Researchers from Cleveland Clinic in Ohio have undertaken an effort to get clarity on optimal component placement in total shoulder arthroplasty (TSA). The team, led by Eric T. Ricchetti, M.D., sought to evaluate the use of a standard and an augmented glenoid component. A total of 88 patients with advanced glenohumeral osteoarthritis underwent TSA; 57 had a standard component and 31 had a posteriorly augmented (STEP) glenoid component.
Augmented Glenoid Implant Trumps Standard in TSA
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Dr. Ricchetti told OTW, “The patients were chosen for one or the other type of glenoid component (standard or augmented) based on how much glenoid (socket) bone loss they had on pre operative CT. This was done by pre-operative planning with the software we have. The augmented implant was more likely to be used when there was more bone loss.”
“We were happy to learn that the augmented glenoid implant allowed better correction of pathology than what is able with a standard component. This is promising for cases with more bone loss where the only previous option was a standard component. There is evidence that if you don’t correct pathology as well, like what can happen with a standard component in these more severe cases, the replacement does not last as long over time.”
Asked for details on the custom written 3D analysis software, Dr. Ricchetti commented, “The software allows for precise measurements to be made on pre-operative and post-operative CT scans so changes can be determined before and after surgery. The software has an automatic detection method that is able to locate the position of the implants after surgery based on metal markers in the implants.”
As for whether this will be a “practice changer, ” Dr. Ricchetti told OTW, “This study validates the theoretical benefit of the augmented glenoid component for cases with worse bone loss and shows they can be used well in these more challenging cases of bone loss. The data provides support for this newer implant being used in clinical practice.”
“This study is just the first step. It only shows that we can correct pathology well at the time of surgery, but doesn’t show the long term durability of the replacements. That is the next step. We will follow these patients over time and see if cases where pathology is better corrected end up having a more durable replacement that lasts longer and has better function.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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