The Journal of Bone and Joint Surgery (American). 2005;87:1928-1936.
doi:10.2106/JBJS.D.02675
© 2005 The Journal of Bone and Joint Surgery, Inc.
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 Shoulder/Elbow Test 13: Fall 2005
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Radiographic and Computed Tomography Analysis of Cemented Pegged Polyethylene Glenoid Components in Total Shoulder Replacement

Edward H. Yian, MD1, Clément M.L. Werner, MD2, Richard W. Nyffeler, MD2, Christian W. Pfirrmann, MD2, Arun Ramappa, MD2, Atul Sukthankar, MD2 and Christian Gerber, MD2

1 Southern California Permanente Medical Group, 3401 South Harbor Boulevard, Santa Ava, CA 92704
2 Department of Orthopaedic Surgery, University of Zurich, Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland. E-mail address for C. Gerber: christian.gerber{at}balgrist.ch

Investigation performed at the Department of Orthopaedic Surgery, University of Zurich, Balgrist, Zurich, Switzerland

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the ResOrtho Foundation, Zurich, Switzerland. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Zimmer, Inc.). Also, a commercial entity (Zimmer, Inc.) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Glenoid loosening continues to be the primary reason for failure of total shoulder arthroplasty. The purpose of this study was to evaluate, with use of a sensitive and reproducible imaging method, the radiographic and clinical results of total shoulder replacement with a pegged, cemented polyethylene glenoid implant.

Methods: Forty-three patients (forty-seven shoulders) underwent a total shoulder replacement with a cemented polyethylene glenoid component with four threaded pegs. The patients were examined clinically, with fluoroscopically guided radiographs, and with computed tomography at an average of forty months. In addition to conventional scoring of radiographic lucency, an 18-point scoring system was used to quantify cement-peg lucencies in six zones of the back surface of the glenoid component as seen on computed tomography scans.

Results: On the average, the absolute Constant score improved from 39 points preoperatively to 70 points at the time of follow-up (p = 0.0001) and the pain score improved from 5 to 13 points (p = 0.001). The mean active anterior elevation improved by 34° (p = 0.001) and the mean abduction, by 46° (p = 0.006). Two patients had symptomatic glenoid loosening requiring revision. Twenty-one of the forty-seven shoulders had radiographic lucency around the glenoid pegs, and nine had progression of the lucency by at least two grades. Computed tomography detected lucencies, primarily at the bone-cement interface, in thirty-six shoulders. The scores for the lucencies seen on the computed tomography scans were associated with the radiographic lucency scores (p < 0.001), pain scores (p = 0.04), and abduction strength (p = 0.02). Computed tomography was more sensitive than radiography with regard to identifying the number of pegs associated with lucency and the size of the lucencies. The overall reproducibility of the scoring based on the computed tomography was higher than that of the radiographic scoring.

Conclusions: Computed tomography provided a more sensitive and reproducible tool for the assessment of loosening of pegged glenoid components than did fluoroscopically guided conventional radiography. Further improvement in implant design and fixation technique appears to be necessary for long-term success of cemented glenoid components.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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F. A. Matsen III, J. Clinton, J. Lynch, A. Bertelsen, and M. L. Richardson
Glenoid Component Failure in Total Shoulder Arthroplasty
J. Bone Joint Surg. Am., April 1, 2008; 90(4): 885 - 896.
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