methods

We reviewed the clinical and radiographic features of 215 total shoulder arthroplasties that we revised for symptomatic glenoid component failure.

Results

Glenoid component failure was associated with poor patient self-assessed shoulder function (mean Simple Shoulder Test score, 3.0 ± 2.7).
These shoulders often showed multiple failure modes; 72% had glenoid component loosening, 69% had polyethylene wear, 51% had glenohumeral decentering, and 25% had humeral component loosening.
Metal-backed/hybrid and keeled glenoid designs had higher rates of loosening (P = .010), malposition (P = .007), dislocation (P < .001), and early failure (P = .044) in comparison to pegged designs.
Glenoid components with cement on the backside were more prevalent among those revised sooner than 5 years after the index surgery (P < .001).

Conclusions

Glenoid component failure remains a major cause of poor patient outcomes after total shoulder arthroplasty. The occurrence of severe glenoid component failure might be reduced by paying attention to glenoid component design and insertion technique, restoring the normal balance of the humeral head in the center of the glenoid, and considering a reverse total shoulder when the shoulder is unstable because of soft tissue deficiency.

Level of evidence: Level IV; Case Series; Treatment Study. Copyright remains with the authors and publisher.

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