Total shoulder arthroplasty is an established treatment with the commonest cause of failure loosening of the glenoid component. Hydroxyapatite metal-backed glenoid components could offer better survivorship due to improved fixation. The aim of this study was to investigate periprosthetic radiolucency rates associated with an uncemented, metal-backed polyethylene glenoid component with medium-term results.
Methods
A single centre retrospective study examining radiological outcomes of the Epoca metal-backed glenoid component. Radiographs were analysed for post-operative adequacy of glenoid seating and radiographs at follow-up assessed for periprosthetic lucencies and any revision procedures were recorded.
Results
Forty-one patients were followed up with a mean follow-up time of 5.5 years (3–8 years). Primary indication for total shoulder arthroplasty was osteoarthritis (80%). Mean age was 69 years (53–86 years). Ninety-five per cent of glenoid components were completely seated. At follow-up six patients had undergone revision (14.6%). Thirty of the remaining patients (86%) did not demonstrate any radiolucency on follow-up radiographs. Complete glenoid seating post-operatively was associated with lower rate of subsequent radiolucency and revision (P < 0.01).
Conclusion
Low rates of radiolucency at medium-term follow-up with an uncemented metal-backed glenoid, however significant rates of revision. Complete seating of the glenoid component was associated with lower rates of radiolucency and revision.
National Joint Registry. 14th annual report, England Wales and Northern Ireland, 2017, p.162.
2.
National Joint Registry. 10th annual report, England Wales and Northern Ireland, 2013, p.118.
3.
WiaterJMFabingMH. Shoulder arthroplasty: prosthetic options and indications. J Am Acad Orthop Surg2009; 17: 415–425.
4.
BarlowJDYuanBJSchleckCD, et al.Shoulder arthroplasty for rheumatoid arthritis: 303 consecutive cases with minimum 5-year follow-up. J Shoulder Elbow Surg2014; 23: 791–799.
5.
BryantDLitchfieldRSandowM, et al.A comparison of pain, strength, range of motion, and functional outcomes after hemiarthroplasty and total shoulder arthroplasty in patients with osteoarthritis of the shoulder. A systematic review and meta-analysis. J Bone Joint Surg Am2005; 87: 1947–1956.
6.
FevangBTNystadTWSkredderstuenA, et al.Improved survival for anatomic total shoulder prostheses. Acta Orthop2015; 86: 63–70.
7.
van den BekeromMPGeervlietPCSomfordMP, et al.Total shoulder arthroplasty versus hemiarthroplasty for glenohumeral arthritis: a systematic review of the literature at long-term follow-up. Int J Shoulder Surg2013; 7: 110–115.
8.
BarwoodSSetterKJBlaineTA, et al.The incidence of early radiolucencies about a pegged glenoid component using cement pressurization. J Shoulder Elbow Surg2008; 17: 703–708.
9.
HainesJFTrailIANuttallD, et al.The results of arthroplasty in osteoarthritis of the shoulder. J Bone Joint Surg Br2006; 88: 496–501.
10.
PapadonikolakisANeradilekMBMatsenFA3rd. Failure of the glenoid component in anatomic total shoulder arthroplasty: a systematic review of the English-language literature between 2006 and 2012. J Bone Joint Surg Am2013; 95: 2205–2212.
11.
BrostromLAKronbergMWallenstenR. Should the glenoid be replaced in shoulder arthroplasty with an unconstrained Dana or St. Georg prosthesis?Ann Chir Gynaecol1992; 81: 54–57.
12.
TorchiaMECofieldRHSettergrenCR. Total shoulder arthroplasty with the Neer prosthesis: long-term results. J Shoulder Elbow Surg1997; 6: 495–505.
13.
BoileauPAvidorCKrishnanSG, et al.Cemented polyethylene versus uncemented metal-backed glenoid components in total shoulder arthroplasty: a prospective, double-blind, randomized study. J Shoulder Elbow Surg2002; 11: 351–359.
14.
CastagnaARandelliMGarofaloR, et al.Mid-term results of a metal-backed glenoid component in total shoulder replacement. J Bone Joint Surg Br2010; 92: 1410–1415.
15.
ClementNDMathurKCollingR, et al.The metal-backed glenoid component in rheumatoid disease: eight- to fourteen-year follow-up. J Shoulder Elbow Surg2010; 19: 749–756.
16.
FucenteseSFCostourosJGKuhnelSP, et al.Total shoulder arthroplasty with an uncemented soft-metal-backed glenoid component. J Shoulder Elbow Surg2010; 19: 624–631.
17.
MontoyaFMagoschPScheidererB, et al.Midterm results of a total shoulder prosthesis fixed with a cementless glenoid component. J Shoulder Elbow Surg2013; 22: 628–635.
18.
PapadonikolakisAMatsenFA3rd. Metal-backed glenoid components have a higher rate of failure and fail by different modes in comparison with all-polyethylene components: a systematic review. J Bone Joint Surg Am2014; 96: 1041–1047.
19.
RosenbergNNeumannLModiA, et al.Improvements in survival of the uncemented Nottingham total shoulder prosthesis: a prospective comparative study. BMC Musculoskelet Disord2007; 8: 76–76.
20.
WallaceALPhillipsRLMacDougalGA, 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. J Bone Joint Surg Am1999; 81: 510–518.
21.
TauntonMJMcIntoshALSperlingJW, et al.Total shoulder arthroplasty with a metal-backed, bone-ingrowth glenoid component. Medium to long-term results. J Bone Joint Surg Am2008; 90: 2180–2188.
22.
Al-Hourani K, Smith J, Crowther M, et al. Short-term rates of radiolucency after primary total shoulder arthroplasty using a cementless metal-backed pegged polyethylene glenoid. J Shoulder Elbow Surg. Epub ahead of print 6 August 2018. DOI: 10.1177/1758573218789339.
23.
WalchGBadetRBoulahiaA, et al.Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty1999; 14: 756–760.
24.
FranklinJLBarrettWPJackinsSE, et al.Glenoid loosening in total shoulder arthroplasty. Association with rotator cuff deficiency. J Arthroplasty1988; 3: 39–46.
25.
LazarusMDJensenKLSouthworthC, et al.The radiographic evaluation of keeled and pegged glenoid component insertion. J Bone Joint Surg Am2002; 84-A: 1174–1182.
26.
SarahJSanjayGSanjayS, et al.Failure mechanism of the all-polyethylene glenoid implant. J Biomech2010; 43: 714–719.
27.
ChurchillRSBoormanRSFehringerEV, et al.Glenoid cementing may generate sufficient heat to endanger the surrounding bone. Clin Orthop Relat Res2004; 419: 76–79.
28.
BarrettWPFranklinJLJackinsSE, et al.Total shoulder arthroplasty. J Bone Joint Surg Am1987; 69: 865–872.
29.
BellSNGschwendN. Clinical experience with total arthroplasty and hemiarthroplasty of the shoulder using the Neer prosthesis. Int Orthop1986; 10: 217–222.
30.
BoydADJrThomasWHScottRD, et al.Total shoulder arthroplasty versus hemiarthroplasty. Indications for glenoid resurfacing. J Arthroplasty1990; 5: 329–336.
31.
KleppsSChiangASMillerS, et al.Incidence of early radiolucent glenoid lines in patients having total shoulder replacements. Clin Orthop Relat Res2005; 435: 118–125.
32.
WirthMAKorvickDLBasamaniaCJ, et al.Radiologic, mechanical, and histologic evaluation of 2 glenoid prosthesis designs in a canine model. J Shoulder Elbow Surg2001; 10: 140–148.
33.
EdwardsTBKadakiaNRBoulahiaA, et al.A comparison of hemiarthroplasty and total shoulder arthroplasty in the treatment of primary glenohumeral osteoarthritis: results of a multicenter study. J Shoulder Elbow Surg2003; 12: 207–213.
34.
BohsaliKIWirthMARockwoodCAJr. Complications of total shoulder arthroplasty. J Bone Joint Surg Am2006; 88: 2279–2292.
35.
ZykovaASafonovVYanovskaA, et al.Formation of solution-derived hydroxyapatite coatings on titanium alloy in the presence of magnetron-sputtered alumina bond coats. Open Biomed Eng J2015; 9: 75–82.
36.
WirthMARockwoodCAJr. Complications of total shoulder-replacement arthroplasty. J Bone Joint Surg Am1996; 78: 603–616.
37.
CofieldRHDalyPJ. Total shoulder arthroplasty with a tissue-ingrowth glenoid component. J Shoulder Elbow Surg1992; 1: 77–85.
38.
McElwainJPEnglishE. The early results of porous-coated total shoulder arthroplasty. Clin Orthop Relat Res1987; 218: 217–224.
39.
MartinSDZurakowskiDThornhillTS. Uncemented glenoid component in total shoulder arthroplasty. Survivorship and outcomes. J Bone Joint Surg Am2005; 87: 1284–1292.
40.
BoileauPMoineauGMorin-SalvoN, et al.Metal-backed glenoid implant with polyethylene insert is not a viable long-term therapeutic option. J Shoulder Elbow Surg2015; 24: 1534–1543.
41.
PapadonikolakisAMatsenF. Metal-backed glenoid components have a higher rate of failure and fail by different modes in comparison with all-polyethylene components. J Bone Joint Surg Am2014; 96: 1041–1047.
