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The Bone & Joint Journal
Vol. 98-B, Issue 8 | Pages 1080 - 1085
1 Aug 2016
Gauci MO Boileau P Baba M Chaoui J Walch G

Aims

Patient-specific glenoid guides (PSGs) claim an improvement in accuracy and reproducibility of the positioning of components in total shoulder arthroplasty (TSA). The results have not yet been confirmed in a prospective clinical trial. Our aim was to assess whether the use of PSGs in patients with osteoarthritis of the shoulder would allow accurate and reliable implantation of the glenoid component.

Patients and Methods

A total of 17 patients (three men and 14 women) with a mean age of 71 years (53 to 81) awaiting TSA were enrolled in the study. Pre- and post-operative version and inclination of the glenoid were measured on CT scans, using 3D planning automatic software. During surgery, a congruent 3D-printed PSG was applied onto the glenoid surface, thus determining the entry point and orientation of the central guide wire used for reaming the glenoid and the introduction of the component. Manual segmentation was performed on post-operative CT scans to compare the planned and the actual position of the entry point (mm) and orientation of the component (°).


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_12 | Pages 8 - 8
1 Jul 2014
Flatow E
Full Access

The incidence of total shoulder arthroplasty continues to increase. The most common reason for failure of a total shoulder arthroplasty is the glenoid component. Two styles of cemented all-polyethylene components are commonly implanted. These two styles are pegged glenoid and keel glenoid components. Data regarding the superiority of the styles has focused on radiolucent lines, complete loosening and need for revision procedures. Several retrospective and randomised controlled trials have been published to examine these endpoints. There is a trend in the literature to demonstrate decreased rates of radiolucent lines with pegged glenoid components, but a recent systematic review of available trials did not demonstrate a significant difference in the rate of radiolucent lines between the two styles. A slightly increased rate of revision was noted for the keel components. Overall pegged and keel glenoids both still represent good options in total shoulder arthroplasty


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_12 | Pages 13 - 13
1 Jul 2014
Bigliani L
Full Access

Radiolucent lines in total shoulder arthroplasty around the glenoid component are not uncommon in post-operative x-rays and the incidence varies. A certain percentage progress and as the lines enlarge can lead to component loosening. One study reported a 9% incidence at 2 years and 27% incidence at 5 years. A recent long term study (15 to 20 years) reported a 73% incidence. Radiolucent lines can be caused by anatomy (posterior glenoid wear) or pathology (inflammatory arthritis) as well as technical factors such as glenoid implant design (metal back) and improper implantation techniques where the prosthesis is not fully seated or cement is used to fill a defect. Every attempt should be made to avoid lucent lines. Minimal bone should be removed from the glenoid vault and a pressure injection type of insertion is helpful in getting the cement into the cancellous bone. Furthermore a peg type of glenoid implant rather than a keel type is preferred as this has been associated with a lower incidence of radiolucent lines