Anatomical total shoulder arthroplasty in young patients with osteoarthritis

Marc Olivier Gauci (1) , Nicolas Bonnevialle (2) , Grégory Moineau (3) , Mohammed Baba (4) , Gilles Walch (5) , Pascal Boileau (1)

1 CHU Nice - Centre Hospitalier Universitaire de Nice
2 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
3 Clinique Pasteur-Lanroze (FRANCE)
4 Sydney Adventist Hospital (AUSTRALIA)
5 Centre Orthopédique Santy

AIMS: Controversy about the use of an anatomical total shoulder arthroplasty (aTSA) in young arthritic patients relates to which is the ideal form of fixation for the glenoid component: cemented or cementless. This study aimed to evaluate implant survival of aTSA when used in patients aged < 60 years with primary glenohumeral osteoarthritis (OA), and to compare the survival of cemented all-polyethylene and cementless metal-backed glenoid components. MATERIALS AND METHODS: A total of 69 consecutive aTSAs were performed in 67 patients aged < 60 years with primary glenohumeral OA. Their mean age at the time of surgery was 54 years (35 to 60). Of these aTSAs, 46 were undertaken using a cemented polyethylene component and 23 were undertaken using a cementless metal-backed component. The age, gender, preoperative function, mobility, premorbid glenoid erosion, and length of follow-up were comparable in the two groups. The patients were reviewed clinically and radiographically at a mean of 10.3 years (5 to 12, sd 26) postoperatively. Kaplan-Meier survivorship analysis was performed with revision as the endpoint. RESULTS: A total of 26 shoulders (38%) underwent revision surgery: ten (22%) in the polyethylene group and 16 (70%) in the metal-backed group (p < 0.0001). At 12 years' follow-up, the rate of implant survival was 74% (sd 0.09) for polyethylene components and 24% (sd 0.10) for metal-backed components (p < 0.0002). Glenoid loosening or failure was the indication for revision in the polyethylene group, whereas polyethylene wear with metal-on-metal contact, instability, and insufficiency of the rotator cuff were the indications for revision in the metal-backed group. Preoperative posterior subluxation of the humeral head with a biconcave/retroverted glenoid (Walch B2) had an adverse effect on the survival of a metal-backed component. CONCLUSION: The survival of a cemented polyethylene glenoid component is three times higher than that of a cementless metal-backed glenoid component ten years after aTSA in patients aged < 60 years with primary glenohumeral OA. Patients with a biconcave (B2) glenoid have the highest risk of failure.

Mots clés: All-polyethylene glenoid; Metal-backed glenoid; Primary glenohumeral osteoarthritis; Revision; Survival; Total shoulder arthroplasty

Domaines: Médecine humaine et pathologie

Marc Olivier Gauci, Nicolas Bonnevialle, Grégory Moineau, Mohammed Baba, Gilles Walch, et al.. Anatomical total shoulder arthroplasty in young patients with osteoarthritis. The Bone & Joint Journal (BJJ), 2018, 100-B (4), pp.485-492. ⟨10.1302/0301-620X.100B4.BJJ-2017-0495.R2⟩. ⟨hal-02135074⟩