Glenoid or not glenoid component in primary osteoarthritis
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ORIGINAL ARTICLE
Glenoid or not glenoid component in primary osteoarthritis Kany Jean
Received: 8 September 2012 / Accepted: 16 October 2012 / Published online: 30 November 2012 Springer-Verlag France 2012
Abstract The optimal choice for the treatment of end-stage primary glenohumeral osteoarthritis remains controversial, with alternatives including total shoulder replacement (TSR) and humeral head replacement (HHR). The objective of this review is to analyze the effect of TSR compared with HHR on rates of pain relief, range of motion, patient satisfaction and revision surgery in patients with primary glenohumeral osteoarthritis. Compared with HHR, TSR provided significantly greater pain relief, gain in forward elevation, and gain in external rotation and patient satisfaction. Furthermore, TSR required significantly less revision surgery glenoid component loosening than patients undergoing HHR (progression of osteoarthritis changes with subchondral sclerosis, joint space narrowing and glenoid subsidence). A convex-back pegged glenoid component with a modern instrumented cement pressurization technique achieves risk of loosening. For 10 years, a high interest regarding new designs of uncemented metal back glenoid components has developed with promising results, because they allow glenoid bone graft in case of glenoid erosion or dysplasia and a one-stage glenoid bone reconstruction in case of revision surgery. Keywords Glenoid component Metal-backed Full-cemented
is often manifested clinically by pain, loss of function and the presence of a clunking noise and sensation and is one of the primary reasons for revision [1–4]. Authors still debate to better understand causes of these failures: what about technical mistakes, patient anatomical conditions or glenoid design components? So far, the full-polyethylene (full-PE) glenoid component (certainly the most commonly fitted component at the present time) can be cemented (pegged or keeled), or not (ingrowth). A certain concern regarding metal back (MB) glenoid components has developed, due to problems mentioned in the literature [5], such as dismantling, rapid wear of polyethylene and foreign body reaction leading to loosening. However, glenoid loosening is often well tolerated [6] with a revision rate of only 2–5 % [7]. The purpose of this review is to analyze the clinical and biomechanical data currently available to determine the potential benefits as well as limitations of glenoid. So, we will successively study • • •
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Introduction Failure of the glenoid component is the most common complication of total shoulder arthroplasty and accounts for a majority of the unsatisfactory results after this procedure. It
Causes of glenoid component failures Results and survival rate of humeral head replacement (HHR) Results and survival rate of total shoulder replacement (TSR) with specific analysis of the glenoid component
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TSR with full-PE implant (cemented or ingrowth) TSR with MB component
Possible strategies for minimizing the risk of glenoid component failur
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