Results of total shoulder arthroplasty with a monoblock porous tantalum glenoid component: A prospective minimum 2-year follow-up study

Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] (Impact Factor: 2.29). 09/2012; 22(4). DOI: 10.1016/j.jse.2012.06.001
Source: PubMed


Aseptic loosening of all-polyethylene glenoid components remains a limiting factor in achieving long-term implant survival in total shoulder arthroplasty (TSA). This study prospectively evaluated the functional and radiographic outcomes of patients undergoing TSA with a novel, porous, tantalum-backed glenoid component, with a minimum 2 years of follow-up.

Materials and methods:
Porous tantalum-backed glenoid components were used in 19 TSAs in 19 patients. All patients were available for radiographic follow-up at an average of 38 months (range, 24-64 months). Patients were evaluated prospectively using the American Shoulder and Elbow Surgeons (ASES) score and pain on a visual analog scale (VAS). Radiographs were evaluated for component loosening and failure of the porous tantalum backing at a minimum 2 years of follow-up.

The mean VAS decreased from 8.6 to 2.9 (P < .0001). The mean ASES score improved from 21 to 70 points (P < .05). Mean active forward elevation improved from 75° to 131° (P < .0001). At latest follow-up, all glenoid components except 1 had complete in-growth of the porous tantalum keel; however, 4 components (21%) failed by fracture at the keel-glenoid face junction.

There was an unacceptably high rate of glenoid component failure (21%) due to fracture at the keel-glenoid face junction in this series. The manufacturer has subsequently revised this early design to reduce the risk of failure. The results of this study illustrate that caution should be exercised in the use of novel implants with an unproven clinical track record.

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    • "Despite the poor outcomes for metal-backed glenoids, newer designs are being introduced with different materials comprised of porous coating, such as trabecular metals. Unfortunately, even the newer trabecular metal designs appear to be subject to higher failure rates.[15] "
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    ABSTRACT: Total shoulder arthroplasty (TSA) is successful in providing pain relief and functional improvements for patients with shoulder arthritis. Outcomes are directly correlated with implant position and fixation, which ultimately affects wear and longevity. Metal-backed glenoid components were introduced as an alternative to the standard cemented glenoid fixation. Early loosening and cavitary glenoid bone loss has been reported as a major complication associated with these metal-backed glenoids, which presents the surgeon with a challenging revision situation. Furthermore, failure of bilateral TSA in patients with metal-backed glenoids is extremely rare. We present two patients with early failure of bilateral TSA secondary to loosening of the metal-backed glenoids. Both patients had significant glenoid bone loss and were treated with four different types of revision techniques. A description of treatments and outcomes of both patients are reported along with the simple shoulder test and American Shoulder and Elbow Surgeons scores. One patient underwent revision to bilateral reverse prosthesis and experienced a much-improved outcome in comparison to the patient revised to a hemiarthroplasty and resection arthroplasty, for each shoulder respectively. In patients who present with failed TSA, revision to a reverse prosthesis with or without staged glenoid bone graft should be considered as an option of treatment. It is also important to rule out infection with intraoperative tissue biopsy before proceeding to revision surgery. However, in patients with catastrophic glenoid bone loss, both hemiarthroplasty and resection arthroplasty can provide an alternative treatment option, but they are associated with a poorer functional outcome and pain relief.
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    ABSTRACT: Der Glenoidersatz ist ein kritischer Punkt im Rahmen der anatomischen Schulterendoprothetik. Trotz besserer Resultate der Totalendoprothesen (TEP) gegenüber den Hemiendoprothesen (HEP) besteht große Zurückhaltung bzgl. der Implantation eines Glenoids. Präoperativ gilt es bereits die Indikation für einen Glenoidersatz sorgfältig abzuwägen und eine genaue Planung vorzunehmen. Goldstandard ist derzeit ein „All-Polyethylen-Glenoid“ mit zementierter Verankerung. Für eine lange und komplikationslose Standzeit kommt der Implantationstechnik entscheidende Bedeutung zu. Der Erhalt des subchondralen Knochens und die möglichst anatomische Wiederherstellung der glenoidalen Gelenkfläche sind hierbei wichtige Schlüsselfaktoren. Trotzdem scheint im Verlauf nach über 10 Jahren die revisionspflichtige Lockerungsrate signifikant zuzunehmen. Deshalb ist der Bedarf gegeben, verbesserte modulare und konvertierbare Implantate mit alternativen Fixationsmöglichkeiten zu entwickeln.
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