Aseptic Glenoid Baseplate Loosening After Reverse Total Shoulder Arthroplasty: A Systematic Review and Meta-Analysis.
Journal
JBJS reviews
ISSN: 2329-9185
Titre abrégé: JBJS Rev
Pays: United States
ID NLM: 101674872
Informations de publication
Date de publication:
May 2019
May 2019
Historique:
entrez:
31
5
2019
pubmed:
31
5
2019
medline:
26
5
2020
Statut:
ppublish
Résumé
Aseptic glenoid baseplate loosening can lead to the failure of reverse total shoulder arthroplasty (RTSA). Estimates of the prevalence of aseptic glenoid baseplate loosening after RTSA are required to guide clinical decisions, but published results are variable and lack precision. The goal of this meta-analysis was to determine a precise estimate of the prevalence of aseptic glenoid baseplate loosening after RTSA and to explore variation in the prevalence according to different variables, such as the type of procedure (primary or revision), preoperative diagnosis, the center of rotation of the glenoid component (medialized or lateralized), study size, the definition of aseptic glenoid baseplate loosening, and the duration of follow-up. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. We searched the MEDLINE and Embase databases for English-language articles describing the outcomes after RTSA with a minimum 12-month follow-up in which radiographic findings of aseptic glenoid baseplate loosening were reported. Random-effects meta-analysis was performed, and meta-regression was used to explore the influence of variables on heterogeneity. Subgroup analyses and sensitivity analyses were performed. One hundred and three studies (covering 6,583 RTSAs) performed from 1991 to 2015 met our inclusion criteria. The pooled prevalence of radiographic aseptic glenoid baseplate loosening for all RTSAs was 1.16% (95% confidence interval [CI], 0.80% to 1.69%). The prevalence of aseptic glenoid baseplate loosening was lower among primary RTSAs (0.90%; 95% CI, 0.54% to 1.49%) than among revision RTSAs (3.64%; 95% CI, 1.91% to 6.84%). The pooled prevalence of aseptic glenoid baseplate loosening by diagnosis was 2.69% for osteoarthritis with bone loss, 1.71% for cuff tear arthropathy, 1.20% for rheumatoid arthritis, 1.08% for sequelae of fracture, 0.94% for irreparable massive cuff tear, and 0.25% for acute proximal humeral fracture. The prevalence of aseptic glenoid baseplate loosening was not significantly different for prostheses with a medialized center of rotation (1.15%) versus a lateralized center of rotation (1.84%). To our knowledge, the present study represents the first meta-analysis investigating only aseptic glenoid baseplate loosening after RTSA. Multiple variables were found to be associated with the prevalence of aseptic glenoid baseplate loosening. The rates reported here are lower than those reported previously because of the inclusion of more recent evidence and more studies that evaluated aseptic glenoid baseplate loosening. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Sections du résumé
BACKGROUND
BACKGROUND
Aseptic glenoid baseplate loosening can lead to the failure of reverse total shoulder arthroplasty (RTSA). Estimates of the prevalence of aseptic glenoid baseplate loosening after RTSA are required to guide clinical decisions, but published results are variable and lack precision. The goal of this meta-analysis was to determine a precise estimate of the prevalence of aseptic glenoid baseplate loosening after RTSA and to explore variation in the prevalence according to different variables, such as the type of procedure (primary or revision), preoperative diagnosis, the center of rotation of the glenoid component (medialized or lateralized), study size, the definition of aseptic glenoid baseplate loosening, and the duration of follow-up.
METHODS
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. We searched the MEDLINE and Embase databases for English-language articles describing the outcomes after RTSA with a minimum 12-month follow-up in which radiographic findings of aseptic glenoid baseplate loosening were reported. Random-effects meta-analysis was performed, and meta-regression was used to explore the influence of variables on heterogeneity. Subgroup analyses and sensitivity analyses were performed.
RESULTS
RESULTS
One hundred and three studies (covering 6,583 RTSAs) performed from 1991 to 2015 met our inclusion criteria. The pooled prevalence of radiographic aseptic glenoid baseplate loosening for all RTSAs was 1.16% (95% confidence interval [CI], 0.80% to 1.69%). The prevalence of aseptic glenoid baseplate loosening was lower among primary RTSAs (0.90%; 95% CI, 0.54% to 1.49%) than among revision RTSAs (3.64%; 95% CI, 1.91% to 6.84%). The pooled prevalence of aseptic glenoid baseplate loosening by diagnosis was 2.69% for osteoarthritis with bone loss, 1.71% for cuff tear arthropathy, 1.20% for rheumatoid arthritis, 1.08% for sequelae of fracture, 0.94% for irreparable massive cuff tear, and 0.25% for acute proximal humeral fracture. The prevalence of aseptic glenoid baseplate loosening was not significantly different for prostheses with a medialized center of rotation (1.15%) versus a lateralized center of rotation (1.84%).
CONCLUSIONS
CONCLUSIONS
To our knowledge, the present study represents the first meta-analysis investigating only aseptic glenoid baseplate loosening after RTSA. Multiple variables were found to be associated with the prevalence of aseptic glenoid baseplate loosening. The rates reported here are lower than those reported previously because of the inclusion of more recent evidence and more studies that evaluated aseptic glenoid baseplate loosening.
LEVEL OF EVIDENCE
METHODS
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Identifiants
pubmed: 31145263
doi: 10.2106/JBJS.RVW.18.00132
pii: 01874474-201905000-00004
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e7Références
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Levy O, Narvani A, Hous N, Abraham R, Relwani J, Pradhan R, Bruguera J, Sforza G, Atoun E. Reverse shoulder arthroplasty with a cementless short metaphyseal humeral implant without a stem: clinical and radiologic outcomes in prospective 2- to 7-year follow-up study. J Shoulder Elbow Surg. 2016 Aug;25(8):1362-70. Epub 2016 Feb 26.
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Ozgur SE, Sadeghpour R, Norris TR. Revision shoulder arthroplasty with a reverse shoulder prosthesis : use of structural allograft for glenoid bone loss. Orthopade. 2017 Dec;46(12):1055-62.
Matsuki K, King JJ, Wright TW, Schoch BS. Outcomes of reverse shoulder arthroplasty in small- and large-stature patients. J Shoulder Elbow Surg. 2018 May;27(5):808-15. Epub 2017 Dec 29.
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