Total Shoulder Arthroplasty With an Uncemented Glenoid Component

Abstract

Progressive radiolucencies, radiographic failure, and clinical loosening requiring revision remain a concern with cemented polyethylene glenoids. The purpose of this study was to evaluate the results associated with the use of an uncemented glenoid component during total shoulder arthroplasty. Eighty-two consecutive total shoulder arthroplasties in 73 patients were performed using an uncemented glenoid component. Seventy-seven shoulders in 69 patients (40 females and 29 males) were available for follow-up. Diagnoses included osteoarthritis in 44 shoulders, rheumatoid arthritis in 29, and avascular necrosis in 4 shoulders. The mean age at TSA was 65.8 years (S.D. = 9.7, range 37-89). The average duration of follow-up was 6.5 years (S.D. = 2.7, range 3.5-10 years). Radiolucencies were noted around the glenoid component and/or screws in 45% of shoulders. Modified ASES scores improved from 18.4 ± 10.4 preoperatively to 77.6 ± 16.5 at follow-up (P < 0.0001). Ten of the glenoids (13.1%) had clinical failure, and 8 of these glenoids also had radiographic failure. Four significant independent predictors of clinical failure were noted on multivariate analysis: male gender (P = 0.02), pain (P < 0.01), major cuff tear (P < 0.008), and radiographic failure (P < 0.001). Clinical survivorship according to Kaplan-Meier method was 98% at 5 years, 83% at 8 years, and 77% at 10 years. Radiographic survivorship was 98% at 5 years and 79% at 10 years. While the radiographic and functional results of total shoulder arthroplasty utilizing an uncemented glenoid component appear to be comparable to those of cemented polyethylene components, both clinical and radiographic failure are an ongoing concern and mandate continued close scrutiny.