Lazarus, J Bone Joint Surg Am 2002 - The Radiographic Evaluation of Keeled and Pegged Glenoid Component Insertion

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The Radiographic Evaluation of Keeled and Pegged Glenoid Component Insertion

Lazarus, Matsen, et al.·J Bone Joint Surg Am·2002·466 citations·Retrospective cohort

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Background

Radiolucent lines about the glenoid component of a total shoulder replacement are a common finding, even on initial postoperative radiographs. The achievement of complete osseous support of the component has been shown to decrease micromotion. We evaluated the ability of a group of experienced shoulder surgeons to achieve complete cementing and support in a series of patients managed with keeled and pegged glenoid components.

Methods

We reviewed the initial postoperative radiographs of 493 patients with primary osteoarthritis who had been managed with total shoulder arthroplasty by 17 different surgeons.
165 patients were excluded because of inadequate radiographs, leaving 328 patients available for review.
Of these, 39 patients had a keeled component and 289 had a pegged component.
The method of Franklin was used to grade the degree of radiolucency around the keeled components, and a modification of that method was used to grade the degree of radiolucency around the pegged components.
The efficacy of component seating on host subchondral bone was evaluated with a newly constructed 5-grade scale based on the percentage of the component that was supported by subchondral bone.
Each radiograph was graded 4 times, by 2 separate reviewers on 2 separate occasions.

Results

Radiolucencies were extremely common, with only 20 of the 328 glenoids demonstrating no radiolucencies.
On a numeric scale (with 0 indicating no radiolucency and 5 indicating gross loosening), the mean radiolucency score was 1.8 ± 0.9 for keeled components and 1.3 ± 0.9 for pegged components (p = 0.0004).
After defining categories of "better" and "worse" cementing, we found that pegged components more commonly had "better cementing" than did keeled components (p = 0.0028).
Incomplete seating was also common, particularly among patients with keeled components.
95 of the 121 pegged components that had been inserted by the most experienced surgeon had "better cementing," compared with 85 of the 168 pegged components that had been inserted by the remaining surgeons (p < 0.00001).

Conclusions

Perfectly cementing and seating a glenoid replacement is a difficult task. Radiolucencies and incomplete component seating occur more frequently in association with keeled components compared with pegged components. Surgeon experience may be an important variable in the achievement of a good technical outcome.

Copyright remains with the authors and publisher.

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The Radiographic Evaluation of Keeled and Pegged Glenoid Component Insertion

Lazarus, Matsen, et al.·J Bone Joint Surg Am·2002·466 citations·Retrospective cohort

|

Background

Radiolucent lines about the glenoid component of a total shoulder replacement are a common finding, even on initial postoperative radiographs. The achievement of complete osseous support of the component has been shown to decrease micromotion. We evaluated the ability of a group of experienced shoulder surgeons to achieve complete cementing and support in a series of patients managed with keeled and pegged glenoid components.

Methods

We reviewed the initial postoperative radiographs of 493 patients with primary osteoarthritis who had been managed with total shoulder arthroplasty by 17 different surgeons.
165 patients were excluded because of inadequate radiographs, leaving 328 patients available for review.
Of these, 39 patients had a keeled component and 289 had a pegged component.
The method of Franklin was used to grade the degree of radiolucency around the keeled components, and a modification of that method was used to grade the degree of radiolucency around the pegged components.
The efficacy of component seating on host subchondral bone was evaluated with a newly constructed 5-grade scale based on the percentage of the component that was supported by subchondral bone.
Each radiograph was graded 4 times, by 2 separate reviewers on 2 separate occasions.

Results

Radiolucencies were extremely common, with only 20 of the 328 glenoids demonstrating no radiolucencies.
On a numeric scale (with 0 indicating no radiolucency and 5 indicating gross loosening), the mean radiolucency score was 1.8 ± 0.9 for keeled components and 1.3 ± 0.9 for pegged components (p = 0.0004).
After defining categories of "better" and "worse" cementing, we found that pegged components more commonly had "better cementing" than did keeled components (p = 0.0028).
Incomplete seating was also common, particularly among patients with keeled components.
95 of the 121 pegged components that had been inserted by the most experienced surgeon had "better cementing," compared with 85 of the 168 pegged components that had been inserted by the remaining surgeons (p < 0.00001).

Conclusions

Perfectly cementing and seating a glenoid replacement is a difficult task. Radiolucencies and incomplete component seating occur more frequently in association with keeled components compared with pegged components. Surgeon experience may be an important variable in the achievement of a good technical outcome.

Copyright remains with the authors and publisher.

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