3/9/2018 1 Glenoid Component ‐ None, Poly, Metal ‐ What Will Last the Longest? Charles M. Jobin, MD Associate Professor Orthopedic Surgery Residency Program Director Shoulder & Elbow Surgery Columbia University New York, NY Winter SKS: Shoulder, Knee, and Sports Meeting Friday, Feb 23rd, 2018 7:10am 2 Disclosures Consultant – Acumed, Wright/Tornier, Zimmer/Biomet JSES, JBJS, JAAOS, JOR, JSEA – Reviewer JAAOS Shoulder/Elbow Deputy Editor Orthobullets.com – Author Big Problem = Opportunity for Big Impact Glenoid component frequently (70%) develops lucent lines and loosening TSA projected 333% increase 2011-30 (Padegimas CORR 2015) Ethical Dilemma: balancing new technology vs proven techniques Revision burden will be large
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2018 2 Jobin TSA Glenoid Componenet short · 2018-03-09 · 3/9/2018 1 Glenoid Component ‐None, Poly, Metal ‐ What Will Last the Longest? Charles M. Jobin, MD Associate Professor
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3/9/2018
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Glenoid Component ‐ None, Poly, Metal ‐What Will Last the Longest?
Charles M. Jobin, MDAssociate Professor Orthopedic Surgery
Residency Program Director
Shoulder & Elbow Surgery
Columbia University
New York, NY
Winter SKS: Shoulder, Knee, and Sports MeetingFriday, Feb 23rd, 2018 7:10am
Ethical Dilemma: balancing new technology vs proven techniques
Revision burden will be large
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New Technology
New:
Glenoid designs
Fixation concepts
Materials
Studied biomechanically, in animal models, and in patients
…But long term superiority over existing techniques is relatively unknown…
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Poly vs Metal‐Backed: Survivorship
Mayo registry, 1542 TSAs with 6 glenoid typesRevision Survivorship: 5, 10, 15 years
Neer II all-poly (n=99): 96%, 96%, and 95% Neer II metal-backed (n=316): 96%, 94%, and 89%Cofield 1 metal-backed ingrowth (n=314): 86%, 79%, and 67% Cofield 2 all-poly keeled (n=497): 99%, 94%, and 89% Cofield 2 all-poly pegged (n=358): 99% at 5 years only
Conclusions: Survival best with cemented all-polyethylene (Fox JSES 2009)
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Mid‐Long Term Pegged Poly Outcomes
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330 TSA, 7.2 yrs f/u
Revision free survival99% at 5 years83% at 10 years
Radiographic poly survival92% at 5 years43% at 10 years
Failure risk: Walch A2, B2, C, <65 yrs old
High mid-term Xray and clinical failure for pegged poly
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Glenoid Fixation Options : Current Market
Cemented Pegs (in-line or spread)
Cemented Keel
Ingrowth Metal (pegs, post, cage...)
Hybrid Cement pegs and Ingrowth metal
Metal backed (ingrowth post + screws)
Posterior Augment (wedge, step, half-wedge)
Metal: is it Back?
“metal backed” in-growth glenoids had 50% failure by 10 years (Cofield JBJS 2008)
Solution: Glenoid FixationPeg “Around Growth” Fins ‐ Outcomes
Churchill JSES 2010: 20 TSA, 5 yrs, 75% bone growth between fins
Groh JSES 2010: 83 TSA, 2 yrs, 29% bone growth between fins
Arnold JSES 2011: 35 TSA, 3.5 yrs, CT. 91% bone growth between fins
Wirth JBJS Am 2012: 44 TSA, 3 yrs, 68% bone growth between fins
Vidil EJOST 2013: 26 TSA, 80% bone growth between fins.
Parks JSES 2016: 76 TSA 3 yr XR follow up 50% bone growth around fins
Conclusions: Bone grows around poly fins in 30-90% at mid-term follow up
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98 TSA with 2nd Gen TM glenoid (2011 – 2015)
3 centers, postoperative Xrays: 0, 1, 2 yrs, and latest follow up
Early Outcomes of a 2nd Generation Porous Tantalum‐Backed Glenoid: A Multi‐Center Cohort Study
2015 CSES Biennial Meeting David Kovacevic, Charles M. Jobin, Janice J. He, Rolando Izquierdo, Ryan J. Krupp, Craig C. Satterlee, Jonathan K. Kazam, William N. Levine
Solution: Glenoid Ingrowth Fixation ‐ Outcomes
RLL at 2 years 0.6±1.1
28% no RLL change
57% decrease in RLL score from
post-op = INGROWTH
Metal debris 11% at 2.8yrs
Debris despite solid ingrowth
2% with catastrophic failure
metal fragmentation
RLL Grade 1 1 Year Follow-Up
Radiolucency and Metal Debris
68 TSA, 2 yr, no cement
92% min or zero RLL
44% with metallic debris, increased with time
no component dissociation
(Endrizzi JBJS 2016)
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Grade 1: debris
Grade 2: axillary debris
Grade 3: breakage
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Does Glenoid Bone Ingrow?
6 of 351 glenoids retrieved at 1.2 years during revision not for glenoid failure