Glenoid perforation with pegged components during total shoulder arthroplasty

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Clinical outcomes research

Background:

• Glenoid wear in total shoulder arthroplasty (TSA) can lead to a medialized joint line.
• Pegged glenoid components may perforate the medial glenoid cortex in these cases.
• The clinical implications of medial peg perforation are not well understood.

Purpose of the Study:

• To determine if uncontained glenoid pegs are associated with higher failure rates.
• To assess if peg perforation impacts clinical outcomes after TSA.
• To compare implant survival and functional scores between contained and uncontained peg groups.

Main Methods:

• Retrospective case-control study comparing 25 TSA cases with uncontained pegs to 25 cases with contained pegs.
• Follow-up averaged over 5 years.
• Implant survival assessed by revision for glenoid loosening; clinical outcomes measured by American Shoulder and Elbow Surgeons (ASES) and Penn Shoulder Scores.

Main Results:

• No significant difference in symptomatic glenoid loosening between groups.
• Two patients (8%) in the uncontained group required revision for rotator cuff tears.
• Uncontained pegs were associated with significantly lower Penn and ASES function scores, but similar pain and satisfaction scores.

Conclusions:

• Uncontained pegs in TSA are not linked to early glenoid loosening.
• While pain relief is comparable, shoulder function is significantly impaired in patients with uncontained pegs.
• This suggests careful consideration of glenoid component placement to optimize functional outcomes.