GLENOID COMPONENT – PEGGED OR KEELED

There were two high quality (Edwards et al. 2007, Gartsman et al. 2000) and two low quality (Throckmorton et al. 2010, Lazarus et al. 2002) studies which met inclusion criteria. These studies demonstrated that pegged components have a lower incidence of postoperative radiolucent lines. There was no significant difference in either functional outcomes, pain, or patient reported outcome measures. There was also no significant difference in the incidence of glenoid component loosening, radiographic failure or need for revision surgery between groups. The included studies have only short-term follow-up (2 years). Longer follow-up is needed to demonstrate if there will be a clinically significant difference between pegged and keeled glenoid components. Additionally, identifying if glenoid component type will influence implant survivorship can only be determined with long term follow-up (>10 years). Given the current evidence, it is at the discretion of the surgeon as to which implant to use based on comfort with surgical technique to reproducibly achieve a successful outcome. Furthermore, the pegged constructs studied are not the implants commonly in use today.

Strength of Evidence (quality of evidence): Strong

Benefits & Harms:

There are no risks associated with the use of either glenoid component as they are already standard practice for use during anatomic total shoulder arthroplasty. These decisions are currently being made at the discretion of the surgeon.

Outcome Importance:

Implant survivorship and predictability of the clinical outcome following anatomic total shoulder arthroplasty will result in lower incidence of reoperation, longer duration of pain relief, and maintained shoulder function.

Cost Effectiveness/Resource Utilization:

Evidence based decision making on type of glenoid component utilized for anatomic total shoulder arthroplasty should result in longer survivorship. Methods to prevent need for reoperation/ revision shoulder arthroplasty decreases cost and health care resources often required for an extended period of time due to the increased complexity associated with revision surgery. Pegged and keeled glenoid components have similar cost so currently either implant does not add additional expense.

Acceptability:

Currently both pegged and keeled glenoid components are used frequently during anatomic total shoulder arthroplasty therefore there should be no issues implementing this recommendation as it does not influence a change in clinical practice.

Feasibility:

This recommendation does not impact a change in clinical practice recommendation therefore until further evidence is available continued use of either pegged or keeled glenoid components is appropriate.

Future Research: 

Most important future research is high quality investigation with either prospective randomized trials or prospective cohort studies to establish long term (>10 year) follow-up of these implants is critical to determine survivorship/ failure rates, clinical and functional outcomes.