Papadonikolakis, J Bone Joint Surg Am 2013 - Failure of the Glenoid Component in Anatomic Total Shoulder Arthroplasty: A Systematic Review of the English-Language Literature between 2006 and 2012
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Failure of the Glenoid Component in Anatomic Total Shoulder Arthroplasty: A Systematic Review of the English-Language Literature between 2006 and 2012
Papadonikolakis, Matsen, et al.·J Bone Joint Surg Am·2013·191 citations
Papadonikolakis and colleagues pooled recent reports of anatomic TSA to test whether glenoid failure is becoming less frequent and which patient and surgical factors predict it.
Systematic review with random‑effects meta‑analysis of 27 English‑language articles published December 2006 to February 2012, covering 3853 TSAs done from 1976 to 2007. Therapeutic Level IV.
Glenoid failure rates are falling over time, and certain preoperative and surgical factors raise the risk of failure.
Key Findings
Pooled annual rates were 7.3% for asymptomatic radiolucent lines (range 0% to 33%), 1.2% for symptomatic glenoid loosening and 0.8% for revision for glenoid failure.
Year of surgery was not significantly associated with any of the three rates. The authors note the data were too weak to reject a decline with confidence.
In 3 studies comparing 88 keeled with 91 pegged polyethylene glenoids, keeled components had more asymptomatic radiolucent lines (pooled odds ratio 2.37, p = 0.01): 13.6% vs 8.3% per year.
Symptomatic loosening was associated with female sex (p = 0.04) and Walch class (p = 0.04 across all five classes). Prior publications had linked male sex to failure.
Uneroded Walch A1 glenoids had more asymptomatic radiolucent lines than medially eroded A2 glenoids (p = 0.03), and miscellaneous diagnoses were the only risk factor for revision (p = 0.04).
Across studies, symptomatic loosening tracked revision closely (r = 0.77), but asymptomatic radiolucent lines did not track revision (r = 0.03).
Authors' conclusion
This is the first systematic review of the published evidence on glenoid component failure. Although the authors of individual articles proposed various risk factors for glenoid component failure, many of these relationships were not significant in the present study. A consistent methodological approach to future investigations is likely to improve the quality of the evidence on which patients, techniques, and prostheses are selected for total shoulder arthroplasty.
Papadonikolakis and colleagues pooled recent reports of anatomic TSA to test whether glenoid failure is becoming less frequent and which patient and surgical factors predict it.
Systematic review with random‑effects meta‑analysis of 27 English‑language articles published December 2006 to February 2012, covering 3853 TSAs done from 1976 to 2007. Therapeutic Level IV.
Glenoid failure rates are falling over time, and certain preoperative and surgical factors raise the risk of failure.
Key Findings
Pooled annual rates were 7.3% for asymptomatic radiolucent lines (range 0% to 33%), 1.2% for symptomatic glenoid loosening and 0.8% for revision for glenoid failure.
Year of surgery was not significantly associated with any of the three rates. The authors note the data were too weak to reject a decline with confidence.
In 3 studies comparing 88 keeled with 91 pegged polyethylene glenoids, keeled components had more asymptomatic radiolucent lines (pooled odds ratio 2.37, p = 0.01): 13.6% vs 8.3% per year.
Symptomatic loosening was associated with female sex (p = 0.04) and Walch class (p = 0.04 across all five classes). Prior publications had linked male sex to failure.
Uneroded Walch A1 glenoids had more asymptomatic radiolucent lines than medially eroded A2 glenoids (p = 0.03), and miscellaneous diagnoses were the only risk factor for revision (p = 0.04).
Across studies, symptomatic loosening tracked revision closely (r = 0.77), but asymptomatic radiolucent lines did not track revision (r = 0.03).
Authors' conclusion
This is the first systematic review of the published evidence on glenoid component failure. Although the authors of individual articles proposed various risk factors for glenoid component failure, many of these relationships were not significant in the present study. A consistent methodological approach to future investigations is likely to improve the quality of the evidence on which patients, techniques, and prostheses are selected for total shoulder arthroplasty.