gms | German Medical Science

Objectives: Glenoid component loosening remains a challenge in anatomic total shoulder arthroplasty. This study evaluates the longevity of anatomic shoulder arthroplasty using the Eclipse humeral component and cemented polyethylene pegged glenoid (Arthrex, Naples, FL, USA), comparing outcomes and complications in primary versus secondary osteoarthritis.

Methods: 211 cases of stemless aTSA with a pegged glenoid were enrolled in our local registry. Between January 2011 and December 2016, 197 individuals who underwent primary anatomic shoulder arthroplasty using the described components were retrospectively evaluated grouped into primary (Group 1) or secondary osteoarthritis (Group 2), 14 patient treated for other conditions than osteoarthritis were excluded. Clinical and radiological assessments were conducted 2, 5, and 10 years postoperatively or if the patient has presented himself due to complaints, including: Constant Score, DASH, SPADI, SSV, EQ-5D-5L, Walch Classification, Critical Shoulder Angle, Lateral Acromion Index, Glenohumeral Distance, Glenoid Cement Penetration, Component Loosening. We compared complications, revision rates and survival rates between groups using Kaplan-Maier curves and Log-Rank-test.

Results and conclusion: Group 1 (n=153) and Group 2 (n=44) had follow-up durations averaging 74.2±29.9 and 77.2±28.2 months (p = 0.54). Group 1, older at inclusion (67±8 years) compared to Group 2 (59±10 years, p<0.001), demonstrated a revision rate of 50%, as opposed to 55% in Group 2. Group 1 exhibited longer mean survival (77±30 months vs. 66±23 months, p=0.015). No significant differences were found between titanium coated vs standard humeral components in terms of survival rates (p=0.76). Key revision causes were glenoid loosening (G1: n=65; G2: n=21), periprosthetic fractures (G1: n=7; G2: n=2), and low-grade infections (G1: n=2; G2: n=1). Preoperative functional scores (Constant Score: G1 = 36±16, G2 = 34±17; qDASH, SPADI: both groups 42±20, 42±23 respectively) and radiologic parameters (Critical Shoulder Angle, Lateral Acromion Index) were similar across groups. Operative time was shorter for Group 1 (99±22 minutes vs. 109±23 minutes, p=0.016). Postoperative radiologic and clinical assessments at 2, and 5 years revealed no significant differences (p>0.05) in non-revised patients.

Both groups demonstrated alarmingly high revision rates with comparable follow-up. Primary osteoarthritis patients showed longer mean survival despite being older. Glenoid loosening was the predominant revision cause, underscoring the need for further research into glenoid failure mechanisms to enhance patient outcomes and implant longevity.