Articles   |    
Resurfacing of the Glenoid in Total Shoulder Arthroplasty. A Comparison, at a Mean of Five Years, of Prostheses Inserted with and without Cement*
View Disclosures and Other Information
Investigation performed at the Prince of Wales Hospital, University of New South Wales, Sydney
J Bone Joint Surg Am, 1999 Apr 01;81(4):510-8
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


Background: Clinically evident loosening of a glenoid component inserted with cement in total shoulder arthroplasty is infrequent, but radiographic changes that indicate loosening at the implant-bone interface are common and have been associated with functional limitation. We compared the results of total shoulder arthroplasties in which the glenoid implant had been inserted with cement with those of arthroplasties in which a bone-ingrowth glenoid implant had been inserted without cement.Methods: The results of eighty-six consecutive total shoulder arthroplasties, performed by the same surgeon, were retrospectively reviewed between four and seven years after the operation. Fifty-eight shoulders in which the primary glenoid implant was in situ were assessed with use of the Simple Shoulder Test and Short Form-36 questionnaires, clinical examination, and fluoroscopic imaging of the glenoid implant-bone interface. Thirty-two of the glenoid components had been fixed with cement and twenty-six, without cement.Results: Complications occurred in 16 percent (fourteen) of the eighty-six shoulders, and 9 percent (eight) of the shoulders needed a revision operation. None of the revisions were done because of loosening of the glenoid component. Five of the eight revisions involved implants that had been inserted without cement. Three of these implants were revised because of early instability and two, because the polyethylene component had separated from the metal tray of the glenoid implant. With the numbers available, we could not detect any significant differences between the groups with respect to pain, range of motion, function of the shoulder, or general health. Radiographic analysis demonstrated a high level of interobserver agreement (kappa = 0.89). Radiolucent lines were observed after 41 percent (thirteen) of the thirty-two arthroplasties performed with cement compared with 23 percent (six) of the twenty-six arthroplasties performed without cement. The proportion of implants classified as probably loose was approximately three times greater in the group in which cement had been used. Eccentric wear of the posterior rim of the metal tray and focal osteolysis under the metal tray were observed in the group in which the component had been inserted without cement; these findings may indicate a potential for progression of radiographic loosening with increased durations of follow-up.Conclusions: We concluded that, despite the higher rate of early complications, the intermediate-term outcomes of arthroplasties in which the glenoid implant is inserted without cement are comparable with those of arthroplasties with cementing of the glenoid component.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    Georgia - Choice Care Occupational Medicine & Orthopaedics
    Louisiana - Ochsner Health System
    MA - Boston Medical Center and Boston University School of Medicine
    LA - Ochsner Health System