Radiographic comparison of pegged and keeled glenoid components.

Glenoid loosening is one reason for failure of total shoulder arthroplasty. Several factors, including radiographic lucency, have been shown to be associated with glenoid loosening. The purpose of this study was to assess the correlation between glenoid design and immediate radiographic lucency in a prospective randomized clinical trial. Total shoulder arthroplasty was performed in 43 patients over a 2-year period. Twenty-three patients were randomized into the keel group and twenty patients into the pegged group. Postoperative radiographs obtained within 6 weeks of surgery were evaluated by 3 raters to determine glenoid lucency. On a scale from 0 (no lucency) to 5 (gross lucency and component loosening), the rate of lucency was 39% (9/23) in the keeled components, which was significantly higher than the rate of 5% (1/20) observed in the pegged components (P = .026). Patient age, gender, and glenoid size did not significantly affect glenoid component lucency (P > .05). The consistency reliability among raters (Cronbach alpha) was 0.87, and the intertester reliability was 0.87. Pegged glenoid components have less radiographic lucency when compared with keeled glenoid components in the immediate postoperative period.

[1]  J. Iannotti,et al.  Functional outcome after shoulder arthroplasty for primary osteoarthritis: a multicenter study. , 2002, Journal of shoulder and elbow surgery.

[2]  Tom R Norris,et al.  Decision making in glenohumeral arthroplasty. , 2003, The Journal of arthroplasty.

[3]  E. Flatow,et al.  Incidence of Early Radiolucent Glenoid Lines in Patients Having Total Shoulder Replacements , 2005, Clinical orthopaedics and related research.

[4]  J G Seiler,et al.  Assessment of Radiolucent Lines about the Glenoid: An In Vitro Radiographic Study* , 1997, The Journal of bone and joint surgery. American volume.

[5]  P J Prendergast,et al.  Three-dimensional finite element analysis of glenoid replacement prostheses: a comparison of keeled and pegged anchorage systems. , 2000, Journal of biomechanical engineering.

[6]  P J Prendergast,et al.  Contact stresses in the glenoid component in total shoulder arthroplasty , 2003, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[7]  R. G. Stiles,et al.  Complications of hip arthroplasty causing periprosthetic radiolucency on plain radiographs. , 1994, AJR. American journal of roentgenology.

[8]  Jove Graham,et al.  Retrieved glenoid components: a classification system for surface damage analysis. , 2002, The Journal of arthroplasty.

[9]  T. Thornhill,et al.  Evaluation of a nonconstrained total shoulder prosthesis. , 1988, AJR. American journal of roentgenology.

[10]  G. Walch,et al.  Hydrotherapy Rehabilitation After Shoulder Surgery , 2003 .

[11]  P J Prendergast,et al.  Structural analysis of an offset-keel design glenoid component compared with a center-keel design. , 2001, Journal of shoulder and elbow surgery.

[12]  C. Neer,et al.  Recent experience in total shoulder replacement. , 1982, The Journal of bone and joint surgery. American volume.

[13]  D. P. O'connor,et al.  Glenoid component insertion in total shoulder arthroplasty: comparison of three techniques for drying the glenoid before cementation. , 2007, Journal of shoulder and elbow surgery.

[14]  I. Clarke,et al.  Clinical and radiographic assessment of a non-constrained total shoulder , 2004, International Orthopaedics.

[15]  R. Cofield,et al.  Total shoulder arthroplasty with the Neer prosthesis: long-term results. , 1997, Journal of shoulder and elbow surgery.

[16]  I A Trail,et al.  The results of shoulder arthroplasty in patients with rheumatoid arthritis. , 2002, The Journal of bone and joint surgery. British volume.

[17]  G. Walch,et al.  Cemented Glenoid Component: Results in Osteoarthritis and Rheumatoid Arthritis , 1999 .

[18]  S W O'Driscoll,et al.  Radiographic assessment of ingrowth total shoulder arthroplasty. , 2000, Journal of shoulder and elbow surgery.

[19]  Frederick A Matsen,et al.  The Radiographic Evaluation of Keeled and Pegged Glenoid Component Insertion , 2002, The Journal of bone and joint surgery. American volume.

[20]  D. Dines,et al.  Glenoid replacement in total shoulder arthroplasty. , 1998, The Orthopedic clinics of North America.

[21]  C A Rockwood,et al.  Radiologic, mechanical, and histologic evaluation of 2 glenoid prosthesis designs in a canine model. , 2001, Journal of shoulder and elbow surgery.

[22]  R. Friedman,et al.  Total shoulder arthroplasty. , 1996, Journal of the South Carolina Medical Association.

[23]  R. Cofield,et al.  Radiographic analysis of polyethylene glenoid components using modern cementing techniques. , 2004, Journal of shoulder and elbow surgery.

[24]  B F Morrey,et al.  Stress analyses of glenoid components in total shoulder arthroplasty. , 1999, Journal of shoulder and elbow surgery.

[25]  D. P. O'connor,et al.  Radiographic Comparison of Two Glenoid Preparation Techniques in Total Shoulder Arthroplasty , 2005, Clinical orthopaedics and related research.

[26]  James A. Johnson,et al.  Does keel size, the use of screws, and the use of bone cement affect fixation of a metal glenoid implant? , 2003, Journal of shoulder and elbow surgery.

[27]  U P Wyss,et al.  Loosening performance of cemented glenoid prosthesis design pairs. , 2001, Clinical biomechanics.

[28]  S. Hasan,et al.  Characteristics of unsatisfactory shoulder arthroplasties. , 2002, Journal of shoulder and elbow surgery.

[29]  R. Jinnah,et al.  The Dana total shoulder arthroplasty. , 1988, The Journal of bone and joint surgery. American volume.

[30]  B. McNeil,et al.  Cemented total hip prosthesis: radiographic and scintigraphic evaluation. , 1989, Radiology.

[31]  Jochem Nagels,et al.  Stress shielding and bone resorption in shoulder arthroplasty. , 2003, Journal of shoulder and elbow surgery.

[32]  I. Kelly,et al.  Neer total shoulder replacement in rheumatoid arthritis. , 1987, The Journal of bone and joint surgery. British volume.

[33]  R. Cofield.  Total shoulder arthroplasty with the Neer prosthesis. , 1984, The Journal of bone and joint surgery. American volume.

[34]  G. Walch,et al.  Morphologic study of the glenoid in primary glenohumeral osteoarthritis. , 1999, The Journal of arthroplasty.

[35]  K. Tallroth,et al.  Loosening of threaded acetabular components , 1993 .

[36]  G. Walch,et al.  Technique of Glenoid Resurfacing in Shoulder Arthroplasty , 1999 .

[37]  G. Walch,et al.  Cemented polyethylene versus uncemented metal-backed glenoid components in total shoulder arthroplasty: a prospective, double-blind, randomized study. , 2002, Journal of shoulder and elbow surgery.

[38]  M. Pearl,et al.  Geometric analysis of commonly used prosthetic systems for proximal humeral replacement. , 1999, The Journal of bone and joint surgery. American volume.

[39]  Gilles Walch,et al.  The Influence of Glenohumeral Prosthetic Mismatch on Glenoid Radiolucent Lines: Results of a Multicenter Study , 2002, The Journal of bone and joint surgery. American volume.

[40]  P J Prendergast,et al.  Stress analysis of glenoid component designs for shoulder arthroplasty , 1997, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[41]  B. Norris,et al.  Modern Cement Technique and the Survivorship of Total Shoulder Arthroplasty , 1996, Clinical orthopaedics and related research.

[42]  J. Wolf,et al.  Influence of Comorbidity on Self-Assessment Instrument Scores of Patients with Idiopathic Adhesive Capsulitis , 2002, The Journal of bone and joint surgery. American volume.

[43]  F A Matsen,et al.  Glenoid loosening in total shoulder arthroplasty. Association with rotator cuff deficiency. , 1988, The Journal of arthroplasty.

[44]  W. Walsh,et al.  Resurfacing of the glenoid in total shoulder arthroplasty. A comparison, at a mean of five years, of prostheses inserted with and without cement. , 1999, The Journal of bone and joint surgery. American volume.

[45]  C A Rockwood,et al.  Complications of total shoulder-replacement arthroplasty. , 1996, The Journal of bone and joint surgery. American volume.

[46]  A. Skirving.  Total shoulder arthroplasty — current problems and possible solutions , 1999, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[47]  R H Cofield,et al.  Fluoroscopically positioned radiographs of total shoulder arthroplasty. , 1992, Journal of shoulder and elbow surgery.