Keeled versus pegged glenoid components in total shoulder arthroplasty for primary osteoarthritis: a meta-analysis.

We sought to compare functional outcomes and survival between non-smokers, former smokers, and current smokers who underwent anatomical total shoulder arthroplasty (aTSA) in a large cohort of patients. A retrospective review of a prospectively collected shoulder arthroplasty database was performed between August 1991 and September 2020 to identify patients who underwent primary aTSA. Patients were excluded for preoperative diagnoses of fracture, infection, or oncological disease. Three cohorts were created based on smoking status: non-smokers, former smokers, and current smokers. Outcome scores (American Shoulder and Elbow Surgeons (ASES), Constant-Murley score, Shoulder Pain and Disability Index (SPADI), Simple Shoulder Test (SST), University of California, Los Angeles activity scale (UCLA)), range of motion (external rotation (ER), forward elevation (FE), internal rotation, abduction), and shoulder strength (ER, FE) evaluated at two- to four-year follow-up were compared between cohorts. Evaluation of revision-free survival was performed using the Kaplan-Meier method to final follow-up. We included 428 primary aTSAs with a mean follow-up of 2.4 years (SD 0.6). Our cohort consisted of 251 non-smokers, 138 former smokers who quit a mean 21 years (SD 14) prior to surgery (25 pack-years (SD 22)), and 39 current smokers (23 pack-years (SD 20)). At two- to four-year follow-up, former smokers had less favourable SPADI, SST, and FE strength compared to non-smokers, and current smokers had less favourable SPADI, SST, ASES score, UCLA score, Constant-Murley score, FE, abduction, and ER strength compared to non-smokers. Non-smokers exhibited higher revision-free survival rates at two, five, eight, and ten years postoperatively compared to former smokers and current smokers, who had similar rates. Our study suggests that smoking has a negative effect on aTSA functional outcomes that may persist even after quitting.

Radiographic comparison of pegged and keeled glenoid components using modern cementing techniques: A prospective randomized study

What's New in Shoulder and Elbow Surgery.

BackgroundThe purpose of this study was to examine biomechanical properties and the degree of radiolucency of two cemented basic glenoid designs for total shoulder arthroplasty. Our hypothesis was that a component with increased micro-motion in the laboratory at time zero would also exhibit a greater amount of radiolucency in patients at a minimum of 2 years post total shoulder arthroplasty.MethodsThirty cadaveric shoulders were divided into 2 groups (keel vs. peg). The glenoid components were first loaded with a single axial eccentric force of 196 N in all orientations and then with a transversal load of 49 N to simulate in vivo loads with abduction. Displacement of the glenoid component was determined with four different linear variable-differential transducers. In the second phase, 56 antero-posterior x-rays of 52 patients with either the same keeled (n = 24) or pegged (n = 32) glenoid component with a minimum of 24 months follow-up were evaluated for radiolucency.ResultsBiomechanically the pegged glenoid showed a significant increase in micro-motion during eccentric axial loading as well as during combined loading in the anterior, posterior, and inferior position as compared to the keeled glenoid (p < 0.05). In contrast all results were significant with greater radiolucency for the keeled glenoid component (p = 0.001).ConclusionWhile the pegged component exhibited a greater amount of micro-motion during biomechanical testing, radiolucency was greater in patients with a keeled component. These findings provide support for both components from different perspectives and highlight the need for well-constructed studies to determine whether glenoid design has an effect on clinical outcome, because influences are multifactorial and biomechanical forces may not recreate forces seen in vivo.

Comparison of Pegged and Keeled Glenoid Components for Total Shoulder Arthroplasty

Background:With variations in joint destruction, patient expectations and health status, it can be difficult to interpret outcomes following arthroplasty. The purpose of this study was to determine the relationships between different outcome indicators in 44 patients followed for two years after a reverse shoulder arthroplasty.Methods:Prospectively collected outcomes included the Constant-Murley score, Simple Shoulder Test (SST), range of motion (ROM), strength, patient satisfaction with their care and independent clinician case-review to determine global clinical outcome. Continuous outcomes were divided in two subgroups according to definitions of functional outcomes. Cohen’s kappa was used to evaluate agreement between outcomes. Pearson correlations were used to quantify interrelationships.Results:Although 93% of patients were substantially satisfied, fewer had good results on the other outcomes: 68% on global clinical outcome, 46% on SST and 73% on Constant-Murley score. The SST demonstrated better than chance agreement with Constant-Murley score, ROM in flexion, abduction and external rotation, and strength in external rotation. No agreement between satisfaction and other outcomes were observed. Significant correlations were observed between Constant-Murley score and SST (r = 0.78). The Constant-Murley score and SST demonstrated variable correlation with ROM and strength in flexion, abduction, internal and external rotation (0.38 < r < 0.73); the highest correlations being observed with shoulder elevation ROM (r > 0.50).Conclusions:Results show that outcome varies according to patient perspective and assessment methods. Patient satisfaction with their care was related to neither self-reported nor physical impairment outcomes. Positive patient ratings of satisfaction may not necessarily be evidence of positive outcomes.

There is still debate regarding whether the remnant tendon on the greater tuberosity should be removed during rotator cuff repair (RCR). This study aimed to evaluate whether remnant preservation (RP) in RCR leads to better clinical outcomes. Medical records of 833 consecutive patients with rotator cuff tears (RCTs) between December 2019 and April 2022 were retrospectively reviewed. Patients were divided into a RP group and a conventional repair (CR) group, and 1:1 propensity score matching was performed based on age, sex, tear size, tear type, repair method, and fatty infiltration. After matching, 33 patients were included in each group. Clinical outcomes were compared using range of motion (ROM), visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, University of California-Los Angeles (UCLA) score, Simple Shoulder Test (SST) score, and the Quick Disabilities of the Arm, Shoulder, and Hand (quick-DASH) score preoperatively and at 3 months, 6 months, and final follow-up. Magnetic resonance imaging (MRI) was performed at the final follow-up to evaluate the integrity of the repaired rotator cuff tendons. The mean patient age was 56.6 ± 7.7 years in RP group and 56.8 ± 7.8 in CR group, with an average follow-up of 29.5 ± 4.2 months. The mean MRI follow-up time was also 29.5 ± 4.2 months. Final follow-up scores were higher than preoperative scores in both groups. There were no significant differences between the two groups in final follow-up scores for any assessment. However, at 3 and 6 months postoperatively, the RP group showed better functional scores on ASES, Constant-Murley, SST, and Quick-DASH compared to the CR group. Additionally, at 3 months postoperatively, the RP group had better VAS scores. In patients with acute tears, the differences in ASES, Constant-Murley, SST, and VAS scores between the groups were even more pronounced. The RP group also showed superior flexion, external rotation, and internal rotation at 3 and 6 months postoperatively, with no differences before surgery or at the final follow-up. Regarding abduction, the RP group had a greater angle at 6 months and at the final follow-up. There were no statistically significant differences in retear rates between the groups, although the RP group demonstrated better quality of the repaired rotator cuff. Both groups showed improved outcomes compared to preoperative scores at final follow-up, with no differences between groups at that time point. RP repair improved early clinical outcomes and resulted in better quality of the repaired rotator cuff compared to CR.

Considerable interest has been focused on the design of the glenoid component used in total shoulder arthroplasty in order to reduce the risk of loosening. One design-related feature that has attracted attention is whether to use pegged or keeled cemented glenoid components. The main purpose of this study was to compare the fixation of cemented keeled glenoid components with that of cemented in-line pegged glenoid components. In a prospective randomized study, we compared the stability of cemented, all-polyethylene, keeled glenoid components and cemented, all-polyethylene, in-line three-pegged glenoid components by radiostereometric analysis. Twenty-seven shoulders in twenty-five patients with osteoarthritis (twenty-two shoulders had primary and five shoulders had secondary osteoarthritis) were included. There were sixteen women and nine men, and the mean age was sixty-four years. Radiostereometric analysis and conventional radiographs were carried out at five days, at four months, and at one and two years postoperatively. The mean Constant and Murley score preoperatively and two years postoperatively was 25 and 70, respectively, for shoulders with the keeled glenoid component and 22 and 70 for the shoulders with a pegged component. No significant difference was detected between groups with regard to the average micromigration of the glenoid components at any of the time points. The average translation was <1 mm, while the median value was <0.3 mm at two years, with no significant difference between the different axes. In five shoulders (three with the keeled component and two with the pegged component), translation at two years was >1 mm. In fourteen shoulders (eight with the keeled and six with the pegged component), the rotation around one or several axes was >2 degrees . We were not able to detect any specific pattern with regard to movement for either type of component nor were we able to detect any difference between the two types of components in the way they migrated, if migration occurred. Cemented all-polyethylene keeled or in-line three-pegged glenoid components appear to have similar stability during the first two years after surgery. Studies with a longer follow-up period are needed to relate these findings to long-term clinical and radiographic outcomes.

Computed tomography revealed the correlation between radiolucency and alignment of all-polyethylene pegged glenoid component more than 10 years after total shoulder arthroplasty in the Japanese population

The objective of this study was to conduct a meta-analysis and cost-effectiveness analysis of the effect of glenoid design on radiolucency, loosening, and revision after total shoulder arthroplasty. We conducted a systematic review of PubMed, MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and CINAHL with use of a search for the terms arthroplasty AND shoulder AND (peg OR keel). Data on study design and on the end points of radiolucency, loosening, and revision were extracted independently and in duplicate. Random-effect models were used to calculate the pooled risk ratio and risk difference. The risk difference was used to estimate the number needed to treat (the number of individuals who would have to receive a pegged component to avoid one loosening or revision). Eight studies with a total of 1460 patients (mean age, sixty-seven years) were included. The mean study quality was 1.75 points (95% confidence interval [CI], 1.26 to 2.24) on the 3-point modified Jadad scale. There was no significant difference in the risk of any radiolucency (risk ratio, 0.42; 95% CI, 0.12 to 1.42) or in the risk of severe radiolucency (risk ratio, 0.65; 95% CI, 0.23 to 1.82) between pegged and keeled components. The pooled risk ratio for revision was 0.27 (95% CI, 0.08 to 0.88) in favor of pegged components (p = 0.028). At a cost-effectiveness threshold of $50,000 per quality-adjusted life year, pegged components can be between $2325 and $40,920 more expensive than keeled components and still be cost-effective. Our study produced evidence that pegged glenoid components were associated with a lower revision risk compared with keeled components. However, the difference was rather small and will therefore be most meaningful to high-volume shoulder arthroplasty centers. Because of the similarity between primary and secondary costs, pegged glenoid designs were more cost-effective than keeled glenoid designs.

Survival and clinical outcomes of the Eclipse™ stemless anatomic total shoulder arthroplasty: a comparative study of glenoid component designs and humeral head materials.

Aim of workThis study aimed to compare the effects of supra-scapular nerve block, posterior intra-articular hydro-dilatation, and hydro-dilatation of the shoulder interval, in terms of improving pain, function, and range of motion in patients with adhesive capsulitis.Patients and methodsA total of 50 patients diagnosed with adhesive capsulitis were randomly divided into three groups. The first group received a suprascapular nerve block, the second group underwent posterior intra-articular hydro-dilatation, and the third group underwent shoulder interval hydro-dilatation. Patient assessment was conducted using visual analogue scale for pain, shoulder pain and disability index, and measurements of range of motion.ResultsGroup 1 experienced rapid and sustained pain reduction (p-value < 0.001 at both baseline vs. first follow-up and baseline vs. second follow-up), with non-significant improvement in internal rotation after 12 weeks (p value = 0.330). Group 2 showed delayed improvement in internal rotation (p-value = 0.068), but more sustained pain reduction (p-value < 0.001) and improved range of motion in all directions at the 12-week mark. Group 3 exhibited rapid pain reduction (p-value < 0.001) and improved range of motion, but non-significant improvements in internal (p-value = 0.131) and external rotation (p-value = 0.052) after 12 weeks.ConclusionAlthough no significant differences were observed among the three groups, we recommend posterior intra-articular hydro-dilatation as it yielded the most promising and sustainable outcomes as regard pain reduction and range of motion improvement. Suprascapular nerve block is recommended for patients with prominent pain symptoms. Rotator interval hydro-dilatation is the least recommended intervention, being the most challenging and painful technique, and as it demonstrated a less sustained effect on range of motion.Key Points• This study aimed to find the best treatment modality for adhesive capsulitis through comparing the effects of suprascapular nerve block, posterior intra-articular hydro-dilatation, and hydro-dilatation of the shoulder interval.• Although no significant differences were found among three modalities, posterior intra-articular hydro-dilatation showed the best long-term outcomes for pain and range of motion. Suprascapular nerve block is recommended for patients with severe pain, while hydro-dilatation of the shoulder interval had less lasting benefits.

Anatomic total shoulder arthroplasty improves pain and function with a reported reoperation rate of approximately 1% per year. With improved glenoid fixation, reverse shoulder arthroplasty implants may outperform anatomic total shoulder arthroplasty. We evaluate the functional outcomes and reoperation rate of anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty at a minimum eight-year follow-up or revision. Between 2005 and 2010, 187 shoulders (137 anatomic total shoulder arthroplasty, 50 reverse shoulder arthroplasty) were retrospectively reviewed at a mean of 8.8 years. The mean age at surgery was 67 years. Females were more commonly treated with reverse shoulder arthroplasty. Both groups had similar body mass index and comorbidities. Outcome measures evaluated included abduction, forward elevation, external rotation, internal rotation, Simple Shoulder Test, Constant score, American Shoulder and Elbow Score, University of California Los Angeles Shoulder score, and Shoulder Pain and Disability Index. At follow-up, anatomic total shoulder arthroplasty demonstrated greater overhead range of motion and external rotation. All patient-reported outcomes remained similar between groups. Reverse shoulder arthroplasty patients were more likely to rate shoulders as much better or better after surgery (90% versus 67%, p = 0.004). Complications were observed in 24% of anatomic total shoulder arthroplasties and 8% of reverse shoulder arthroplasties (p = 0.02). Reoperation was more common in anatomic total shoulder arthroplasties (23% versus 4%, p = 0.003). At mid-to-long-term follow-up, reverse shoulder arthroplasties demonstrated significantly fewer complications and reoperations than anatomic total shoulder arthroplasties. Despite similar patient-reported outcomes, reverse shoulder arthroplasty patients were more likely to be satisfied with their shoulder.

Reverse shoulder arthroplasty with isolated latissimus-dorsi transfer/additional teres-major transfer for combined loss of elevation and external rotation: A systematic review and meta-analysis

The overhead throwing motion is complex, and restrictions in range of motion (ROM) at the hip may place additional demands on the shoulder that lead to injury. However, the relationship between hip and shoulder ROM in athletes with and without a history of shoulder injury is unknown. To (1) determine if differences exist in hip and shoulder ROM between professional baseball players with a history of shoulder injury and those with no history of shoulder injury and (2) assess relationships between hip and shoulder ROM in these players. Cross-sectional study. Fifty-seven professional baseball players. Outcome measures consisted of hip extension and internal rotation, shoulder internal and external rotation, glenohumeral internal-rotation deficit, and history of shoulder injury. Differences in shoulder and hip ROM were assessed with a 1-way analysis of variance. Associations between hip and shoulder ROM were assessed with linear regression. Nonpitchers with a history of shoulder injury had more external rotation and less internal rotation of the shoulder than nonpitchers with no history of shoulder injury. Glenohumeral internal-rotation deficit was greater in both pitchers and nonpitchers with a history of shoulder injury. The relationship between dominant hip extension and shoulder external rotation was significant for pitchers with a history of shoulder injury and nonpitchers with a history of shoulder injury. Shoulder injury may be associated with specific measures of hip and shoulder ROM, and hip extension and shoulder external rotation may be related in baseball players with a history of shoulder injury. Additional research is necessary to understand the specific mechanisms of shoulder injury in the throwing athlete.