The effects of glenoid wear patterns on patients with osteoarthritis in total shoulder arthroplasty: an assessment of outcomes and value

Background: Despite the success of total shoulder arthroplasty (TSA), concerns remain about the longevity of the implant, in particular, glenoid component survivorship. The purpose of this study was to determine whether preoperative glenoid wear patterns affect clinical outcomes and value in patients undergoing TSA. Methods: A comparative cohort study was conducted of 309 patients with a total of 344 TSA procedures, performed for primary glenohumeral osteoarthritis. Computed tomography scans were obtained in all patients, with preoperative glenoid wear pattern characterized as either concentric (n = 196; follow- up time, 49.2 months) or eccentric (n = 148; follow- up time, 52.3 months) according to a modified Levine classification. A clinical, radiographic, and economic assessment was performed between the 2 wear patterns. Results: There was no significant difference in American Shoulder and Elbow Surgeons (ASES) score in the concentric group (80.8 +/- 20.8) compared with the eccentric group (77.6 +/- 21.2) at final follow- up (P = .159). Range of motion and final visual analog scale for pain score were similar between the 2 groups. Radiographic evidence of gross glenoid loosening was significantly lower in the concentric group [11 of 195 (5.6%)] compared with the eccentric group [18 of 147 (12.2%)] (P = .030). Revision rates were similar between the concentric group [4 of 195 (2.0%)] and the eccentric group [3 of 147 (2.0%)]. A value assessment also showed no significant difference between the concentric and eccentric groups [concentric 26.1 vs. eccentric 25.5 (DASES score/$10,000 hospital cost) (P = .479)]. Conclusions: Similar clinical results and value can be expected with both concentric and eccentric glenoid wear patterns in TSA. Concerns arise, however, as the eccentric group demonstrated a more than 2-fold increased rate of glenoid component loosening compared with the concentric group. (C) 2015 Journal of Shoulder and Elbow Surgery Board of Trustees.