Total shoulder arthroplasty with hybrid fixation of glenoid components consisting of cementless porous metal pegs or cage along with cemented backside polyethylene surface: a systematic review.

Recently, hybrid glenoid components have been developed, consisting of cementless highly porous metal central peg, monoblock keel or cage along with cemented backside polyethylene surface. The aims of this study were twofold: (1) to determine the revision and complication rates of hybrid glenoid components, consisting of porous metal pegs or coatings attached to the polyethylene, for aseptic loosening in TSA and (2) to evaluate the rate of radiolucent lines in patients who underwent TSA with hybrid glenoid components consisting of porous metal pegs or coatings attached to the polyethylene. The US National Library of Medicine (PubMed/MEDLINE), EMBASE and the Cochrane Database of Systematic Reviews were queried for publications utilizing the following keywords: "hybrid" OR "bone-ingrowth" OR "bone ingrowth" AND "TSA" OR "total" AND "shoulder" AND "arthroplasty" OR "replacement". Five articles were included for analysis (470 operated shoulders, mean follow-up: 47.5 months). The overall weighted mean modified methodology Coleman score was 51.2/100, indicating a moderate level of overall methodological quality. The survival rate of hybrid glenoid components was 97.4% (458 out of 470 cases), while the rate of glenoid-related complications was 2.8% (13 cases). Finally, there were 54 cases (out of 313 reported; 17.3%) with glenoid radiolucency (none of them required revision). TSA with hybrid fixation glenoid components was associated with high survivorship and low rate of glenoid component-related complications at 4 years mean follow-up. In addition, there was limited evidence to show that the short- to mid-term outcome of TSA using hybrid glenoid components is not inferior to the outcome of cemented all-polyethylene glenoid components.

Arthroscopic anatomic complete versus non-anatomic repair of massive rotator cuff tears: a systematic review of comparative trials.

Several clinical studies have compared the clinical and functional outcomes of arthroscopic anatomic complete repair and arthroscopic partial repair for massive rotator cuff tears (MRCTs). To our knowledge, no systematic review of these comparative trials has been published yet. A systematic analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. Six studies were eligible for analysis, and they were level III case-control studies. There were 223 cases of complete repair and 208 cases of partial repair (mean age range 59-67 years, mean follow-up range 24-45 months). All studies reported significant postoperative improvement in the reported subjective scores and range of motion in both groups. Complete repair was associated with at least equal or better functional outcomes compared to the partial repair. The rate of complications requiring reoperation in the complete and partial repair cohorts was 1.3% and 3.4%, respectively. Although the overall rate of radiographic integrity of the complete and partial repair cohorts was 61.1% and 26.7%, respectively, we found no clinical relevance in this finding. There is moderate-to-good quality evidence to support that both arthroscopic complete and partial repairs of MRCTs are associated with satisfactory functional outcomes and low rate of complications requiring reoperation. Complete repair is associated with at least equal or better functional outcomes compared to the partial repair and, therefore, it should remain the first line of treatment.