Modern cement technique and the survivorship of total shoulder arthroplasty

Thirty-eight consecutive Neer II total shoulder arthroplasties were performed in 35 patients by one surgeon using the so called modem cement technique and followed for a mean of 5 years (range, 2-9.5 years). The preoperative diagnosis was osteoarthritis or avascular necrosis in 22 shoulders, rheumatoid arthritis in 10 shoulders, and posttraumatic arthritis in 6 shoulders. The components were implanted using specific improved techniques for cement fixation initially described for total hip arthroplasty. Twenty-six metal-backed and 12 polyethylene glenoid components were used. The humeral component was implanted with cement in 32 shoulders. There were no intraoperative fractures or postoperative neurapraxias. At most recent followup, 36 shoulders had no or slight pain with activity. The mean increase in active forward elevation was 38 degrees and in active external rotation was 29 degrees. There have been no revisions, and all components remain in place. With failure defined as definite radiographic loosening of the components, there was 97% survivorship at 5 years, and 93% at 8 years. Radiolucent lines around more than 50% of the bone cement interface of the humeral component were present in only 3 shoulders. Radiolucent lines around more than 50% of the bone cement interface of the glenoid component were seen in only 2 shoulders. Both components in 1 severely osteopenic shoulder had a complete radiolucent line and a change in position. Meticulous attention to cement technique may improve the long term survival of cemented total shoulder arthroplasty components.