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One and two-year clinical outcomes for a polyethylene glenoid with a fluted peg: one thousand two hundred seventy individual patients from eleven centers

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Abstract

Purpose

Clinical shoulder science lacks a benchmark against which the early clinical value of new glenoid components can be compared; such a benchmark may be derived from a multicenter study of patients receiving an established, internationally used design of glenoid component.

Methods

We obtained data from 11 centers on 1270 patients having total shoulder arthroplasty using an all-polyethylene component with a fluted central peg. We analyzed individual patient outcomes at 1 and 2 years after surgery. We compared the improvement for each patient to the minimal clinically important difference (MCID) and calculated each patient’s improvement as a percent of maximal possible improvement (MPI).

Results

The preoperative scores improved from SST 3 ± 2, ASES 37 ± 15, Constant score 36 ± 16, and Penn score 30 ± 19 to SST 10 ± 2, ASES 90 ± 12, Constant 76 ± 13, and Penn 80 ± 24 (p < 0.001 for each). A high percentage of patients improved by more than the MCID (SST 96%, ASES 98%, Constant 94%, Penn 93%) and obtained improvement of at least 30% of the MPI (SST 95%, ASES 98%, Constant 91%, Penn 87%). The clinical outcomes realized with this glenoid design were not worse for the 41% of shoulders with preoperative type B glenoids or for the 30% of shoulders with more than 15 degrees of glenoid retroversion.

Conclusions

Individual patients from 11 international practices having total shoulder arthroplasty using a basic glenoid component design obtained highly significant clinical outcomes, providing a benchmark against which the early outcomes of new designs can be compared to determine whether they provide increased clinical value.

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Acknowledgements

We thank Susan DeBartolo, University of Washington, Department of Orthopaedics and Sports Medicine, (blinded for review purposes) for her editorial work on this manuscript.

Funding

There was no extramural funding for this investigation.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA

    Frederick A. Matsen III

  2. Department of Orthopaedic Surgery, Cleveland Clinic, Mail Code A41, G Building, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Joseph P. Iannotti

  3. Orthopaedic Surgery, Aurora Health Center, 3003 W Good Hope Road, Milwaukee, WI, 53209, USA

    R. Sean Churchill

  4. Shoulder & Elbow Surgery, Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Lieven De Wilde

  5. Fondren Orthopaedic Group, L.L.P., 7401 S Main St, Houston, TX, 77030, USA

    T. Bradley Edwards

  6. Upper Limb Unit, Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Melbourne, VIC, 3181, Australia

    Matthew C. Evans

  7. Orthopaedic Shoulder and Elbow Surgery, Columbus Community Hospital Orthopaedics and Sports Medicine, 4508 38th Street, Suite 133, Columbus, NE, 68601, USA

    Edward V. Fehringer

  8. Asheville Orthopaedic Associates, P.A, 111 Victoria Road, Asheville, NC, 28801, USA

    Gordon I. Groh

  9. California Pacific Orthopaedics, 2351 Clay Street, Suite 510, San Francisco, CA, 94115, USA

    James D. Kelly II

  10. Orthopaedic Associates of Wisconsin, N15 W28300 Golf Road, Pewaukee, WI, 53072, USA

    Christopher M. Kilian

  11. Shoulder and Elbow Unit, “D. Cervesi” Hospital, Via L. v. Beethoven 46, 47841, Cattolica, Italy

    Giovanni Merolla

  12. California Pacific Orthopaedics, 2351 Clay Street, Suite 510, San Francisco, CA, 94115, USA

    Tom R. Norris

  13. Orthopaedic and Trauma Unit, University of Modena and Reggio Emilia, Via Universita, 4, 41121, Modena, MO, Italy

    Giuseppe Porcellini

  14. Knoxville Orthopaedic Clinic, 260 Fort Sanders West Blvd, Knoxville, TN, 37922, USA

    Edwin E. Spencer Jr

  15. Paris Shoulder Unit, Clinique Bizet, 21 rue Georges Bizet, 75116, Paris, France

    Anne Vidil

  16. Department of Orthopaedics, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MC 7774, San Antonio, TX, 78229-3900, USA

    Michael A. Wirth

  17. Department of Orthopaedics & Sports Medicine, University of Washington, 4245 Roosevelt Way NE, Box 354740, Seattle, WA, 98105, USA

    Stacy M. Russ

  18. The Mountain-Whisper-Light Statistics, 1827 23rd Avenue East, Seattle, WA, 98112, USA

    Moni Neradilek

  19. The University of Texas Medical Branch, 301 University Blvd., Route 0165, Galveston, TX, 77555-0165, USA

    Jeremy S. Somerson

Authors
  1. Frederick A. Matsen III
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  2. Joseph P. Iannotti
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  3. R. Sean Churchill
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  4. Lieven De Wilde
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  7. Edward V. Fehringer
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  8. Gordon I. Groh
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  10. Christopher M. Kilian
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  15. Anne Vidil
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  16. Michael A. Wirth
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  17. Stacy M. Russ
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  18. Moni Neradilek
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  19. Jeremy S. Somerson
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Corresponding author

Correspondence to Frederick A. Matsen III.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This was a retrospective cohort study approved by our Institutional Review Board (HSD# STUDY00001714). For this type of study, formal consent is not required.

Informed consent

N/A.

Conflict of interest

Financial remuneration the authors, or any member of their family, may have received directly related to the subject of the article: none.

The following is blinded for review purposes:

Dr. Matsen (first and corresponding author), Dr. De Wilde, Dr. Groh, Dr. Kilian, Dr. Merolla, Mr. Neradilek, Dr. Porcellini, Ms. Russ, Dr. Somerson, and Dr. Vidil have no conflict of interests to report.

The following doctors have conflict of interests outside of the submitted work as noted:

Dr. Iannotti reports personal fees from DePuy Synthes, personal fees from DJO Surgical, personal fees from Wright Tornier, from null, outside the submitted work.

Dr. Churchill reports personal fees from Wright Medical Tornier, Inc., during the conduct of the study; personal fees from Wright Medical Tornier, Inc., outside the submitted work. In addition, Dr. Churchill has a patent Glenoid Anchor Post licensed to Tornier Inc.

Dr. Edwards reports personal fees and non-financial support from Wright Medical Inc., during the conduct of the study; personal fees and non-financial support from Wright Medical Inc., outside the submitted work; and royalties and consulting fees from Wright Medical Inc. & DJO.

Dr. Evans reports other from DePuy-Johnson and Johnson, outside the submitted work.

Dr. Fehringer reports grants from University of Nebraska Medical Center, other from Wright Medical, during the conduct of the study.

Dr. Kelly reports other from Wright Medical, during the conduct of the study; personal fees and other from Wright Medical, outside the submitted work.

Dr. Norris reports personal fees and other from Wright Medical, during the conduct of the study.

Dr. Spencer reports personal fees from Tornier/Wright, outside the submitted work.

Dr. Wirth reports other from DePuy-Johnson and Johnson, other from Wright Medical, other from Elsevier, grants from Arthrex, outside the submitted work. In addition, Dr. Wirth has a patent with royalties paid.

Additional information

Level of Evidence: Level IV Therapeutic

Investigation performed at University of Washington Department of Orthopedics and Sports Medicine, Seattle WA

Appendix

Appendix

Table 4 Association of risk factors with % MPI by outcome scale and follow-up year
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Table 5 Association of risk factors with post-op score by scale and year
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Matsen, F.A., Iannotti, J.P., Churchill, R.S. et al. One and two-year clinical outcomes for a polyethylene glenoid with a fluted peg: one thousand two hundred seventy individual patients from eleven centers. International Orthopaedics (SICOT) 43, 367–378 (2019). https://doi.org/10.1007/s00264-018-4213-3

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