Browsing by Subject "Arthroplasty, Replacement, Shoulder"
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Item Comparison of Pegged and Keeled Glenoid Components for Total Shoulder Arthroplasty: A Systematic Review(2017-01-17) Argo, Madison; Landrum, Matthew; Box, Hayden; Khazzam, MichaelBACKGROUND: Glenohumeral joint arthritis is a large contributor to disability in our population, especially our aging population. Total shoulder arthroplasty (TSA) has been shown to be a very effective treatment modality for this condition. Unfortunately, as hardware ages, the components are susceptible to failure and most commonly, this failure results from glenoid component loosening. To date, there has been insufficient evidence to guide surgeons as to which glenoid design has superior outcomes and results in the lowest failure rate. The purpose of this study is to determine whether keeled or pegged cemented glenoid components resulted in fewer complications, lower incidence of radiolucency or symptomatic loosening, or superior clinical outcomes. METHODS: A systematic review was performed to isolate studies comparing results following TSA using either all cemented pegged or keeled glenoid components. A total of 4 papers met the inclusion criteria. Of these 4, the radiographic assessment of radiolucency, the clinical outcomes, the component failures, and patient function was further analyzed using pooled data to determine if there was significant difference in the outcome of these implants. RESULTS: A risk difference forest plot analysis was created comparing the 107 pegged glenoid components to the 96 keeled glenoid components. The pooled risk difference for presence of radiolucent lines favored pegged components -0.32 (95% CI, -0.62, -0.03) which was significant (p = 0.03). There was no significant difference between pegged and keeled components in the risk of glenoid loosening (RD, -0.02; 95% CI, -0.09 to 0.05) or glenoid failures (RD, -0.02; 95% CI, -0.07 to 0.02). CONCLUSIONS: The current systematic review demonstrates that keeled glenoid components are more likely to develop radiolucent lines after TSA. There was, however, no difference in the rate of radiographically deemed "at risk" glenoids or revision for glenoid failure between pegged and keeled cemented all-polyethylene components. The paucity of comparative keeled and pegged outcomes data in the literature renders detecting difference between the two designs difficult. Further comparative studies are needed to assess the relative rates of glenoid loosening between components as well as evaluate standardized clinical outcomes between the groups.Item Glenoid Bone Stock and Rotator Cuff Pathology: Correlation and Inter-rater Analysis(2019-01-22) Siebert, Matthew; Chalian, Majid; Pezeshk, Parham; Lawson, Parker; Xi, Yin; Khazzam, Michael; Chhabra, AvneeshBACKGROUND: Glenoid bone stock and morphology and rotator cuff muscle quality and tendon integrity are all important factors affecting the outcome of total shoulder arthroplasty. We hypothesize that the severity of glenoid bone loss correlates with rotator cuff tendon pathologies and severity of fatty infiltration of the rotator cuff musculature. METHODS: We retrospectively reviewed 45 CT scans of 44 patients (mean age 62 years; range 22 to 77 years) who underwent shoulder CT for primary shoulder pain. Measurements of glenoid bone loss, bone stock, version and joint line medialization were assessed on a 2-dimensional CT image in the axial plane after correction in the scapular plane. Measurements were defined by use of the Friedman line to approximate the surface of the paleoglenoid. Glenoid version was measured by Friedman technique. Glenoid morphology was assigned by modified Walch classification. Rotator cuff muscle fatty infiltration was assessed by MRI and each muscle assigned a Goutallier score. MRI was used to assess rotator cuff tendon tears. RESULTS: There was a statistical difference in the Goutallier score for the supraspinatus and infraspinatus muscle fatty infiltration between Walch subtypes (p < 0.05). There was statistical difference in the severity of subscapularis tendon tear between different Walch subtypes (p < 0.05). Degree of anteversion, anterior glenoid and medial glenoid bone loss correlate to subscapularis tendon tear severity (p<0.05). Anterior bone loss and joint-line medialization correlate to increased fatty infiltration of the subscapularis muscle (p<0.05). Degree of retroversion correlates to glenoid bone loss at all points and glenohumeral joint-line medialization (p<0.05). B2, B3 glenoids have significantly greater bone loss at all points (anterior, middle and posterior), whereas D type glenoids exhibited greater anterior and middle bone loss compared to other Walch classes. CONCLUSIONS: B2, B3 and D type glenoids are correlated with greater bone loss compared to other Walch sub-types. High-grade tears of the subscapularis tendon correlated to greater pathologic anteversion, and anterior and posterior glenoid bone loss. Anterior bone loss and joint-line medialization was correlated to increased fatty infiltration of the subscapularis muscle. Pathologic retroversion correlates to global increase in bone loss and humeral head medialization. Further studies are required to determine the casual relationships between glenoid bone loss and subscapularis tendon tears.