Healio
Healio
April 30, 2012
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Ingrowth anatomic glenoid with column and screw fixation improves pain but subject to revision risk

Use of an ingrowth anatomic glenoid with column and screw fixation is a viable way to offer patients pain relief and improved motion in cases of deficient glenoid bone, but a high revision rate means more durable, successful reconstructive options may lie elsewhere.

Perspective from James C. Esch, MD

For this study, researchers used an ingrowth anatomic glenoid component with column and screw fixation for 21 shoulder arthroplasties — 8 for revision arthroplasty and 13 for arthritic wear leading to bone loss. Each patient was monitored for a mean of 11.1 years clinically and a mean of 9.1 years by X-ray.

According to the study abstract, the researchers found that 7 shoulders required revision at a mean of 10.4-year follow-up. The 14 shoulders that did not undergo revision demonstrated significant decreases in pain ratings, with mean external rotation increasing from 28° to 43° and mean active elevation increasing from 100° to 125°. When assessed radiographically, four of the unrevised shoulders were at risk for glenoid loosening and one shoulder was at risk for humeral loosening.

Perspective

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James C. Esch, MD
James C. Esch, MD

This report is on 21 very difficult patients with a painful shoulder who experienced significant glenoid bone loss.  One third of the cases were revision cases and two-thirds had primary arthritis.  These patients were candidates for a standard total shoulder arthroplasty rather than a reverse shoulder arthroplasty.  The authors implanted a metal backed glenoid using a peg and screw fixation.  Seven shoulders had a revision, but the mean was over 10 years, which is satisfactory.  The other 14 patients had decreased pain and improved range of motion. 

Standard cemented glenoid peg or keel polyethylene fixation is difficult to impossible in this group of patients, depending on the degree of bone loss.  This report offers encouragement for development of a secure metal-backed peg-and-screw glenoid, similar to the fixation in current reverse total shoulder implants.  This would enable the surgeon to treat a patient with painful glenoid bone loss and an intact functioning rotator cuff with a standard total shoulder rather than a reverse total shoulder. 

James C. Esch, MD
Orthopaedic Specialists of North County
Oceanside, CA
Disclosures: Esch has no relevant financial disclosures.
Sources/Disclosures

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Source:

Lawrence TM. J Should Elbow Surg. 2012. doi:10.1016/j.jse.2011.12.013