Comparison of Pegged and Keeled Glenoid Components for Total Shoulder Arthroplasty: A Systematic Review
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BACKGROUND: 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.