Total shoulder arthroplasty with a metal-backed, bone-ingrowth glenoid component: Medium to long-term results

Michael J. Taunton, Amy L. McIntosh, John W. Sperling, Robert H. Cofield

Research output: Contribution to journalArticle

95 Citations (Scopus)

Abstract

Background: Loosening of a cemented glenoid component is an important cause of failure in shoulder arthroplasty. This studywas developed to examine the outcome of patientsmanaged with ametal-backed, bone-ingrowth glenoid component as an alternative to a cemented component. Methods: The study group included eighty-three total shoulder arthroplasties with ametal-backed, bone-ingrowth glenoid component performed between1989and1994.Seventy-four shouldershad a diagnosis of primary osteoarthritis, and nine shoulders had other diagnoses. All patients were followed radiographically and clinically for a minimum of two years or until the time of revision surgery. Kaplan-Meier survival estimates were performed with revision and/or radiographic failure as the end points. Results: The mean clinical follow-up was 9.5 years, and the mean radiographic follow-up was 7.1 years. Pain ratings (on a scale of 1 to 5) decreased from a mean of 4.7 preoperatively to 2.0 postoperatively. The mean range of motion in active elevation increased from 102° preoperatively to 135° postoperatively; the mean external rotation increased from 27° to 56°. Glenohumeral joint instability developed in fourteen shoulders. Radiographic changes consistent with glenoid component loosening were present in thirty-three shoulders. Polyethylene wear with metal wear of the glenoid component was noted in twenty-one shoulders, and humeral component looseningwas seenin fifteen shoulders. Revision procedureswere performed in twenty-six shoulders. There were no identifiable patient, disease, or surgical characteristics associated with failure, either clinically or radiographically. The five-year survival estimate free of revision or radiographic failure was 79.9%(95%confidence interval, 71.6% to 89.3%), and the ten-year survival estimate was 51.9% (95% confidence interval, 41.0% to 65.8%). Conclusions: The high rate of failure of total shoulder arthroplasties performed with this metal-backed, bone-ingrowth glenoid component raises concerns as to its use, and perhaps the use of other types of metal-backed components, in shoulder arthroplasty, other than for special situations. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)2180-2188
Number of pages9
JournalJournal of Bone and Joint Surgery - Series A
Volume90
Issue number10
DOIs
StatePublished - Oct 1 2008

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Arthroplasty
Metals
Bone and Bones
Survival
Confidence Intervals
Joint Instability
Shoulder Joint
Kaplan-Meier Estimate
Polyethylene
Articular Range of Motion
Reoperation
Osteoarthritis
Pain

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Total shoulder arthroplasty with a metal-backed, bone-ingrowth glenoid component : Medium to long-term results. / Taunton, Michael J.; McIntosh, Amy L.; Sperling, John W.; Cofield, Robert H.

In: Journal of Bone and Joint Surgery - Series A, Vol. 90, No. 10, 01.10.2008, p. 2180-2188.

Research output: Contribution to journalArticle

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abstract = "Background: Loosening of a cemented glenoid component is an important cause of failure in shoulder arthroplasty. This studywas developed to examine the outcome of patientsmanaged with ametal-backed, bone-ingrowth glenoid component as an alternative to a cemented component. Methods: The study group included eighty-three total shoulder arthroplasties with ametal-backed, bone-ingrowth glenoid component performed between1989and1994.Seventy-four shouldershad a diagnosis of primary osteoarthritis, and nine shoulders had other diagnoses. All patients were followed radiographically and clinically for a minimum of two years or until the time of revision surgery. Kaplan-Meier survival estimates were performed with revision and/or radiographic failure as the end points. Results: The mean clinical follow-up was 9.5 years, and the mean radiographic follow-up was 7.1 years. Pain ratings (on a scale of 1 to 5) decreased from a mean of 4.7 preoperatively to 2.0 postoperatively. The mean range of motion in active elevation increased from 102° preoperatively to 135° postoperatively; the mean external rotation increased from 27° to 56°. Glenohumeral joint instability developed in fourteen shoulders. Radiographic changes consistent with glenoid component loosening were present in thirty-three shoulders. Polyethylene wear with metal wear of the glenoid component was noted in twenty-one shoulders, and humeral component looseningwas seenin fifteen shoulders. Revision procedureswere performed in twenty-six shoulders. There were no identifiable patient, disease, or surgical characteristics associated with failure, either clinically or radiographically. The five-year survival estimate free of revision or radiographic failure was 79.9{\%}(95{\%}confidence interval, 71.6{\%} to 89.3{\%}), and the ten-year survival estimate was 51.9{\%} (95{\%} confidence interval, 41.0{\%} to 65.8{\%}). Conclusions: The high rate of failure of total shoulder arthroplasties performed with this metal-backed, bone-ingrowth glenoid component raises concerns as to its use, and perhaps the use of other types of metal-backed components, in shoulder arthroplasty, other than for special situations. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.",
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AU - McIntosh, Amy L.

AU - Sperling, John W.

AU - Cofield, Robert H.

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N2 - Background: Loosening of a cemented glenoid component is an important cause of failure in shoulder arthroplasty. This studywas developed to examine the outcome of patientsmanaged with ametal-backed, bone-ingrowth glenoid component as an alternative to a cemented component. Methods: The study group included eighty-three total shoulder arthroplasties with ametal-backed, bone-ingrowth glenoid component performed between1989and1994.Seventy-four shouldershad a diagnosis of primary osteoarthritis, and nine shoulders had other diagnoses. All patients were followed radiographically and clinically for a minimum of two years or until the time of revision surgery. Kaplan-Meier survival estimates were performed with revision and/or radiographic failure as the end points. Results: The mean clinical follow-up was 9.5 years, and the mean radiographic follow-up was 7.1 years. Pain ratings (on a scale of 1 to 5) decreased from a mean of 4.7 preoperatively to 2.0 postoperatively. The mean range of motion in active elevation increased from 102° preoperatively to 135° postoperatively; the mean external rotation increased from 27° to 56°. Glenohumeral joint instability developed in fourteen shoulders. Radiographic changes consistent with glenoid component loosening were present in thirty-three shoulders. Polyethylene wear with metal wear of the glenoid component was noted in twenty-one shoulders, and humeral component looseningwas seenin fifteen shoulders. Revision procedureswere performed in twenty-six shoulders. There were no identifiable patient, disease, or surgical characteristics associated with failure, either clinically or radiographically. The five-year survival estimate free of revision or radiographic failure was 79.9%(95%confidence interval, 71.6% to 89.3%), and the ten-year survival estimate was 51.9% (95% confidence interval, 41.0% to 65.8%). Conclusions: The high rate of failure of total shoulder arthroplasties performed with this metal-backed, bone-ingrowth glenoid component raises concerns as to its use, and perhaps the use of other types of metal-backed components, in shoulder arthroplasty, other than for special situations. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

AB - Background: Loosening of a cemented glenoid component is an important cause of failure in shoulder arthroplasty. This studywas developed to examine the outcome of patientsmanaged with ametal-backed, bone-ingrowth glenoid component as an alternative to a cemented component. Methods: The study group included eighty-three total shoulder arthroplasties with ametal-backed, bone-ingrowth glenoid component performed between1989and1994.Seventy-four shouldershad a diagnosis of primary osteoarthritis, and nine shoulders had other diagnoses. All patients were followed radiographically and clinically for a minimum of two years or until the time of revision surgery. Kaplan-Meier survival estimates were performed with revision and/or radiographic failure as the end points. Results: The mean clinical follow-up was 9.5 years, and the mean radiographic follow-up was 7.1 years. Pain ratings (on a scale of 1 to 5) decreased from a mean of 4.7 preoperatively to 2.0 postoperatively. The mean range of motion in active elevation increased from 102° preoperatively to 135° postoperatively; the mean external rotation increased from 27° to 56°. Glenohumeral joint instability developed in fourteen shoulders. Radiographic changes consistent with glenoid component loosening were present in thirty-three shoulders. Polyethylene wear with metal wear of the glenoid component was noted in twenty-one shoulders, and humeral component looseningwas seenin fifteen shoulders. Revision procedureswere performed in twenty-six shoulders. There were no identifiable patient, disease, or surgical characteristics associated with failure, either clinically or radiographically. The five-year survival estimate free of revision or radiographic failure was 79.9%(95%confidence interval, 71.6% to 89.3%), and the ten-year survival estimate was 51.9% (95% confidence interval, 41.0% to 65.8%). Conclusions: The high rate of failure of total shoulder arthroplasties performed with this metal-backed, bone-ingrowth glenoid component raises concerns as to its use, and perhaps the use of other types of metal-backed components, in shoulder arthroplasty, other than for special situations. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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