Key result
Lower preoperative glenoid bone mineral density was not significantly associated with an increased risk of aseptic glenoid implant loosening in anatomic total shoulder arthroplasty (HR range 0.998-1.004; P≥0.121).
Why the study?
Aseptic loosening of glenoid implants is the primary cause of revision in anatomic total shoulder arthroplasty, but the impact of preoperative glenoid bone mineral density on loosening remains unclear.
Is lower preoperative glenoid bone mineral density associated with aseptic glenoid implant loosening in patients undergoing anatomic total shoulder arthroplasty?
Cohort (n=93)
Is lower preoperative glenoid bone mineral density associated with aseptic glenoid implant loosening in patients undergoing anatomic total shoulder arthroplasty?
Effect estimate: HR 0.998-1.004 (95% CI 0.996-1.007)
p-value: p=≥0.121
Preoperative glenoid bone mineral density was not clearly associated with aseptic glenoid implant loosening in anatomic total shoulder arthroplasty, though a moderate difference was seen in the subchondral cortical plate.
Background: Aseptic loosening of glenoid implants is the primary revision cause in anatomic total shoulder arthroplasty (aTSA). While supported by biomechanical studies, the impact of glenoid bone quality, more specifically bone mineral density (BMD), on aseptic glenoid loosening remains unclear. We hypothesized that lower preoperative glenoid BMD was associated with and a risk factor for aseptic glenoid implant loosening in aTSA. Methods: We retrospectively included 93 patients (69 females and 24 males; mean age, 69.2 years) who underwent preoperative non-arthrographic shoulder computed tomography (CT) scans and aTSA between 2002 and 2014. Preoperative glenoid BMD (CT numbers in Hounsfield unit) was measured in 3D using a reliable semi-automated quantitative method, in the following six contiguous volumes of interest (VOI): cortical, subchondral cortical plate (SC), subchondral trabecular, and three successive adjacent layers of trabecular bone. Univariate Cox regression was used to estimate the impact of preoperative glenoid BMD on aseptic glenoid implant loosening. We further compared 26 aseptic glenoid loosening patients with 56 matched control patients. Results: Glenoid implant survival rates were 89% (95% confidence interval CI, 81%-96%) and 57% (41%-74%) at 5 and 10 years, respectively. Hazard ratios for the different glenoid VOIs ranged between 0.998 and 1.004 (95% CI [0.996, 1.007], p≥0.121). Only the SC VOI showed significantly lower CTn in the loosening group (622±104 HU) compared with the control group (658±88 HU) (p=0.048), though with a medium effect size (d=0.42). There were no significant differences in preoperative glenoid BMD in any other VOI between patients from the loosening and control groups. Conclusions: Although the preoperative glenoid BMD was statistically significantly lower in the SC region of patients with aseptic glenoid implant loosening compared with controls, this single-VOI difference was only moderate. We are thus unable to prove that lower preoperative glenoid BMD is clearly associated with and a risk factor for aseptic glenoid implant loosening in aTSA. However, due to its proven biomechanical role in glenoid implant survival, we recommend extending this study to larger CT datasets to further assess and better understand the real impact of preoperative glenoid BMD on glenoid implant loosening/survival and aTSA outcome overall. Trial registration: Retrospectively registered
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Mariaux et al. (2020) conducted a cohort in Aseptic glenoid implant loosening in anatomic total shoulder arthroplasty (n=93). Lower preoperative glenoid bone mineral density (BMD) vs. Higher preoperative glenoid BMD was evaluated on Aseptic glenoid implant loosening (HR 0.998-1.004, 95% CI 0.996-1.007, p=≥0.121). Lower preoperative glenoid bone mineral density was not significantly associated with an increased risk of aseptic glenoid implant loosening in anatomic total shoulder arthroplasty (HR range 0.998-1.004; P≥0.121).
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