Clinical and radiographic outcomes of hybrid glenoid fixation with a central porous titanium post: analysis of 713 consecutive shoulders.

BACKGROUND

Hybrid glenoid component fixation represents an emerging technology in total shoulder arthroplasty (TSA) design. However, there is a paucity of larger-scale studies reporting the outcomes following implantation of these components. This study aimed to determine the outcomes following primary TSA using hybrid glenoid component fixation with a central porous titanium post.

METHODS

A retrospective review of 2 institutional databases identified patients aged ≥ 18 years who underwent primary elective hybrid TSA between 2009 and 2018 with a minimum of 2 years of follow-up. Outcomes evaluated included the visual analog scale pain score, range of motion, American Shoulder and Elbow Surgeons (ASES) score, complications, and implant survivorship free from reoperation or revision. Postoperative imaging was assessed for glenoid radiolucent lines and evidence of aseptic glenoid component loosening (AGL).

RESULTS

A total of 713 shoulders in 666 patients with a mean age of 61 ± 6 years were included in the study at a mean follow-up period of 4.3 years (range, 2.0-9.1 years); male shoulders comprised 50.9% of shoulders. Notable clinical improvements were observed with respect to the visual analog scale pain score (7.0 to 1.4, P < .001), active forward elevation (91° to 155°, P < .001), active external rotation (21° to 50°, P < .001), and the ASES score (38.6 to 82.7, P < .001), with all exceeding the substantial clinical benefit threshold for TSA. The active internal rotation score also showed significant improvement (3.1 to 5.7, P < .001). Glenoid radiolucent lines were identified in 57 TSAs (8.2%), with 1 radiographically loose glenoid component (0.1%). There were 54 complications (7.6%), with postoperative rotator cuff tear as the most common complication (n = 15, 2.1%); only 4 cases (0.6%) of glenoid-related complications (AGL) were observed. The Kaplan-Meier rate of survival free from revision surgery was 98.7% at 1 year, 98.5% at 2 years, and 96.7% at 5 years.

CONCLUSIONS

Hybrid glenoid component fixation of anatomic TSA with a central porous titanium post demonstrated statistically significant and clinically meaningful improvements in pain, range of motion, and ASES scores. Although AGL remains a concern, only 0.6% of TSAs sustained glenoid-related complications at a mean follow-up period of 4.3 years and the rate of survivorship free from revision was 96.7% at 5 years. These favorable clinical findings support the theoretical advantages of hybrid glenoid fixation; however, large comparative investigations with long-term follow-up are needed to validate these results.