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Patterns of Loosening of Polyethylene Keeled Glenoid Components After Shoulder Arthroplasty for Primary OsteoarthritisResults of a Multicenter Study with More Than Five Years of Follow-up
Gilles Walch, MD1; Allan A. Young, MD2; Pascal Boileau, MD3; Markus Loew, MD4; Dominique Gazielly, MD5; Daniel Molé, MD6
1 Centre Orthopédique Santy, 24 Avenue Paul Santy, F-69008 Lyon, France. E-mail address: walch.gilles@wanadoo.fr
2 Sydney Shoulder Specialists, Level 2, 156 Pacific Highway, St. Leonards 2065, New South Wales, Australia
3 Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet II, Medical University of Nice-Sophia Antipolis, 151 Route de St. Antoine de Ginestière, 06202 Nice, France
4 University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
5 Hopitaux Universitaires de Geneve, Service de Chirurgie Orthopédique, Rue Gabrielle Perret-Gentil 4, 1211 Genève 14, Switzerland
6 Clinique de Traumatologie, 49 rue Hermite, F-54000 Nancy, France
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Investigation performed at Centre Orthopédique Santy and Hôpital privé Jean Mermoz, Lyon, France

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Jan 18;94(2):145-150. doi: 10.2106/JBJS.J.00699
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The aim of this study was to radiographically analyze the long-term glenoid migration patterns following total shoulder arthroplasty to better understand the factors responsible for loosening.


Complete radiographic follow-up of more than five years was available for 518 total shoulder arthroplasties performed for primary glenohumeral osteoarthritis with use of an anatomically designed prosthesis with a cemented, all-polyethylene, keeled glenoid component. Radiographs were assessed for humeral head subluxation, periprosthetic radiolucent lines, and shifting of the position of the glenoid component. The type of migration of the glenoid was defined according to the direction of tilt, or as subsidence in the case of medial migration.


Definite radiographic evidence of glenoid loosening was observed in 166 shoulders (32%) and was characterized by radiolucency of ≥2 mm over the entire bone-cement interface in thirty shoulders and by a migration of the glenoid component (shift or subsidence) in 136 shoulders. Three predominant patterns of migration of the glenoid component were observed: superior tilting in fifty-two shoulders (10%), subsidence in forty-one shoulders (7.9%), and posterior tilting in thirty-three shoulders (6.4%). Superior tilting of the glenoid was associated with three risk factors: low positioning of the glenoid component, superior tilt of the glenoid component on the immediate postoperative coronal plane radiographs, and superior subluxation of the humeral head (p < 0.05 for all). Subsidence of the glenoid component was associated with the use of reaming to optimize the seating and positioning of the glenoid component (p < 0.001). Posterior tilting of the glenoid component was associated with preoperative posterior subluxation (i.e., a Walch type-B glenoid) and with excessive reaming (p < 0.01 for both).


The three patterns of migration observed in this study underscore the potential importance of the supporting bone beneath the glenoid component. In some shoulders, use of a keel or pegs to provide fixation of a polyethylene component in the absence of good support from subchondral bone may not be sufficient to resist compressive and eccentric forces, resulting in loosening. Preserving subchondral bone may be important for long-term longevity of the glenoid component.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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    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.
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