A comparison of pegged vs. keeled glenoid components regarding functional and radiographic outcomes in anatomic total shoulder arthroplasty: a systematic review and meta-analysis
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Background: The number of total shoulder arthroplasties (TSAs) performed is increasing annually, with a continued effort to improve outcomes using new techniques and materials. In anatomic TSAs, the main options for glenoid fixation currently involve keeled or pegged components. The aim of this review was to determine which fixation option provides optimal long-term functional outcomes with decreased rates of revision surgery and radiolucency. Methods: The MEDLINE, Embase, PubMed, and Cochrane databases were searched from 2007 to July 10, 2017, for all articles that examined TSAs using either pegged or keeled glenoid fixations. All studies were screened in duplicate for eligibility. Two separate analyses were completed examining noncomparative and comparative studies independently. Results: A total of 7 comparative studies and 25 noncomparative studies were included in the final analysis. Included in the analysis were 4 randomized (level I) studies, 1 level II study, 8 level III studies, and 19 level IV studies. Meta-analysis of the comparative studies demonstrated a higher rate of revision surgery with keeled fixations compared with pegged fixations (odds ratio, 6.22; 95% confidence interval [CI], 1.38-28.1; P = .02). No significant difference was found with respect to functional outcomes, such as the American Shoulder and Elbow Surgeons score (mean difference, 9.54; 95% CI, -8.25 to 27.34; P = .29) and Constant score (mean difference, 5.31; 95% CI, -12.28 to 22.89; P = .55), as well as radiolucency rates (odds ratio, 1.89; 95% CI, 0.56-6.39; P = .30). Conclusion: Pegged glenoid fixation may result in a decreased risk of revision TSAs, but no significant differences in patient-reported outcomes have been identified to date.