Article Text

Glenoid failure after total shoulder arthroplasty with cemented all-polyethylene versus metal-backed implants: a systematic review protocol
  1. Renato Aroca Aroca Zan1,
  2. Rafael Fuchs Lazarini2,
  3. Fabio Teruo Matsunaga1,
  4. Nicola Archetti Netto1,
  5. João Carlos Belloti1,3,
  6. Marcel Jun Sugawara Tamaoki1
  1. 1Orthopedics and Traumatology—Division of Hand surgery and Upper Limb, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
  2. 2Department of Orthopaedics and Traumatology, Hospital Felicio Rocho, Belo Horizonte, Minas Gerais, Brazil
  3. 3Universidade Federal de Sao Paulo Escola Paulista de Medicina, São Paulo, Brazil
  1. Correspondence to Dr Renato Aroca Aroca Zan; re_zan{at}


Introduction Anatomical total shoulder arthroplasty (TSA) is an effective treatment adopted for patients with glenohumeral osteoarthritis (OA). The glenoid component failure is the main risk that occurs in this therapeutic choice; however, doubts remain regarding the selection of the best implant for avoiding complication. This systematic review aims to evaluate the glenoid component in TSA by comparing the complications of different types of implants.

Methods and analysis A systematic review of randomised clinical trials or quasi-randomised trials will be performed by applying the Preferred Reporting Items for Systematic Review and Meta-Analysis protocols and comparing polyethylene (keeled and pegged) versus metal-backed implants in adult patients with glenohumeral OA. Our search strategy will be performed using MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, EMBASE and Web of Science. Data management and extraction will be performed using a data withdrawal form and by analysing study method characteristics, participant characteristics, intervention characteristics, results and methodological domains. The database search will be performed by February 2021. The Grading of Recommendations Assessment, Development and Evaluation will be used for assessing the quality of evidence of each study selected; however, some critical and important outcomes were determined such as the shoulder function through functional scores (Constant-Murley and American Shoulder and Elbow Surgeons), complications represented by pain (Visual Analogue Scale), surgical revision, radiograph radiolucency and loosening. The confidence in estimated effects for these outcomes will be applied as the overall confidence. The outcomes will be defined as early or late, according to the postoperative follow-up of less than or greater than 1 year, respectively, for complications and radiographs. For the shoulder function, follow-ups will be divided into 6, 12 and 24 months. Heterogeneity is expected in systematic reviews; therefore, the selection of outcomes, as well as the sample size, and specific statistical analysis can lead to meta-analysis; however, if it fails, narrative evidence synthesis will be conducted. Other analyses such as descriptive, subgroup and sensitivity analyses will be performed whenever possible. This systematic review will, therefore, provide evidence concerning the best clinical practice for avoiding complications.

Ethics and dissemination This study has been approved by the Institutional Review Board of Universidade Federal de São Paulo (protocols 0725/2017, 2.157.415 and 70473017.5.0000.5505), and the findings will be disseminated through peer-reviewed publication and conference presentations.

PROSPERO registration number CRD42018079537.

  • shoulder
  • statistics & research methods
  • adult orthopaedics
  • elbow & shoulder
  • radiology & imaging

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  • Contributors All authors participated in all stages of preparation of this study; however, each one was responsible for a step in its confection. RAAZ is the guarantor of the review and drafted the manuscript. RAAZ, FTM, JCB and MJST conceptualised the methods. RAAZ and RFL contributed to the development of the eligibility criteria and data extraction items. RAAZ, FTM and MJST designed the work. NAN helped with the electronic search and translation. All authors reviewed several drafts of the manuscript for critical content and approved the final protocol.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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