Survival of the pegged glenoid component in shoulder arthroplasty: part II.
BACKGROUND
Loosening of the glenoid component is a primary reason for failure of an anatomic shoulder arthroplasty. Pegged glenoids were designed in an effort to outperform keeled components. This study evaluated the midterm clinical and radiographic survival of a single implant design with implantation of an in-line pegged glenoid component and identified risk factors for radiographic loosening and clinical failure.


METHODS
There were 330 total shoulder arthroplasties that had been implanted with a cemented, all-polyethylene, in-line pegged glenoid component evaluated with an average clinical follow-up of 7.2 years. Of these shoulders, 287 had presurgical, initial postsurgical, and late postsurgical radiographs (mean radiographic follow-up, 7.0 years).


RESULTS
At most recent follow-up, 30 glenoid components had been revised for aseptic loosening. This translated to a rate of glenoid component survival free from revision for all 330 shoulders of 99% at 5 years and 83% at 10 years. Of 287 glenoid components, 120 were considered loose on the basis of radiographic evaluation. Four humeral components were considered loose. Component survival (Kaplan-Meier) free from radiographic failure at 5 and 10 years was 92% and 43%. Severe presurgical glenoid erosion (Walch A2, B2, C) and patient age <65 years were risk factors for radiographic failure. Late humeral head subluxation was associated with radiographic failure.


CONCLUSIONS
Despite the predominant thinking that pegged glenoid components may be superior to keeled designs, midterm radiographic and clinical failure rates were high with this pegged component design, particularly after 5 years. Advanced presurgical glenoid erosion and younger patient age are risk factors for radiographic loosening. Revision rates underestimate radiographic glenoid loosening.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Paul B
PB
McLendon
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Bradley S
BS
Schoch
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: sperling.john@mayo.edu.
John W
JW
Sperling
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Joaquín
J
Sánchez-Sotelo
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Cathy D
CD
Schleck
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Robert H
RH
Cofield
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D061165:Glenoid Cavity / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012307:Risk Factors; D012785:Shoulder Joint / Q000000981:diagnostic imaging* / Q000601:surgery*; D000072227:Shoulder Prosthesis; D055815:Young Adult
Shoulder arthroplasty; arthroplasty; glenoids; pegged glenoids; radiographic survival; revision surgery; shoulder; survival