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Metal-Backed Glenoid Components Have a Higher Rate of Failure and Fail by Different Modes in Comparison with All-Polyethylene Components: A Systematic Review

Papadonikolakis, Anastasios MD; Matsen, Frederick A. III MD

Journal of Bone & Joint Surgery - American Volume: 18 June 2014 - Volume 96 - Issue 12 - p 1041–1047
doi: 10.2106/JBJS.M.00674
Evidence-Based Orthopaedics
Supplementary Content

Background: Glenoid component failure is a common and serious complication of total shoulder arthroplasty. The purpose of this study was to evaluate published evidence on whether metal backing lessens the rate of glenoid component failure.

Methods: A comprehensive systematic review yielded twenty-one studies on radiolucency, radiographic failure, and revision after arthroplasty with metal-backed glenoid components and twenty-three studies with all-polyethylene components. Our analysis included data on 1571 metal-backed and 3035 all-polyethylene components. The mean duration of follow-up was 5.8 years in the studies with metal-backed components and 7.3 years with all-polyethylene components.

Results: All-polyethylene components had a 42.5% rate of radiolucency compared with 34.9% for metal-backed components (p = 0.0026) and a 21.1% rate of radiographic loosening or failure compared with 16.8% for metal-backed components (p = 0.0005). However, the rate of revision was more than three times higher with metal-backed components (14.0%) than with all-polyethylene components (3.8%, p < 0.0001). Although 77% of the revisions of all-polyethylene components were for loosening, 62% of the revisions of metal-backed components were for other reasons, such as component fracture, screw breakage, component dissociation, polyethylene wear, metal wear, and rotator cuff tear (p < 0.0001).

Conclusions: The published evidence indicates that metal-backed glenoid components require revision at a significantly higher rate and for different reasons in comparison with all-polyethylene components.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Southeastern Orthopedics, 730 Oakridge Boulevard, Suite B, Lumberton, NC 28358. E-mail address:

2Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Box 356500, 1959 N.E. Pacific Street, Seattle, WA 98195. E-mail address:

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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