Early debris formation with a porous tantalum glenoid component: radiographic analysis with 2-year minimum follow-up.

Document Type

Article

Publication Date

6-15-2016

Journal Title

The Journal of bone and joint surgery. American volume

MeSH Headings

Aged, Aged, 80 and over, Arthroplasty, Replacement, Shoulder, Female, Humans, Male, Middle Aged, Prosthesis Design, Prosthesis Failure, Shoulder Joint, Shoulder Prosthesis, Tantalum, Tomography, X-Ray Computed, Treatment Outcome

Abstract

BACKGROUND: Porous tantalum has been used effectively in hip, knee, and reverse shoulder arthroplasty implants. However, a first-generation porous tantalum glenoid component for use in anatomic shoulder arthroplasty previously demonstrated failure, with failure usually preceded by the appearance of intra-articular metallic debris. After redesign, the component was reintroduced in 2009. The purpose of the current study was to evaluate the radiographic and clinical outcomes of the redesigned glenoid component.

METHODS: Sixty-eight patients undergoing total shoulder arthroplasty received a Trabecular Metal porous tantalum glenoid component (73 components; 5 patients underwent staged bilateral procedures). No polymethylmethacrylate cement was used (off-label usage in the U.S.). A grading system to assess metallic debris formation was developed using radiographs of the previous generation of porous tantalum glenoid components that failed. Radiographs from the current series were independently reviewed by 2 shoulder arthroplasty specialists, and their results were compared. Glenoid components were evaluated for signs of bone ingrowth and metallic debris formation.

RESULTS: Sixty-six (90%) of the 73 components were evaluated at a minimum of 2 years of follow-up (mean radiographic follow-up of 50.8 months; range, 24 to 68 months). Of these, 92.4% demonstrated minimal or no glenoid radiolucency. Overall, the prevalence of metallic tantalum debris formation was 44% (29 of 66). Sequential radiograph review demonstrated that the incidence of metallic debris formation increased for each year of follow-up, with radiographs from 2, 3, 4, and ≥5 years of follow-up demonstrating a metallic debris incidence of 23%, 36%, 49%, and 52%, respectively. Additionally, the severity of metallic debris formation increased with follow-up duration. There was no component dissociation or revision due to implant breakage in this series.

CONCLUSIONS: The porous tantalum glenoid component studied had excellent short-term component fixation. However, the development of metallic debris, increasing in both overall incidence and degree of severity over time, raises concern for potential failure of this glenoid component. Longer follow-up is required.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

ISSN

1535-1386

Comments

Division of Orthopedics, Maine Medical Partners, Falmouth, ME.

First Page

1023

Last Page

1029

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