Sunday, January 14, 2018

In total shoulders is the rate of glenoid component failure associated with cysts in the bone?

Total shoulder arthroplasty with minimum 5-year follow-up: does the presence of subchondral cysts in the glenoid increase risk of failure?

The authors studied 75 patients underwent TSA for primary osteoarthritis with minimum 5-year follow-up. Using preoperative CT scans each patient was classified as having no cysts in 8 patients (11%), small cyst formation in 27 (36%), medium cysts in 19 (25%), and large cysts in 21 patients. The glenoid components used in this study are shown below



They found a high prevalence of radiographic loosening (41%) after 5 years.
The overall revision rate was 7% (5 of 75). All revised patients were in the groups with medium or large cysts.

Comment: These authors do not provide us with strategies for managing the cystic glenoid. In our practice, we impaction graft large cysts and use a glenoid component with an ingrowth central peg  (two such designs are shown below) to optimize initial fixation.


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