Taunton, J Bone Joint Surg Am 2008 - Total Shoulder Arthroplasty with a Metal-Backed, Bone-Ingrowth Glenoid Component. Medium to Long-Term Results

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Total Shoulder Arthroplasty with a Metal-Backed, Bone-Ingrowth Glenoid Component. Medium to Long-Term Results

Taunton, Cofield, et al.·J Bone Joint Surg Am·2008·153 citations·Retrospective cohort

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Background

Loosening of a cemented glenoid component is an important cause of failure in shoulder arthroplasty. This study was developed to examine the outcome of patients managed with a metal-backed, bone-ingrowth glenoid component as an alternative to a cemented component.

Methods

The study group included 83 total shoulder arthroplasties with a metal-backed, bone-ingrowth glenoid component performed between 1989 and 1994.
74 shoulders had a diagnosis of primary osteoarthritis, and 9 shoulders had other diagnoses.
All patients were followed radiographically and clinically for a minimum of 2 years or until the time of revision surgery.
Kaplan-Meier survival estimates were performed with revision and/or radiographic failure as the end points.

Results

The mean clinical follow-up was 9.5 years, and the mean radiographic follow-up was 7.1 years.
Pain ratings (on a scale of 1 to 5) decreased from a mean of 4.7 preoperatively to 2.0 postoperatively.
The mean range of motion in active elevation increased from 102° preoperatively to 135° postoperatively; the mean external rotation increased from 27° to 56°.
Glenohumeral joint instability developed in 14 shoulders.
Radiographic changes consistent with glenoid component loosening were present in 33 shoulders.
Polyethylene wear with metal wear of the glenoid component was noted in 21 shoulders, and humeral component loosening was seen in 15 shoulders.
Revision procedures were performed in 26 shoulders.
There were no identifiable patient, disease, or surgical characteristics associated with failure, either clinically or radiographically.
The 5-year survival estimate free of revision or radiographic failure was 79.9% (95% confidence interval, 71.6% to 89.3%), and the 10-year survival estimate was 51.9% (95% confidence interval, 41.0% to 65.8%).

Conclusions

The high rate of failure of total shoulder arthroplasties performed with this metal-backed, bone-ingrowth glenoid component raises concerns as to its use, and perhaps the use of other types of metal-backed components, in shoulder arthroplasty, other than for special situations.

Level of evidence: Therapeutic Level IV. Copyright remains with the authors and publisher.

Total Shoulder Arthroplasty with a Metal-Backed, Bone-Ingrowth Glenoid Component. Medium to Long-Term Results.

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Total Shoulder Arthroplasty with a Metal-Backed, Bone-Ingrowth Glenoid Component. Medium to Long-Term Results

Taunton, Cofield, et al.·J Bone Joint Surg Am·2008·153 citations·Retrospective cohort

|

Background

Loosening of a cemented glenoid component is an important cause of failure in shoulder arthroplasty. This study was developed to examine the outcome of patients managed with a metal-backed, bone-ingrowth glenoid component as an alternative to a cemented component.

Methods

The study group included 83 total shoulder arthroplasties with a metal-backed, bone-ingrowth glenoid component performed between 1989 and 1994.
74 shoulders had a diagnosis of primary osteoarthritis, and 9 shoulders had other diagnoses.
All patients were followed radiographically and clinically for a minimum of 2 years or until the time of revision surgery.
Kaplan-Meier survival estimates were performed with revision and/or radiographic failure as the end points.

Results

The mean clinical follow-up was 9.5 years, and the mean radiographic follow-up was 7.1 years.
Pain ratings (on a scale of 1 to 5) decreased from a mean of 4.7 preoperatively to 2.0 postoperatively.
The mean range of motion in active elevation increased from 102° preoperatively to 135° postoperatively; the mean external rotation increased from 27° to 56°.
Glenohumeral joint instability developed in 14 shoulders.
Radiographic changes consistent with glenoid component loosening were present in 33 shoulders.
Polyethylene wear with metal wear of the glenoid component was noted in 21 shoulders, and humeral component loosening was seen in 15 shoulders.
Revision procedures were performed in 26 shoulders.
There were no identifiable patient, disease, or surgical characteristics associated with failure, either clinically or radiographically.
The 5-year survival estimate free of revision or radiographic failure was 79.9% (95% confidence interval, 71.6% to 89.3%), and the 10-year survival estimate was 51.9% (95% confidence interval, 41.0% to 65.8%).

Conclusions

The high rate of failure of total shoulder arthroplasties performed with this metal-backed, bone-ingrowth glenoid component raises concerns as to its use, and perhaps the use of other types of metal-backed components, in shoulder arthroplasty, other than for special situations.

Level of evidence: Therapeutic Level IV. Copyright remains with the authors and publisher.

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