Duey Akiro H, Li Troy, White Christopher A, Patel Akshar V, Cirino Carl M, Parsons Bradford O, Flatow Evan L, Cagle Paul J
Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York City, NY, 10029, USA.
J Orthop. 2023 Jan 20;36:120-124. doi: 10.1016/j.jor.2023.01.006. eCollection 2023 Feb.
The two main glenoid types used in total shoulder arthroplasty (TSA) are the pegged and keeled glenoid designs. We aimed to determine if a pegged glenoid is superior to a keeled glenoid at long-term follow-up as measured by range of motion (ROM), patient reported outcomes (PROs), and radiographic glenoid loosening.
We retrospectively reviewed all patients undergoing TSA by a single surgeon at an urban, academic hospital. The cohort was stratified into two groups based on glenoid type - one group consisting of keeled implants and a second group consisting of pegged implants. For each patient, forward elevation (FE), internal rotation (IR), external rotation (ER), visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) shoulder score, and simple shoulder test (SST) scores were collected preoperatively and at the most recent follow-up visit. Radiographic variables included acromiohumeral interval (AHI) and glenoid loosening.
After applying exclusion criteria, 144 TSAs were included in our study. Of these, 42 (29.2%) had keeled glenoids and 102 (70.8%) had pegged glenoids. Patients with a pegged glenoid implant were older (67.4 vs. 60.7 years; p < 0.001) and had a shorter follow-up time (9.3 vs. 14.4 years; p < 0.001) than patients with a keeled glenoid implant. At the most recent follow-up visit, there were no significant differences among postoperative FE, ER, AHI, or PROs. However, pegged glenoid implants provided significantly more internal rotation (T11 vs. L1; p = 0.010) and were less likely to show evidence of radiographic glenoid loosening (16.7% vs. 42.9%; p=<0.001). Revision rates were not significantly different between the pegged and keeled groups (6.9% vs. 14.3%; p = 0.158).
Although a pegged design correlated with superior internal rotation and less radiographic glenoid loosening, both pegged and keeled glenoid designs offered favorable long-term clinical outcomes following TSA over the long-term.
全肩关节置换术（TSA）中使用的两种主要的关节盂类型是带柄和带龙骨的关节盂设计。我们旨在通过运动范围（ROM）、患者报告结局（PROs）和影像学关节盂松动情况来确定在长期随访中，带柄关节盂是否优于带龙骨的关节盂。
我们回顾性分析了一家城市学术医院中由同一外科医生进行TSA手术的所有患者。根据关节盂类型将队列分为两组——一组为带龙骨植入物组，另一组为带柄植入物组。对于每位患者，术前和最近一次随访时收集前屈（FE）、内旋（IR）、外旋（ER）、视觉模拟量表（VAS）、美国肩肘外科医师学会（ASES）肩部评分和简单肩部测试（SST）评分。影像学变量包括肩峰肱骨头间距（AHI）和关节盂松动情况。
应用排除标准后，我们的研究纳入了144例TSA患者。其中，42例（29.2%）使用带龙骨关节盂，102例（70.8%）使用带柄关节盂。带柄关节盂植入物的患者比带龙骨关节盂植入物的患者年龄更大（67.4岁对60.7岁；p<0.001），随访时间更短（9.3年对14.4年；p<0.001）。在最近一次随访时，术后FE、ER、AHI或PROs之间无显著差异。然而，带柄关节盂植入物提供了显著更多的内旋（T11对L1；p=0.010），且影像学关节盂松动的证据较少（16.7%对42.9%；p=<0.001）。带柄组和带龙骨组的翻修率无显著差异（6.9%对14.3%；p=0.158）。
尽管带柄设计与更好的内旋和更少的影像学关节盂松动相关，但长期来看，TSA术后带柄和带龙骨的关节盂设计均能提供良好的长期临床结局。
