Original article
Radiographic comparison of pegged and keeled glenoid components

https://doi.org/10.1016/j.jse.2004.09.006Get rights and content

Glenoid loosening is one reason for failure of total shoulder arthroplasty. Several factors, including radiographic lucency, have been shown to be associated with glenoid loosening. The purpose of this study was to assess the correlation between glenoid design and immediate radiographic lucency in a prospective randomized clinical trial. Total shoulder arthroplasty was performed in 43 patients over a 2-year period. Twenty-three patients were randomized into the keel group and twenty patients into the pegged group. Postoperative radiographs obtained within 6 weeks of surgery were evaluated by 3 raters to determine glenoid lucency. On a scale from 0 (no lucency) to 5 (gross lucency and component loosening), the rate of lucency was 39% (9/23) in the keeled components, which was significantly higher than the rate of 5% (1/20) observed in the pegged components (P = .026). Patient age, gender, and glenoid size did not significantly affect glenoid component lucency (P > .05). The consistency reliability among raters (Cronbach α) was 0.87, and the intertester reliability was 0.87. Pegged glenoid components have less radiographic lucency when compared with keeled glenoid components in the immediate postoperative period.

Section snippets

Subjects

This study was a prospective randomized trial. The patients were not told which glenoid component design they had received.

All patients had the diagnosis of primary osteoarthritis of the glenohumeral joint. Patients were excluded from participation in this study if they had radiographic evidence of osteopenia or other metabolic bone disease. There were no other inclusion or exclusion criteria. Two patients in the keeled group and two patients in the pegged group were excluded from the study

Subjects

The study consisted of 27 men with a mean age of 67.8 years (SD, 8.1 years) and 16 women with a mean age of 69.9 years (SD, 7.2 years) at the time of arthroplasty. There were 23 keeled glenoid components implanted in 8 women and 15 men and 20 pegged glenoid components implanted in 8 women and 12 men.

There were 3 small, 6 medium, and 14 large keeled glenoid components and 1 small, 6 medium, and 13 large pegged glenoid components. All of the men but 1 had received a large-sized glenoid component;

Discussion

We found that the keeled glenoid components had a higher incidence and higher overall grade of radiographic lucency postoperatively than did the pegged glenoid components. We assumed in formulating our hypothesis that eliminating selection bias with a randomized prospective study would equalize the incidence of radiographic lucency between the keel and peg designs. This was not the case. Our results confirm previous animal, biomechanical, and retrospective studies that have reported that pegged

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