Total Shoulder Arthroplasty Research: Radiographic and clinical comparison of glenoid components

Shoulder joint osteoarthritis is not nearly as common as hip or knee arthritis, but it may be more common than you think. Patients with shoulder arthritis often present to our shoulder clinic because they have significant shoulder pain affecting sleep and basic activities of daily living.

Non-surgical options are initiated to relieve night pain and improve symptoms; however, some patients with severe shoulder joint arthritis do progress to the point of needing a total shoulder replacement . This is a study Dr. Morris and his team published in the Journal of Shoulder and Elbow Surgery.

Background: Glenoid component loosening remains a significant issue after anatomic shoulder arthroplasty. Pegged glenoid components have shown better lucency rates than keeled components in the short term; however, midterm to long-term results have not fully been determined.

We previously reported early outcomes of the current randomized controlled group of patients, with higher glenoid lucency rates in those with a keeled glenoid. The purpose of this study was to evaluate the radiographic and clinical outcomes of these components at minimum 5-year follow-up.

Methods: Fifty-nine total shoulder arthroplasties were performed in patients with primary glenohumeral osteoarthritis. Patients were randomized to receive either a pegged or keeled glenoid component.

Three raters graded radiographic glenoid lucencies. Clinical outcome scores and active mobility outcomes were collected preoperatively and at yearly postoperative appointments.

Results: Of the 46 shoulders meeting the inclusion criteria, 38 (82.6%) were available for minimum 5-year radiographic follow-up. After an average of 7.9 years, radiographic lucency was present in 100% of pegged and 91% of keeled components (P = .617).

Grade 4 or 5 lucency was present in 44% of pegged and 36% of keeled components (P = .743). There were no differences in clinical outcome scores or active mobility outcomes between shoulders with pegged and keeled components at last follow-up.Within the initial cohort, 20% of the keeled shoulders (6 of 30) and 7% of the pegged shoulders (2 of 29) underwent revision surgery

(P = .263). Kaplan-Meier analysis showed no significant difference in survival rates between groups (P = .560).

Conclusion: At an average 7.9-year follow-up, non-ingrowth, all-polyethylene pegged glenoid implants are equivalent to keeled implants with respect to radiolucency, clinical outcomes, and need for revision surgery.

Fortunately, newer glenoid components show promise for early fixation and results at 2-year follow-up, but longer follow-up is needed.

About Dr. Morris:

Dr. Brent J. Morris is a board-certified orthopedic surgeon and fellowship-trained shoulder and elbow specialist in Lexington, Kentucky at Baptist Health Lexington – Orthopedics and Sports Medicine.  Dr. Morris is a fellow of the American Academy of Orthopedic Surgeons (FAAOS) and an Active Member of American Shoulder and Elbow Surgeons (ASES).

Dr. Morris and his research team have published extensively on shoulder surgery and ways to improve outcomes and patient satisfaction following surgery.  He is co-author of a textbook devoted to total shoulder, reverse total shoulder replacement surgery, and revision shoulder replacement surgery, Shoulder Arthroplasty, 2ndEdition (

Brent J. Morris, MD

Kilian CM, Press CM, Smith KM, O’Connor DP, Morris BJ, Elkousy HA, Gartsman GM, Edwards TB. Radiographic and Clinical Comparison of Pegged and Keeled Glenoid Components Using Modern Cementing Techniques: Midterm Results of a Prospective Randomized Study. Published in Journal of Shoulder and Elbow Surgery.


Dr. Brent J. Morris