Keeled versus pegged glenoid components in total shoulder arthroplasty for primary osteoarthritis: a meta-analysis

Background: Glenoid fixation strongly influences longevity and outcomes in anatomic total shoulder arthroplasty. Keeled and pegged designs are common, but comparative evidence for function, range of motion, and survivorship is inconsistent. Methods: A systematic search of PubMed, Scopus, the Cochrane Library, and Google Scholar was conducted from database inception through December 2025. Thirteen comparative studies (n=3,219) met the inclusion criteria. Evaluated outcomes included patient-reported outcome measures (American Shoulder and Elbow Surgeons [ASES], Constant-Murley score, Simple Shoulder Test [SST], visual analog scale [VAS] pain scores), shoulder range of motion (flexion, external rotation, internal rotation), and implant-related outcomes, including failure and revision. Follow-up ranged from short to long-term (up to 26 years). Results: Across pooled analyses, no significant differences were observed between pegged and keeled glenoid components in ASES (P=0.69), Constant-Murley (P=0.61), SST (P=0.74), or VAS pain scores (P=0.88). Postoperative flexion (P=0.61) and external rotation (P=0.35) were comparable between groups. Pegged glenoid components demonstrated a statistically significant but small improvement in internal rotation (mean difference, 1.60°; 95% CI, 0.54°-2.66°; P=0.003). Revision rates were significantly lower with pegged glenoid components compared with keeled designs (risk ratio, 0.49; 95% CI, 0.28-0.86; P=0.01), while overall failure rates did not differ significantly between groups (P=0.07). Conclusions: Both designs yield similar pain relief, functional gains, and shoulder motion across most patient-reported outcome measures. Pegged components show lower revision risk and slightly better internal rotation, although survivorship findings are primarily supported by observational evidence. Selection should be individualized to anatomy, bone quality, and surgical factors, not expectations of superior overall function. Level of evidence: IV.