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. 2022 Jun;14(3):269-277.
doi: 10.1177/1758573220987557. Epub 2021 Jan 20.

Assessing the required glenoid peg penetration in native scapula when bone graft is used during primary and revision shoulder arthroplasty

Daoud Makki  1 , Basel Balbisi  2 , Mohammed S Arshad  3 , Puneet Monga  4 , Steven Bale  5 , Ian Trail  5 , Michael Walton  6
Affiliations

Assessing the required glenoid peg penetration in native scapula when bone graft is used during primary and revision shoulder arthroplasty

Daoud Makki et al. Shoulder Elbow. 2022 Jun.

Abstract

Aims: Achieving purchase in native glenoid bone is essential for the stability of the glenoid baseplate when bone graft is used to address bone loss in both primary and revision shoulder arthroplasty procedures. The aim of this study is to assess the required depth of the baseplate peg in native bone when bone graft is used to result in satisfactory integration.

Patients and methods: The CT scans of patients who underwent either primary or revision arthroplasty procedures with bone graft using the SMR Axioma Trabecular Titanium (TT) Metal Backed glenoid system were assessed. We measured the depth of the glenoid peg in native glenoid bone. Measurements were taken by two authors separately.

Results: The scans of 53 patients (mean age 68 years) with a minimum follow-up of two years were reviewed. Implants included 12 anatomical and 41 reverse geometry prostheses. There were 17 primaries and 36 revisions: hemiarthroplasties (20) total (14) and reverse (2) implants. Bone grafts were from humeral head (15), iliac crest (34) and allograft (4). The mean depths were 8.8 mm (first assessor) and 9.10 mm (second assessor). The glenoid peg violated the glenoid vault in 32 patients and this did not adversely affect the outcome. There were three failures of implants all of which were aseptic failures and had peg penetration of less than 6 mm.

Conclusions: The mean depth of glenoid peg in native bone was 9 mm (variation between 0.2 and 0.52 mm at 95% confidence interval). Aseptic loosening was seen with peg penetration less than 6 mm in native bone. Glenoid vault violation was not associated with loosening.

Keywords: Glenoid peg depth; glenoid bone graft; native glenoid; primary shoulder arthroplasty; revision shoulder arthroplasty.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Axioma SMR Trabecular Titanium (TT) Metal Backed implant.
Figure 2.
Figure 2.
Coronal CT scan showing bone graft (outlined in yellow), the interphase between the graft and the native glenoid (yellow arrow) and the depth of the TT stem in native glenoid (distance between the two green lines).
Figure 3.
Figure 3.
Bland Altman plot comparing the two measurements done by the two authors.
Figure 4.
Figure 4.
Case 1 – 1(a): Preoperative x-ray demonstrating severe glenoid wear. 1(b): Immediate postoperative radiograph. 1(c): Measurements of peg penetration at six weeks. 1(d): Aseptic failure of baseplate on CT scan at three months. Case 2 – 2(a): Preoperative x-ray demonstrating glenoid loosening. 2(b): Immediate postoperative radiograph. 2(c): Measurements of peg penetration at six weeks. 2(d): Aseptic failure of baseplate on CT scan at three months.
Figure 5.
Figure 5.
Coronal MARS CT scans showing no bone integration at the tapered part of the glenoid peg and this was not associated with failure.
Figure 6.
Figure 6.
(a) Axillary radiograph and (b) axial CT scan showing the tapered part of the glenoid stem penetrating the anterior wall (uncontained peg). (c) Axial CT scan showing the tapered part of the glenoid stem lying within the vault (contained peg).
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