Select Online ArticleNonstandard glenoid components for bone deficiencies in shoulder arthroplasty
Section snippets
Materials and methods
We have retrospectively reviewed a total of 38 consecutive patients who had primary (25) or revision (13) shoulder replacement with 3 types of nonstandard glenoid components between January 1989 and December 2007. The 3 different glenoid component designs were used on the basis of the location of the glenoid wear and presence or absence of posterior subluxation. An angled keel glenoid component was used to accept the posterior glenoid wear as-is when there was no or mild joint subluxation
Results
There was improvement in pain after the procedure. Pain scores on a 5-point scale decreased from a mean of 4.8 to 2.8 (P = .001) (Table I). Before surgery, 36 patients (95%) had moderate or severe pain, whereas 24 patients (63%) had no or mild pain or occasional moderate pain at the most recent follow-up. Postoperatively, 12 had moderate and 2 had severe pain. Of these 14 shoulders, 9 had a reoperation, 1 had a radiographically loose glenoid component, and 1 had severe posterior subluxation. In
Discussion
Our thinking that special glenoid component configurations to address peripheral or central bone deficiencies would be a substantial step in improving surgical outcomes has not proved to be true. The experience with use of these nonstandard glenoid components in primary or revision shoulder arthroplasty during an intermediate follow-up period averaging 7.3 years revealed mediocre clinical and radiographic results for this difficult problem. Compared with above 90% 10-year survival rate free of
Conclusions
The role of 3 types of nonstandard glenoid components in anatomic shoulder arthroplasty to correct peripheral or central bone deficiency is uncertain as outcomes were compromised by both component issues and instability. As a result, the use of these 3 types of special components has been discontinued. Recent literature on B2 glenoids treated with reverse shoulder replacement seems to be promising and manages the postoperative instability in patients older than 65 years.11 Pursuit of innovative
Disclaimer
John W. Sperling receives royalties from Biomet.
Robert H. Cofield receives royalties from Smith & Nephew for glenoid component design and royalties from DJO.
Akin Cil, his immediate family, and any research foundations with which he is affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.
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IRB, Mayo Foundation (IRB Modification #Mod10-003944-01).