Background: The objective of this study was to conduct a meta-analysis and cost-effectiveness analysis of the effect of glenoid design on radiolucency, loosening, and revision after total shoulder arthroplasty.
Methods: We conducted a systematic review of PubMed, MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and CINAHL with use of a search for the terms arthroplasty AND shoulder AND (peg OR keel). Data on study design and on the end points of radiolucency, loosening, and revision were extracted independently and in duplicate. Random-effect models were used to calculate the pooled risk ratio and risk difference. The risk difference was used to estimate the number needed to treat (the number of individuals who would have to receive a pegged component to avoid one loosening or revision).
Results: Eight studies with a total of 1460 patients (mean age, sixty-seven years) were included. The mean study quality was 1.75 points (95% confidence interval [CI], 1.26 to 2.24) on the 3-point modified Jadad scale. There was no significant difference in the risk of any radiolucency (risk ratio, 0.42; 95% CI, 0.12 to 1.42) or in the risk of severe radiolucency (risk ratio, 0.65; 95% CI, 0.23 to 1.82) between pegged and keeled components. The pooled risk ratio for revision was 0.27 (95% CI, 0.08 to 0.88) in favor of pegged components (p = 0.028). At a cost-effectiveness threshold of $50,000 per quality-adjusted life year, pegged components can be between $2325 and $40,920 more expensive than keeled components and still be cost-effective.
Conclusions: Our study produced evidence that pegged glenoid components were associated with a lower revision risk compared with keeled components. However, the difference was rather small and will therefore be most meaningful to high-volume shoulder arthroplasty centers. Because of the similarity between primary and secondary costs, pegged glenoid designs were more cost-effective than keeled glenoid designs.
Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
1Department of Orthopedic Surgery, Children’s Hospital Boston, 300 Longwood Avenue, Enders 260, Boston, MA 02115. E-mail address: Patrick.email@example.com
2Department of Orthopedic Surgery, Medical University of Graz, Auenbruggerplatz 2, A-8036 Graz, Austria
3Cartilage Repair Center, Brigham and Women’s Hospital, Harvard Medical School, 850 Boylston Street, Chestnut Hill, MA 02467
4Orthopaedic Department, University Hospital of Basel, University of Basel, Spitalstrasse 21, CH-4051 Basel, Switzerland