Biomechanical analysis of patient specific cone vs conventional stem in revision total knee arthroplasty.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: SP is an employee of Adler Ortho. 16. J Shoulder Elbow Surg. 2022 Nov;31(11):2249-2255. doi: 10.1016/j.jse.2022.04.015. Epub 2022 May 14. Total shoulder replacement stems in osteoarthritis-short, long, or reverse? An analysis of the impact of crosslinked polyethylene. Sandow M(1), Page R(2), Hatton A(3), Peng Y(3). Author information: (1)Wakefield Orthopaedic Clinic, Adelaide, SA, Australia; Centre of Orthopaedic and Trauma Research, University of Adelaide, Adelaide, SA, Australia. Electronic address: msandow@woc.com.au. (2)The Barwon Centre of Orthopaedic Research and Education, Barwon Health and St John of God Hospital, Geelong, VIC, Australia; Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia; School of Medicine, Deakin University, Geelong, VIC, Australia. (3)South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia. BACKGROUND: The 2021 Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) report indicated that total shoulder replacement using both midhead (TMH) length humeral components and reverse arthroplasty (RTSA) had a lower revision rate than stemmed humeral components in anatomic total shoulder arthroplasty (aTSA)-for all prosthesis types and diagnoses. However, there are many factors that affect the outcome of total shoulder replacement, including stem length and polarity, polyethylene type, and glenoid fixation (cemented vs. cementless). The aim of this study was to assess the impact of these variables in the various primary total arthroplasty alternatives for osteoarthritis (OA) in the shoulder. METHODS: Data from a large national arthroplasty registry were analyzed for the period April 2004 to December 2020. The study population included all primary aTSA, RTSA, and TMH shoulder arthroplasty procedures undertaken for OA using either crosslinked polyethylene (XLPE) or noncrosslinked polyethylene (non-XLPE). Because of the previously documented and reported higher revision rate compared with other anatomic total shoulder replacement options, those using cementless metal-backed glenoid components were excluded. The rate of revision was determined by Kaplan-Meier estimates, with comparisons by Cox proportional hazard models. Reasons for revision were also assessed. RESULTS: For a primary diagnosis of OA, aTSA with a cemented XLPE glenoid component had the lowest revision rate, with a 12-year cumulative revision rate of 4.7%, compared with aTSA with cemented non-XLPE glenoid component at 8.7% and RTSA at 6.8%. The revision rate for TMH (with XLPE or non-XLPE) was lower than aTSA with cemented non-XLPE but was similar to the other implants at the same length of follow-up. The reason for revision of cemented aTSR was most commonly component loosening, not rotator cuff deficiency. CONCLUSION: Long-stem humeral components matched with XLPE in aTSA achieve a lower revision rate compared with shorter stems, long stems with conventional polyethylene, and RTSA when used to treat shoulder OA. In all these cohorts, loosening, not rotator cuff failure, was the most common diagnosis for revision. Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.jse.2022.04.015