Sunday, February 12, 2017

Is it time for hybrid polyethylene and metallic cage pegged glenoid components?

There are implant companies that promote hybrid - "metallic cage" pegged polyethylene glenoid components. This is not a new concept. Several companies have introduced glenoid components in the past that have metal pegs in an attempt to solve the problem of radiolucent lines around the glenoid peg holes which in some series can reach a frequency of 70% on initial radiographs. The concern with the cage or metallic cage pegs, is that the junction of the polyethylene to the metallic peg will see extensive stress during the edge loading of the glenoid rim from the humerus. The plastic deformation of the polyethylene is advantageous for the shoulder joint. In this new design the concern is that these "new" hybrid polyethylene components may fail the same way that the metal back glenoid components fail. Dissociation is a true concern. We need to have 5 year data to decide whether this is the case. In the meantime, I continue to use all poly cemented pegged glenoid components such as the one seen on X-rays below: