Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA.
Nova Orthopaedic and Spine Care, Woodbridge, VA, USA.
J Shoulder Elbow Surg. 2017 Dec;26(12):2078-2085. doi: 10.1016/j.jse.2017.07.016. Epub 2017 Sep 13.
Glenoid component loosening remains a significant issue after anatomic shoulder arthroplasty. Pegged glenoid components have shown better lucency rates than keeled components in the short term; however, midterm to long-term results have not fully been determined. We previously reported early outcomes of the current randomized controlled group of patients, with higher glenoid lucency rates in those with a keeled glenoid. The purpose of this study was to evaluate the radiographic and clinical outcomes of these components at minimum 5-year follow-up.
Fifty-nine total shoulder arthroplasties were performed in patients with primary glenohumeral osteoarthritis. Patients were randomized to receive either a pegged or keeled glenoid component. Three raters graded radiographic glenoid lucencies. Clinical outcome scores and active mobility outcomes were collected preoperatively and at yearly postoperative appointments.
Of the 46 shoulders meeting the inclusion criteria, 38 (82.6%) were available for minimum 5-year radiographic follow-up. After an average of 7.9 years, radiographic lucency was present in 100% of pegged and 91% of keeled components (P = .617). Grade 4 or 5 lucency was present in 44% of pegged and 36% of keeled components (P = .743). There were no differences in clinical outcome scores or active mobility outcomes between shoulders with pegged and keeled components at last follow-up. Within the initial cohort, 20% of the keeled shoulders (6 of 30) and 7% of the pegged shoulders (2 of 29) underwent revision surgery (P = .263). Kaplan-Meier analysis showed no significant difference in survival rates between groups (P = .560).
At an average 7.9-year follow-up, non-ingrowth, all-polyethylene pegged glenoid implants are equivalent to keeled implants with respect to radiolucency, clinical outcomes, and need for revision surgery.
在解剖型肩关节置换术后，肩盂假体松动仍然是一个重大问题。与有脊的肩盂假体相比，带钉的肩盂假体在短期内具有更好的透亮率；然而，中期至长期结果尚未完全确定。我们之前报告了当前随机对照患者组的早期结果，其中带脊的肩盂假体的肩盂透亮率更高。本研究的目的是评估这些组件在至少 5 年随访时的影像学和临床结果。
对 59 例原发性肩袖关节炎患者行全肩关节置换术。患者随机分为带钉或有脊的肩盂假体组。3 名评估者对肩盂透亮进行分级。收集术前和术后每年的临床结果评分和主动活动度结果。
在符合纳入标准的 46 个肩中，有 38 个（82.6%）可进行至少 5 年的影像学随访。平均随访 7.9 年后，带钉肩盂假体 100%和有脊肩盂假体 91%出现透亮（P = .617）。带钉肩盂假体 44%和有脊肩盂假体 36%存在 4 级或 5 级透亮（P = .743）。末次随访时，带钉和有脊肩盂假体的临床结果评分和主动活动度结果无差异。在最初的队列中，有脊肩盂假体（30 个中的 6 个）的 20%和带钉肩盂假体（29 个中的 2 个）需要翻修手术（P = .263）。Kaplan-Meier 分析显示两组的生存率无显著差异（P = .560）。
在平均 7.9 年的随访中，非骨长入型全聚乙烯带钉肩盂假体与有脊肩盂假体在透亮率、临床结果和翻修手术需求方面相当。
