Component In Shoulder Arthroplasty Research Articles

Effect of vitamin E–enhanced highly cross-linked polyethylene on wear rate and particle debris in anatomic total shoulder arthroplasty: a biomechanical comparison to ultrahigh-molecular-weight polyethylene

Particle-induced osteolysis resulting from polyethylene wear remains a source of implant failure in anatomic total shoulder designs. Modern polyethylene components are irradiated in an oxygen-free environment to induce cross-linking, but reducing the resulting free radicals with melting or heat annealing can compromise the component's mechanical properties. Vitamin E has been introduced as an adjuvant to thermal treatments. Anatomic shoulder arthroplasty models with a ceramic head component have demonstrated that vitamin E-enhanced polyethylene show improved wear compared with highly cross-linked polyethylene (HXLPE). This study aimed to assess the biomechanical wear properties and particle size characteristics of a novel vitamin E-enhanced highly cross-linked polyethylene (VEXPE) glenoid compared to a conventional ultrahigh-molecular-weight polyethylene (UHMWPE) glenoid against a cobalt chromium molybdenum (CoCrMo) head component. Biomechanical wear testing was performed to compare the VEXPE glenoid to UHMWPE glenoid with regard to pristine polyethylene wear and abrasive endurance against a polished CoCrMo alloy humeral head in an anatomic shoulder wear-simulation model. Cumulative mass loss (milligrams) was recorded, and wear rate calculated (milligrams per megacycle [Mc]). Under pristine wear conditions, particle analysis was performed, and functional biologic activity (FBA) was calculated to estimate particle debris osteolytic potential. In addition, 95% confidence intervals for all testing conditions were calculated. The average pristine wear rate was statistically significantly lower for the VEXPE glenoid compared with the HXLPE glenoid (0.81 ± 0.64 mg/Mc vs. 7.00 ± 0.45 mg/Mc) (P<.05). Under abrasive wear conditions, the VEXPE glenoid had a statistically significant lower average wear rate compared with the UHMWPE glenoid comparator device (18.93 ± 5.80 mg/Mc vs. 40.47 ± 2.63 mg/Mc) (P<.05). The VEXPE glenoid demonstrated a statistically significant improvement in FBA compared with the HXLPE glenoid (0.21 ± 0.21 vs. 1.54 ± 0.49 (P<.05). A newanatomic glenoid component with VEXPE demonstrated significantly improved pristine and abrasive wear properties with lower osteolytic particle debris potential compared with a conventional UHMWPE glenoid component. Vitamin E-enhanced polyethylene shows early promise in shoulder arthroplasty components. Long-term clinical and radiographic investigation needs to be performed to verify if these biomechanical wear properties translate to diminished long-term wear, osteolysis, and loosening.

A biomechanical comparison of elliptical and spherical humeral head components in shoulder arthroplasty

A biomechanical comparison of elliptical and spherical humeral head components in shoulder arthroplasty

Glenoid reconstruction bone loss with a pediculated coracoid autograft during shoulder arthroplasty. A technical note

Reconstruction of glenoid bone loss is a difficult but often required component of shoulder arthroplasty. A variety of free autografts or allografts have been proposed for reconstruction. While Latarjet is well accepted for the management of anterior instability, the use of a coracoid graft has not been described in conjunction with shoulder arthroplasty. We propose that anterior and central glenoid bone defects can be reconstructed with the coracoid process. to provide a vascularized local structural autograft. Level of evidence: IV.

Pectoralis major tendon transfer for management of subscapularis failure after anatomic total shoulder arthroplasty: technique and results

Subscapularis tendon failure after anatomic total shoulder arthroplasty can lead to pain, dysfunction, and early component failure. The purpose of this study was to report on the results of pectoralis major tendon transfer for treatment of irreparable subscapularis tendon failure in the setting of prior shoulder arthroplasty. Patients who underwent pectoralis major muscle transfer for treatment of subscapularis failure in the setting of prior total shoulder arthroplasty or hemiarthroplasty were included in the study. The entirety of the pectoralis major tendon was transferred superficial to the conjoined tendon and placed lateral to the bicipital groove. Eight patients were included in the study. All 7 patient who experienced pain in their shoulder had improvement in their pain postoperatively. Those patients with preserved active motion were able to regain that motion postoperatively. Radiographically, anterior translation was found to be temporarily improved; however, anterior instability would later recur in most cases, though this did not correlate with increased pain or decreased function. Management options ranging from continued observation, revision repair, pectoralis muscle transfer, or revision to reverse total shoulder arthroplasty should be considered in a setting of subscapularis failure after shoulder arthroplasty. Decision-making should be based on physiological age of the patient as well as symptoms present as well as the position and stability of the arthroplasty components. Pectoralis muscle transfer can provide pain relief, improve subjective instability, and preserve function in physiological young patients with an irreparable subscapularis who have well-positioned and well-fixed anatomic shoulder arthroplasty components.

Tribocorrosion is common but mild in modular humeral components in shoulder arthroplasty: an implant retrieval analysis.

BackgroundWear and corrosion at the junctions of modular implants are increasingly recognized issues in the design of hip and knee arthroplasty prostheses, yet less is known about their significance in shoulder arthroplasty.MethodsA query of paired total shoulder implant specimens (eg, humeral head and stem components from the same patient) was performed using an institutional implant retrieval registry. Implants were examined under a stereomicroscope and evaluated for evidence of fretting and corrosion using the modified Goldberg scoring system. Available electronic medical records of included specimens were reviewed to report relevant clinical characteristics and identify potential associations with the presence of tribocorrosion.ResultsEighty-three paired total shoulder implant specimens, explanted at a single institution between 2013 and 2020, were analyzed. Corrosion was identified in 52% (43/83) of humeral head components and 40% (33/83) of humeral stem components. Fretting was identified in 29% (24/83) of humeral head components and 28% (23/83) of humeral stem components. Of the 56 paired implants for which clinical data were available, the duration of implantation (DOI) was less than 2 years in 29% of paired implants and greater than 5 years in 36% of implants. The presence of corrosion or fretting was not associated with DOI, a male humeral head taper, or periprosthetic infection as the indication for revision.ConclusionMild tribocorrosion was present in more than half of the retrieved humeral implant specimens. However, trunnionosis did not manifest as a clinical cause of revision surgery in our study.

Augmented-Reality-Assisted K-Wire Placement for Glenoid Component Positioning in Reversed Shoulder Arthroplasty: A Proof-of-Concept Study.

The accuracy of the implant’s post-operative position and orientation in reverse shoulder arthroplasty is known to play a significant role in both clinical and functional outcomes. Whilst technologies such as navigation and robotics have demonstrated superior radiological outcomes in many fields of surgery, the impact of augmented reality (AR) assistance in the operating room is still unknown. Malposition of the glenoid component in shoulder arthroplasty is known to result in implant failure and early revision surgery. The use of AR has many promising advantages, including allowing the detailed study of patient-specific anatomy without the need for invasive procedures such as arthroscopy to interrogate the joint’s articular surface. In addition, this technology has the potential to assist surgeons intraoperatively in aiding the guidance of surgical tools. It offers the prospect of increased component placement accuracy, reduced surgical procedure time, and improved radiological and functional outcomes, without recourse to the use of large navigation or robotic instruments, with their associated high overhead costs. This feasibility study describes the surgical workflow from a standardised CT protocol, via 3D reconstruction, 3D planning, and use of a commercial AR headset, to AR-assisted k-wire placement. Post-operative outcome was measured using a high-resolution laser scanner on the patient-specific 3D printed bone. In this proof-of-concept study, the discrepancy between the planned and the achieved glenoid entry point and guide-wire orientation was approximately 3 mm with a mean angulation error of 5°.

Radiographic alignment of short stem humeral components in shoulder arthroplasty: a multicenter study

IntroductionShort stem humeral stem components represent an area of potential advancement that may decrease the risk of complications associated with traditional length stems, but early data has demonstrated a high rate of malalignment with certain designs. The utilization of a short stem specifically designed to self-align in the proximal portion of the diaphysis has the potential to provide more consistent adequate alignment. MethodsA multicenter retrospective review was performed on 269 shoulders that had undergone an anatomic Total shoulder arthroplasty or a reverse shoulder arthroplasty with implantation of a self-aligning short stem humeral component. Radiographic outcomes included stem alignment and fill-fit ratios. ResultsRadiographs showed adequate stem alignment in 94% of the shoulders. The differences in the superior region canal-fill ratio between the neutral and malaligned group were statistically significant (P < .0003), and the canal-fill rations in the inferior region were also statistically different between the 2 groups (P < .0001). The trend demonstrated higher fill ratios for the neutral stems. ConclusionThe self-aligning short stem analyzed in this study provided a very high rate of adequate stem radiographic alignment. Higher fill ratios were correlated with improved stem alignment. Further studies are needed to understand if improved initial alignment rates correlate with improved patient outcomes or a decreased rate of mechanical failure or other complications. Level of evidenceIV

Patient-specific planning in shoulder arthroplasty.

Patient-specific instrumentation has been shown to increase a surgeon's precision and accuracy in placing the glenoid component in shoulder arthroplasty. There is, however, little available information about the use of patient-specific planning (PSP) tools for this operation. It is not known how these tools alter the decision-making patterns of shoulder surgeons. The aim of this study was to investigate whether PSP, when compared with the use of plain radiographs or select static CT images, influences the understanding of glenoid pathology and surgical planning. A case-based survey presented surgeons with a patient's history, physical examination, and, sequentially, radiographs, select static CT images, and PSP with a 3D imaging program. For each imaging modality, the surgeons were asked to identify the Walch classification of the glenoid and to propose the surgical treatment. The participating surgeons were grouped according to the annual volume of shoulder arthroplasties that they undertook, and responses were compared with the recommendations of two experts. A total of 59 surgeons completed the survey. For all surgeons, the use of the PSP significantly increased agreement with the experts in glenoid classification (x2 = 8.54; p = 0.014) and surgical planning (x2 = 37.91; p < 0.001). The additional information provided by the PSP also showed a significantly higher impact on surgical decision-making for surgeons who undertake fewer than ten shoulder arthroplasties annually (p = 0.017). The information provided by PSP has the greatest impact on the surgical decision-making of low volume surgeons (those who perform fewer than ten shoulder arthroplasties annually), and PSP brings all surgeons in to closer agreement with the recommendations of experts for glenoid classification and surgical planning. Cite this article: Bone Joint J 2020;102-B(3):365-370.

Short Humeral Stems in Shoulder Arthroplasty.

Since the introduction of shoulder arthroplasty by Neer in 1974, the design of not only the glenoid component but also the humeral component used in shoulder arthroplasty has continually evolved. Changes to the design of the humeral component include a gradually disappearing proximal fin; diversified surface finishes (such as smooth, grit-blasted, and porous coating); a more contoured stem from the originally straight and cylindrical shape; and the use of press-fit uncemented fixation as opposed to cemented fixation. Despite the evolution of the humeral component for shoulder arthroplasty, however, stem-related complications are not uncommon. Examples of stem-related complications include intraoperative humeral fractures, stem loosening, periprosthetic fractures, and stress shielding. These become much more common in revision arthroplasty, where patients are associated with further complications such as surgical difficulty in extracting the humeral component, proximal metaphyseal bone loss due to stress shielding, intraoperative humeral shaft fractures, and incomplete cement removal. Physicians have made many attempts to reduce these complications by shortening the stem of the humeral component. In this review, we will discuss some of the limitations of long-stem humeral components, the feasibility of replacing them with short-stem humeral components, and the clinical outcomes associated with short-stemmed humeral components in shoulder arthroplasty.

Survival of the pegged glenoid component in shoulder arthroplasty: part II

Loosening of the glenoid component is a primary reason for failure of an anatomic shoulder arthroplasty. Pegged glenoids were designed in an effort to outperform keeled components. This study evaluated the midterm clinical and radiographic survival of a single implant design with implantation of an in-line pegged glenoid component and identified risk factors for radiographic loosening and clinical failure. There were 330 total shoulder arthroplasties that had been implanted with a cemented, all-polyethylene, in-line pegged glenoid component evaluated with an average clinical follow-up of 7.2 years. Of these shoulders, 287 had presurgical, initial postsurgical, and late postsurgical radiographs (mean radiographic follow-up, 7.0 years). At most recent follow-up, 30 glenoid components had been revised for aseptic loosening. This translated to a rate of glenoid component survival free from revision for all 330 shoulders of 99% at 5 years and 83% at 10 years. Of 287 glenoid components, 120 were considered loose on the basis of radiographic evaluation. Four humeral components were considered loose. Component survival (Kaplan-Meier) free from radiographic failure at 5 and 10 years was 92% and 43%. Severe presurgical glenoid erosion (Walch A2, B2, C) and patient age <65 years were risk factors for radiographic failure. Late humeral head subluxation was associated with radiographic failure. Despite the predominant thinking that pegged glenoid components may be superior to keeled designs, midterm radiographic and clinical failure rates were high with this pegged component design, particularly after 5 years. Advanced presurgical glenoid erosion and younger patient age are risk factors for radiographic loosening. Revision rates underestimate radiographic glenoid loosening.

Improved accuracy of K-wire positioning into the glenoid vault by intraoperative 3D image intensifier-based navigation for the glenoid component in shoulder arthroplasty

IntroductionThis article aimed to show that navigation, based on an intraoperative mobile 3D image intensifier, can improve the accuracy of central K-wire placement into the glenoid vault for glenoid component. HypothesisThe navigated k-wire placement is more accurate and shows a smaller deviation angle to the standard centerline compared to the classical “free hand technic”. MethodsIn 34 fresh frozen sheep scapulae, 17 K-wire placements using the navigation (group 1) were compared with 17 using standard “face plane technique” (group 2). The relation to glenoid standard and alternative centerlines (CL) and the position within the glenoid vault were analyzed. ResultsIn groups 1 and 2 the angle between the K-wire and standard CL was 2.2° and 4.7°, respectively (P=0.01). The angle between the K-wire and alternative CL was 14.4° for group 1 and 17.2° for group 2 (P=0.02). More navigated K-wire positions were identified within a 5mm corridor along the glenoid vault CL (52 vs. 39; P=0.004). DiscussionIntraoperative 3D image intensifier-based navigation was more accurate and precise than standard K-wire placement. Type of study and level of proofBasic science study, evidence level III.

Computed tomography quantification of bone density adjacent to cemented pegged polyethylene glenoid components in shoulder arthroplasty

Cemented polyethylene devices are the prostheses implanted more frequently, but there is no agreement on the optimal glenoid component design. In this study, bone mineral density (BMD) adjacent to cemented all-polyethylene glenoid components was assessed to gain insights into the characteristics of glenoid bone as a potential risk factor implicated in the failure of shoulder arthroplasty. Twenty-two subjects were examined at an average follow-up of 31 months using the Constant-Murley score (CS) and multi-detector computed tomography. BMD was measured in 5 regions of interest (ROIs) at the sites where radiolucent lines are usually detected. BMD differences among the ROIs were tested. The relationship between BMD and a number of variables (CS subscores, age, gender, follow-up duration) was explored. There was a significant increase in CS scores (p<0.05). Significantly different BMD (p=0.0039) was found in the 5 ROIs, especially between ROIs 2 and 5 (p=0.016, Bonferroni's test) and between ROIs 3 and 5 (p=0.005, Bonferroni's test). BMD was lower in ROI 1 than ROI 3 and in ROI 2 than ROI 4, but the difference was not significant. The heterogeneous BMD distribution may be related to: (1) an interindividual variability in glenoid BMD; (2) the fixation technique; or (3) the different bone response to eccentric loading of the prosthetic head on the glenoid component. BMD analysis may contribute to extent our knowledge on glenoid component loosening and encourage further techniques of glenoid fixation.

Utility and complications of long-stem humeral components in revision shoulder arthroplasty

Currently, there is little information on the benefits and problems associated with long-stem humeral components in shoulder arthroplasty. This study examined the frequency of use, indications, complications, and security of fixation using a long-stem humeral component in revision shoulder arthroplasty. Eighty revision shoulder arthroplasties were monitored clinically for at least 2 years or until repeat revision surgery. The primary indications for use of an intermediate or long stem were proximal bone loss in 40, nonunion in 14, a malpositioned previous stem with bone loss in 10, an acute intraoperative fracture in 7, an acute preoperative periprosthetic fracture in 5, diaphyseal bone loss in 2, and a box-shaped osteotomy to remove a well-fixed stem in 2. Clinical follow-up was an average of 5.9 years, and radiographic follow-up was an average of 4.7 years. Intraoperative complications included fracture removing the previous stem in 5, a cortical perforation in 6, and cement extrusion in 7. Late complications included fracture nonunion in 5, deep infection in 2, and component loosening in 1. One component met criteria to be considered radiographically "at risk" for clinical loosening. Long-stem humeral components are useful to obtain secure fixation in healthy bone in revision shoulder arthroplasty in patients with proximal bone loss, diaphyseal fracture, or a previously malpositioned stem. Complications are frequent, and caution should be taken to avoid intraoperative fractures, distal cortical perforation, or cement extrusion. These components are at low risk for loosening.

Reverse shoulder arthroplasty components and surgical techniques that restore glenohumeral motion

Modifications in reverse shoulder arthroplasty (RSA) have been made with the intent of maximizing motion, although there is little objective evidence outlining their benefit. This study investigated the RSA component combinations that impart the greatest effect on impingement-free glenohumeral motion. A previously validated virtual shoulder model was implanted with RSA components that varied by humeral implant type (inset/onset), glenosphere diameter (30, 36, and 42 mm), glenosphere placement (inferior/neutral), glenosphere center-of-rotation offset (0, 5, and 10 mm), humeral neck-shaft angle (130° and 150°), and humeral offset (zero, five, and ten mm). Motion was simulated in all technique combinations until the point of impingement in abduction, flexion/extension (F/E), and internal/external rotation (IR/ER). Regression analysis was used to rank combinations based on motion. Of 216 possible study combinations, 126 constructs (58%) demonstrated no arm-at-side impingement and were included for analysis. Models with the largest motion in abduction, F/E, and IR/ER, respectively, were inset-42-inferior-10-150-zero (107°), inset-36-inferior-10-130-five (146°), and inset-42-inferior-10-130-ten (121°). Humeral neck-shaft angle, glenosphere center-of-rotation offset, glenosphere placement, and glenosphere diameter had a significant effect on motion in all planes tested. Of these variables, humeral neck-shaft angle was most predictive of a change in abduction and F/E motion, whereas glenosphere placement was most predictive of a change in IR/ER motion. Higher glenosphere center-of-rotation offsets led to an increase in motion in all planes. To maximize motion in abduction, a valgus humeral component should be selected; to maximize F/E, a varus humeral component should be selected; and, to maximize IR/ER, the glenosphere should be placed inferiorly.

Important Factors in the Development of Loosening of Polyethylene Keeled Glenoid Components in Shoulder Arthroplasty for Primary Osteoarthritis: The European Experience

Important Factors in the Development of Loosening of Polyethylene Keeled Glenoid Components in Shoulder Arthroplasty for Primary Osteoarthritis: The European Experience

Cemented Humeral Stem Fixation: Standard of Care

Cemented humeral stem fixation in shoulder joint arthroplasty has been, and continues to be, the gold standard to ensure satisfactory implant orientation and stability. The most commonly performed type of shoulder arthroplasty is hemiarthroplasty in the face of comminuted fracture. Appropriate stem height and version relative to the glenoid is paramount in obtaining a satisfactory result. This has been proven to be reliably reproducible through cement fixation of the stem with careful reattachment of the tuberosities. Total shoulder arthroplasty in rheumatoid patients with questionable bone stock likewise has relied upon cementation of the humeral component to ensure secure fixation, prevent loosening, and avoid subsidence. In younger patients, it is tempting to want to avoid cement in the proximal humerus; nonetheless, most studies have demonstrated loosening of the humeral component not to be problematic once cement has been used. In addition, newer modular components allow head removal (without stem removal), providing ready access to the glenoid should glenoid revision be needed. In addition, the ability to add antibiotics within the cement mantle in high-risk patients affords an advantage in treating and/or avoiding infection. Survivorship studies have not demonstrated an advantage of cementless versus cement fixation of the humeral component in shoulder arthroplasty.

Cemented Glenohumeral Fixation: Standard of Care—Affirms

Cemented humeral stem fixation in shoulder joint arthroplasty has been, and continues to be the “gold standard” to ensure satisfactory implant orientation and stability. The most commonly performed type of shoulder arthroplasty is hemi-arthroplasty in the face of comminuted fracture. Appropriate stem height and version relative to the glenoid is paramount in obtaining a satisfactory result. This has been proven to be reliably reproducible through cement fixation of the stem with careful reattachment of the tuberosities. Total shoulder arthroplasty in rheumatoid patients with questionable bone stock likewise has relied upon “cementation” of the humeral component to ensure secure fixation, prevent loosening and avoid subsidence. In younger patients it is tempting to want to avoid cement in the proximal humerus, nonetheless most studies have demonstrated loosening of the humeral component not to be problematic once cement has been used. In addition, newer modular componentry allows head removal (without stem removal) providing ready access to the glenoid should glenoid revision be needed. The ability to add antibiotics within the cement mantle in high-risk patients additionally affords an advantage in treating and/or avoiding infection. Survivorship studies have not demonstrated any advantage of cementless versus cement fixation of the humeral component in shoulder arthroplasty. Temporizing techniques such as cup arthroplasty and hybrid techniques such as placing tantalum weave surfaces proximally for enhanced tuberosity fixation may have a role, but do not replace the long-standing efficacy of cement fixation of the humeral component in the vast majority of patients requiring shoulder arthroplasty.

In vitro measurement of temperature changes during implantation of cemented glenoid components

Background and purpose It is unclear whether the increase in temperature during cement curing may cause osteonecrosis, leading to loosening of the glenoid component in shoulder arthroplasty. We therefore analyzed the temperature during implantation of cemented glenoid implants.Methods 8 keeled and 8 pegged glenoids were implanted in standardized fashion in 8 pairs of scapulas. Temperature and pressure sensors were implanted at the bone-cement interface in the glenoid. Real-time measurements were made of temperature and pressure within the glenoid vault.Results In no case was the temperature reached high enough to endanger the surrounding bone. The mean increase in temperature was 5° (0.5–6.9) in the keeled group and 2.7° (1.7–3.6) in the pegged group. The mean maximum pressure in the keeled group was 50 kPa (20–100) and in the pegged group it was 113 kPa (60–181). Both differences were statistically significant.Interpretation The temperatures that occur during implantation of cemented components are low and probably not high enough to cause osteonecrosis in the surrounding bone.

Survivorship of the humeral component in shoulder arthroplasty

Loosening of the humeral component is rarely a cause for revision. This study was conducted to determine long-term survivorship of humeral components and investigate the risk factors associated with humeral component removal or revision. From 1984 to 2004, 1423 patients underwent 1584 primary Neer and Cofield shoulder arthroplasties. The Kaplan-Meier method was used to estimate implant survival. Cox proportional hazards regression was used to assess the effects of age, gender, etiology of the disease, surgery type (hemi vs total), fixation (cemented vs noncemented), and the humeral component design (Neer II, Cofield 1 or 2) with survival free of revision or removal of the humeral component. There were 108 revisions and 17 removals of the humeral component. Estimates of survivorship free of revision or removal of the humeral component for any reason was 94.8% (95% confidence interval [CI], 93.6-96.0) at 5 years, 92.0% (95% CI, 90.4-93.6) at 10 years, 86.7% (95% CI, 84.2-89.4) at 15 years, and 82.8% (95% CI, 78.5-87.5) at 20 years. Younger age, male gender, replacement due to posttraumatic arthritis, an uncemented component, and use of a metal-backed glenoid component increased the likelihood of humeral component failure. The need for revision of the humeral component is commonly related to glenoid or glenoid component issues. Patient and diagnostic factors play a role in implant survival; implant type and method of fixation are less important. Level 4; Case series, treatment study.

Survival of the glenoid component in shoulder arthroplasty

This study was conducted to determine the survival of different glenoid component designs, assess the reasons for revision surgery, and identify patient and diagnostic factors that influence this need. Between January 1, 1984, and December 31, 2004, 1337 patients underwent 1542 total shoulder arthroplasties with 6 types of glenoid components: Neer II all-polyethylene, Neer II metal-backed, Cofield 1 metal-backed bone-ingrowth, Cofield 1 all-poly keeled, Cofield 2 all-poly keeled, and Cofield 2 all-poly pegged. Revision was required in 125 shoulders for glenoid component failure. Survival rates free of revision by glenoid implant type at 5, 10, and 15 years were, respectively, 96%, 96%, and 95% for 99 Neer II all-poly; 96%, 94%, and 89% for 316 Neer II metal-backed; 86%, 79%, and 67% for 316 Cofield 1 metal-backed; 94%, 94%, and 87% for 18 Cofield 1 all-poly; 99%, 94%, and 89% for 497 Cofield 2 all-poly keeled; and 99% at 5 years for 358 Cofield 2 all-poly pegged. Glenoid component type was significantly associated with component revision (P < .001). Male gender was associated with a higher risk of revision (P < .001). Compared with degenerative arthritis, posttraumatic arthritis (P = .02) and avascular necrosis (P = .06) were associated with increased risk of revision. Survival is improved with cemented all-polyethylene glenoid components. Revision of cemented all-polyethylene components may be lessened with the use of pegged components in early follow-up. Male gender and the operative diagnoses of posttraumatic arthritis or avascular necrosis are associated with an increased risk of failure. Level IV, Case Series, Treatment Study.