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The hybrid cage glenoid – is it of worth?

Uncemented fixation of a monoblock ingrowth polyethylene glenoid: early follow-up

These authors reviewed their experience with uncemented fixation of a hybrid cage monoblock
polyethylene glenoid component in 51shoulders with a minimum follow-up of 2 years.

Twelve glenoid components (24%) had radiolucent lines. Glenoid lines were rated grade 1,grade 2, and grade 5 (6, 4, and 2 shoulders, respectively). Six shoulders (12%) had humeral lucent lines. Two shoulders (4%) underwent reoperation, only 1 of these occurring due to isolated failure of the glenoid component. As a group, mean ROM and PROMs improved significantly compared with preoperative values and exceeded the minimal clinically important difference.

One patient had failure of the glenoid after a motorcycle accident

Comment: The clinical and radiographic outcomes of this glenoid do not appear to be superior to those with a standard all-polyethylene glenoid component.

See below for a discussion of another recent paper describing the use of this component.

Clinical and radiographic comparison of a hybrid cage glenoid to a cemented polyethylene glenoid in anatomic total shoulder arthroplasty

These authors report the clinical and radiographic outcomes of 316 Exactech hybrid cage glenoids below left) to an age-matched, sex-matched, and follow-up–matched cohort of 316 Exactech cemented all polyethylene glenoid (below right) in patients undergoing anatomic total shoulder arthroplasty with 2 years’ minimum follow-up.

The Exactech cage glenoid patients had significantly lower rates of radiolucent glenoid lines (9.0% vs. 37.6%, P < .0001) and radiolucent humeral lines (3.0% vs. 9.1%, P . .0088) than the Exactech all-polyethylene peg glenoid patients. In the cage glenoid cohort, 4 cases of aseptic glenoid loosening (1.3%) and 4 cases of articular surface dissociation (1.3%) occurred as shown below.

In the all-polyethylene peg cohort, 12 cases of aseptic loosening (3.8%) occurred. Cage glenoid patients had a significantly lower revision rate than all-polyethylene peg glenoid patients (2.5% vs. 6.9%, P . .0088).

Comment: These authors point out the importance of exact alignment of the drilled holes and the direction of impaction required by the metal-coated pegs.

The required direction and accuracy may be difficult to achieve because of challenges with exposure, especially in retroverted glenoids.

Failure to achieve the desired alignment of the holes with the reamed bony surface can result in failure of the component as shown below.

In contrast to the all-polyethylene component with smooth pegs used in this study, we prefer a component with a fluted central peg.

This component has several advantages, including (1) the flexibility of the pegs that can better accommodate minor degrees of malalignment in comparison to the more rigid hybrid pegs and (2) the fluted central peg that allows bone ingrowth which cannot occur with the smooth pegs used in this study.

To see a YouTube of our technique for total shoulder arthroplasty, click on this link.

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