Advertisement

Design of Polyethylene Glenoid Components

  • Ian A. TrailEmail author
Chapter

Abstract

A range of factors, including general factors and those local to the shoulder, affect the long-term survival of the glenoid component in total shoulder arthroplasty (TSA). Unfortunately many of these factors are unknown and, of the ones that have been determined, it is often unclear how they affect glenoid survival.

Of those that are known, general factors include the quality and amount of bone, which is highly dependent on the disease process (many rheumatoid arthritis patients have very thin osteoporotic bone), and patient attitudes towards, and expectations of, their prosthesis.

Local factors associated with the long-term survival of the glenoid component include: glenoid component design; glenoid preparation and cementing techniques; position and alignment of the glenoid component; position of the humeral head; and, finally, surgical technique.

If we are to improve the key outcome of TSA, which is survival of the glenoid component, the most important factor appears to be improved surgical technique, particularly exposure of the glenoid. Specifically, surgeons should be able to expose the posterior aspect of the glenoid easily. Secondly, the glenoid component should be inserted in the correct anatomical position, with instruments developed to allow alignment to the correct inclination, even in the presence of erosion. Thirdly, cementing techniques for fixation should continue to improve. Finally, further research is needed to determine the long-term survival of the anchor peg and the effect of more anatomical humeral head replacements.

Keywords

Polyethylene glenoid component Pegged or keeled Bone ingrowth Metal back Glenoid preparation Cement Alignment Humeral head position 

References

  1. 1.
    Trail IA, Nuttall D. The results of shoulder arthroplasty in patients with rheumatoid arthritis. J Bone Joint Surg Br. 2002;84(8):1121–5.CrossRefGoogle Scholar
  2. 2.
    Fox TJ, Cil A, Sperling JW, Sanchez-Sotelo J, Schleck CD, Cofield RH. Survival of the glenoid component in shoulder arthroplasty. J Shoulder Elb Surg. 2009;18(6):859–63.CrossRefGoogle Scholar
  3. 3.
    Greiner S, Berth A, Kääb M, Irlenbusch U. Glenoid morphology affects the incidence of radiolucent lines around cemented pegged polyethylene glenoid components. Arch Orthop Trauma Surg. 2013;133(10):1331–9.CrossRefGoogle Scholar
  4. 4.
    Craig EV, Nho S, Warren RF, Owen A, Figgie MP, Wright T, Dodson C. Comparison of conforming and non-conforming retrieved glenoid components. J Bone Joint Surg. 2007;16(2):e58.Google Scholar
  5. 5.
    Walch G, Edwards TB, Boulahia A, Boileau P, Mole D, Adeleine P. The influence of glenohumeral prosthetic mismatch on glenoid radiolucent lines: results of a multicenter study. J Bone Joint Surg Am. 2002;84(12):2186–91.CrossRefGoogle Scholar
  6. 6.
    Nho SJ, Ala OL, Dodson CC, Figgie MP, Wright TM, Craig EV, Warren RF. Comparison of conforming and nonconforming retrieved glenoid components. J Shoulder Elb Surg. 2008;17:914–20.CrossRefGoogle Scholar
  7. 7.
    Anglin C, Wyss UP, Nyffeler RW, Gerber C. Loosening performance of cemented glenoid prosthesis design pairs. Clin Biomech (Bristol, Avon). 2001;16:144–50.CrossRefGoogle Scholar
  8. 8.
    Szabo I, Buscayret F, Edwards TB, Nemoz C, Boileau P, Walch G. Radiographic comparison of flat-back and convex-back glenoid components in total shoulder arthroplasty. J Shoulder Elb Surg. 2005;14(6):636–42.CrossRefGoogle Scholar
  9. 9.
    Collin P, Tay AK, Melis B, Boileau P, Walch G. A ten-year radiologic comparison of two-all polyethylene glenoid component designs: a prospective trial. J Shoulder Elb Surg. 2011;20(8):1217–23.CrossRefGoogle Scholar
  10. 10.
    Edwards TB, Labriola JE, Stanley RJ, O’Connor DP, Elkousy HA, Gartsman GM. Radiographic comparison of pegged and keeled glenoid components using modern cementing techniques: a prospective randomized study. J Shoulder Elb Surg. 2010;19(2):251–7.CrossRefGoogle Scholar
  11. 11.
    Gartsman GM, Elkousy HA, Warnock KM, Edwards TB, O’Connor DP. Radiographic comparison of pegged and keeled glenoid components. J Shoulder Elb Surg. 2005;14(3):252–7.CrossRefGoogle Scholar
  12. 12.
    Lazarus MD, Jensen KL, Southworth C, Matsen FA 3rd. The radiographic evaluation of keeled and pegged glenoid component insertion. J Bone Joint Surg Am. 2002;84(7):1174–82.CrossRefGoogle Scholar
  13. 13.
    Haines JF, Trail IA, Nuttall D, Birch A, Barrow A. The results of arthroplasty in osteoarthritis of the shoulder. J Bone Joint Surg Br. 2006;88:496–501.CrossRefGoogle Scholar
  14. 14.
    Lacroix D, Murphy LA, Prendergast PJ. Three-dimensional finite element analysis of glenoid replacement prostheses: a comparison of keeled and pegged anchorage systems. J Biomech Eng. 2000;122(4):430–6.CrossRefGoogle Scholar
  15. 15.
    Nuttall D, Haines JF, Trail IA. A study of the micromovement of pegged and keeled glenoid components compared using radiostereometric analysis. J Shoulder Elb Surg. 2007;16(3):S65–70.CrossRefGoogle Scholar
  16. 16.
    Rahme H, Mattsson P, Wikblad L, Nowak J, Larsson S. Stability of cemented in-line pegged glenoid compared with keeled glenoid components in total shoulder arthroplasty. J Bone Joint Surg Am. 2009;91:1965–72.CrossRefGoogle Scholar
  17. 17.
    Throckmorton TW, Zarkadas PC, Sperling JW, Cofield RH. Pegged versus keeled glenoid components in total shoulder arthroplasty. J Shoulder Elb Surg. 2010;19(5):726–33.CrossRefGoogle Scholar
  18. 18.
    Cheung EV, Sperling JW, Cofield RH. Polyethylene insert exchange for wear after total shoulder arthroplasty. J Shoulder Elb Surg. 2007;16(5):574–8.CrossRefGoogle Scholar
  19. 19.
    Nuttall D, Haines JF, Trail IA. The early migration of a partially cemented fluted pegged glenoid component using radiostereometric analysis. J Shoulder Elb Surg. 2012;21:1191–6.CrossRefGoogle Scholar
  20. 20.
    Nuttall D, Birch A, Haines JF, Watts AC, Trail IA. Migration of a partially cemented fluted glenoid component, inserted using a cannulated preparation system, as measured using radiostereometric analysis and it’s relation to lucency as seen on CT scans. Bone Joint Surg. 2017;99B:674–9.Google Scholar
  21. 21.
    Arnold RM, High RR, Grosshans KT, Walker CW, Fehringer EV. Bone presence between the central peg’s radial fins of a partially cemented pegged all poly glenoidcomponent suggest few radiolucencies. J Shoulder Elb Surg. 2011;20:315–21.CrossRefGoogle Scholar
  22. 22.
    Churchill RS, Zellmer C, Zimmers HJ, Ruggero R. Clinical and radiographic analysis of a partially cemented glenoid implant: five-year minimum follow-up. J Shoulder Elb Surg. 2010;19:1091–7.CrossRefGoogle Scholar
  23. 23.
    Groh GI. Survival and radiographic analysis of a glenoid component with a cementless fluted central peg. J Shoulder Elb Surg. 2010;19:1265–8.CrossRefGoogle Scholar
  24. 24.
    Nagels J, Valstar ER, Stokdijk M, Rozing PM. Patterns of loosening of the glenoid component. J Bone Joint Surg Br. 2002;84:83–7.CrossRefGoogle Scholar
  25. 25.
    Noyes MP, Meccia B, Spencer EE. Five-to-ten-year follow-up with a partially cemented all-polyethylene bone-ingrowth glenoid component. J Shoulder Elb Surg. 2015;24:1458–62.CrossRefGoogle Scholar
  26. 26.
    Wirth MA, Klotz C, Deffenbaugh DL, McNulty D, Richards L, Tipper JL. Cross-linked glenoid prosthesis: a wear comparison to conventional glenoid prosthesis with wear particulate analysis. J Shoulder Elb Surg. 2009;18(1):130–7.CrossRefGoogle Scholar
  27. 27.
    Rockwood CA. Observation on retrieved Hylamer glenoids in shoulder arthroplasty: problems associated with sterilization by gamma irradiation in air. J Shoulder Elb Surg. 2002;11(2):191–7.CrossRefGoogle Scholar
  28. 28.
    Cil A, Sperling JW, Cofield RH. Nonstandard glenoid components for bone deficiencies in shoulder arthroplasty. J Shoulder Elb Surg. 2014;23(7):e149–57.CrossRefGoogle Scholar
  29. 29.
    Budge MD, Nolan EM, Heisey MH, Baker K, Wiater JM. Results of total shoulder arthroplasty with a monoblock porous tantalum glenoid component: a prospective minimum 2-year follow-up study. J Shoulder Elb Surg. 2013;22(4):535–41.CrossRefGoogle Scholar
  30. 30.
    Barwood S, Setter KJ, Blaine TA, Bigliani LU. The incidence of early radiolucencies about a pegged glenoid component using cement pressurization. J Shoulder Elb Surg. 2008;17(5):703–8.CrossRefGoogle Scholar
  31. 31.
    Edwards TB, Sabonghy EP, Elkousy H, Warnock KM, Hammerman SM, O’Connor DP, Gartsman GM. Glenoid component insertion in total shoulder arthroplasty: comparison of three techniques for drying the glenoid before cementation. J Shoulder Elb Surg. 2007;16(3 Suppl):S107–10.CrossRefGoogle Scholar
  32. 32.
    Boileau P, Avidor C, Krishnan SG, Walch G, Kempf JF, Mole D. Cemented polyethylene versus uncemented metal-backed glenoid components in total shoulder arthroplasty: a prospective, double-blind, randomized study. J Shoulder Elb Surg. 2002;11(4):351–9.CrossRefGoogle Scholar
  33. 33.
    Pelletier MH, Langdown A, Gillies RM, Sonnabend DH, Walsh WR. Photoelastic comparison of strains in the underlying glenoid with metal-backed and all-polyethylene implants. J Shoulder Elb Surg. 2008;17(5):779–83.CrossRefGoogle Scholar
  34. 34.
    Glennie RA, Giles JW, Johnson JA, Athwal GS, Faber KJ. An in vitro study comparing limited to full cementation of polyethylene glenoid components. J Orthop Surg Res. 2015;17(10):142.CrossRefGoogle Scholar
  35. 35.
    Kumar G, Page R, Trail IA. CTA analysis of glenoid fixation in a cadaveric model. J Bone Joint Surg Br. 2004;86(Suppl 1):100.Google Scholar
  36. 36.
    Dilisio MF, May NR, Vincent SA, High RR, Walker CW, Manzer MN, Apker KA, Fehringer EV. The association of incomplete glenoid component seating and periprosthetic glenoid radiolucencies after total shoulder arthroplasty. J Shoulder Elb Surg. 2015;8:S1058–2746.Google Scholar
  37. 37.
    De Wilde L, Dayerizadeh N, De Neve F, Basmania C, Van Tongel A. Fully uncemented glenoid component in total shoulder arthroplasty. J Shoulder Elb Surg. 2013;22(10):e1–7.CrossRefGoogle Scholar
  38. 38.
    Wang T, Abrams GD, Behn AW, Lindsey D, Giori N, Cheung EV. Posterior glenoid wear in total shoulder arthroplasty: eccentric anterior reaming is superior to posterior augment. Clin Orthop Relat Res. 2015;473(12):3928–36.CrossRefGoogle Scholar
  39. 39.
    Nyffeler RW, Sheikh R, Atkinson TS, Jacob HA, Favre P, Gerber C. Effects of glenoid component version on humeral head displacement and joint reaction forces: an experimental study. J Shoulder Elb Surg. 2006;15(5):625–9.CrossRefGoogle Scholar
  40. 40.
    Nho SJ, Nam D, Ala OL, Craig EV, Warren RF, Wright TM. Observations on retrieved glenoid components from total shoulder arthroplasty. J Shoulder Elb Surg. 2009;18(3):371–8.CrossRefGoogle Scholar
  41. 41.
    Favre P, Moor B, Snedeker JG, Gerber C. Influence of component positioning on impingement in conventional total shoulder arthroplasty. Clin Biomech (Bristol, Avon). 2008;23(2):175–83.CrossRefGoogle Scholar
  42. 42.
    Walch G, Young AA, Boileau P, Loew M, Gazielly D, Molé D. Patterns of loosening of polyethylene keeled glenoid components after shoulder arthroplasty for primary osteoarthritis: results of a multicentre study with more than five years of follow-up. J Bone Joint Surg Am. 2012;94(2):145–50.CrossRefGoogle Scholar
  43. 43.
    Nguyen D, Ferreira LM, Brownhill JR, King GJ, Drosdowech DS, Faber KJ, Johnson JA. Improved accuracy of computer assisted glenoid implantation in total shoulder arthroplasty: an in-vitro randomized controlled trial. J Shoulder Elb Surg. 2009;18(6):907–14.CrossRefGoogle Scholar
  44. 44.
    Roberts SN, Foley AP, Swallow HM, Wallace WA, Coughlan DP. The geometry of the humeral head and the design of prostheses. J Bone Joint Surg Br. 1991;73(4):647–50.CrossRefGoogle Scholar
  45. 45.
    Walch G, Boileau P. Prosthetic adaptability: a new concept for shoulder arthroplasty. J Shoulder Elb Surg. 1999;8(5):443–51.CrossRefGoogle Scholar
  46. 46.
    Nuttall D, Haines JF, Trail IA. The effect of the offset humeral head on the micromovement of pegged glenoid components: a comparative study using radiostereometric analysis. J Bone Joint Surg Br. 2009;91(6):757–61.CrossRefGoogle Scholar
  47. 47.
    Sabesan VJ, Ackerman J, Sharma V, Baker KC, Kurdziel MD, Wiater JM. Glenohumeral mismatch affects micromotion of cemented glenoid components in total shoulder arthroplasty. J Shoulder Elb Surg. 2015;24(5):814–22.CrossRefGoogle Scholar
  48. 48.
    Chin PY, Sperling JW, Cofield RH, Schleck C. Complications of total shoulder arthroplasty: are they fewer or different? J Shoulder Elb Surg. 2006;15:19–22.CrossRefGoogle Scholar
  49. 49.
    Collins D, Tencer A, Sidles J. Matsen Fr. Edge displacement and deformation of glenoid components in response to eccentric loading. The effect of preparation of the glenoid bone. J Bone Joint Surg Am. 1992;74(4):501–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Wrightington Hospital, Upper Limb Research Department, Hall Lane, Appley BridgeWiganUK

Personalised recommendations