JAAOS - 2026-05-15 - Journal Article
Minimum 48-month Clinical and Radiographic Outcomes of Anatomic Total Shoulder Arthroplasty With a Partially Cemented All-polyethylene Fluted Central Peg Glenoid Component.
Christensen RG, Griswold BG, Sears BW, Kelly JD, Khazzam MS, Mauter LA, Bader JE, Schuette HB, Boyd MA, Hatzidakis AM
Topics
Key Takeaway
At mean 90-month follow-up after aTSA with a fluted central peg glenoid, 28% developed central peg osteolysis and radiolucency progression was associated with 13% greater revision risk and significantly lower ASES and SANE score improvement.
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Summary
This study evaluated clinical and radiographic outcomes of aTSA using a partially cemented all-polyethylene fluted central peg glenoid at minimum 4-year follow-up from a prospective registry. Of 83 shoulders, 19% achieved optimal bony ingrowth, 28% developed central peg osteolysis, and 41% of those with serial imaging showed radiolucency progression. Radiolucency progression correlated with significantly lower ASES (P=0.026) and SANE (P=0.022) improvement, a 13% greater revision risk, and a 25% overall dissatisfaction rate.
Key Limitation
Only 19% of implants achieved optimal bony ingrowth, yet the study cannot determine whether this reflects a design-specific failure mode or patient/surgical factors, limiting conclusions about FCP glenoid selection versus technique optimization.
Original Abstract
BACKGROUND
Partially cemented all-polyethylene glenoids with press-fit fluted central peg (FCP) fixation are commonly used for anatomic total shoulder arthroplasty (aTSA). The purpose of this study was to evaluate clinical outcomes and radiographic findings in patients with ≥48-month follow-up after aTSA with one FCP glenoid design.
METHODS
A prospective patient registry was used to identify a consecutive group of patients who had undergone aTSA using a FCP glenoid and had ≥48-month follow-up. Final postoperative radiographs, as well as short-term if available, were assessed by five shoulder specialists for bony incorporation and/or radiolucency about the FCP using a validated discriminatory method of evaluating native glenoid reaction to the FCP. Changes in patient-reported and clinical outcomes were evaluated, and regression analysis was performed to identify predictors of central peg osteolysis (CPO), poor clinical outcome, or revision.
RESULTS
Eighty-three shoulders satisfied inclusion criteria. At final follow-up (average 90 months), notable improvements were noted in all outcomes ( P < 0.05), including a 75% satisfaction rate. On final imaging, 16 patients (19%) demonstrated optimal FCP bony ingrowth, and 23 (28%) demonstrated CPO. The radiographic appearance of bone around the central peg tended to deteriorate over time and trended with worsened clinical outcomes, but these differences were not notable. Of 73 patients with short-term and final imaging, progression of radiolucency was observed in 30 (41%) and associated with less improvement in American Shoulder and Elbow Surgeons score ( P = 0.026) and Single Assessment Numeric Evaluation ( P = 0.022) scores. Risk of revision was 13% greater in patients with CPO on final imaging while increased age was associated a lower risk of revision.
CONCLUSION
Clinical improvement was observed in most of the patients, but with a dissatisfaction rate of 25%. Progression of CPO was associated with lower improvement in final American Shoulder and Elbow Surgeons score and Single Assessment Numeric Evaluation scores and a higher probability of revision.
LEVEL OF EVIDENCE
Level IV Case Series.