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Validation of the distal filling ratio in uncemented convertible short-stem shoulder arthroplasty

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Radiographic stress shielding is a common finding in uncemented convertible short-stem shoulder arthroplasty (UCSSSA). The distal filling ratio (DFR) has been described as a predictor for the occurrence of stress shielding. A DFR > 70% was mentioned as a risk factor for the occurrence of stress shielding for some UCSSSA. However, measurements were only performed on conventional radiographs and no validation exists for 3D automated planning tools.

Methods

DFR was manually measured on postoperative true ap radiographs of 76 shoulder arthroplasties using a standardized protocol and were compared to preoperative CT scans with an automated calculation of the DFR after virtual implantation of the stem.

Results

The mean DFR measured on X-rays was 75.9% (SD = 8.7; 95% CI = 74–78) vs. 78.9% (SD = 9.1; 95% CI = 76.8–83) automatically measured on CT scans. This difference was significant (p < 0.001). In 7 out of 76 cases (9%) the difference between manual measurement on radiographs and computerized measurement on CT scans was > 10%.

Conclusion

Manual measurement of the DFR is underestimated on conventional radiographs compared to automated calculation on CT scans be a mean of 3%. Therefore, automated measurement of the DFR on CT scans seems to be beneficial, especially in cases with osteopenic cortices. Manual measurement of the DFR on conventional ap radiographs in cases without CT scans, however, is still a viable alternative.

Level of evidence

Level IV, retrospective study.

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Funding

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Authors and Affiliations

  1. OCM (Orthopädische Chirurgie München) Clinic, Steinerstrasse 6, 81369, München, Germany

    Patric Raiss & Thomas Wittmann

  2. Department of Orthopaedic Surgery, Royal Perth Hospital, Victoria Square, Perth, WA, 6000, Australia

    William Blakeney

  3. IMASCAP, 145 Rue René Descartes, 29280, Plouzané, France

    Manuel Urvoy

  4. Centre Orthopedique Santy, 24, Avenue Paul Santy, 69008, Lyon, France

    Gilles Walch

Authors
  1. Patric Raiss
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  2. Thomas Wittmann
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  3. William Blakeney
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  4. Manuel Urvoy
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  5. Gilles Walch
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Corresponding author

Correspondence to Patric Raiss.

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Conflict of interest

Patric Raiss, M.D.: Payed Consultant Stryker & Arthrex Inc. Thomas Wittman, Research Fellow: None. William Blakeney, M.D.: None. Manuel Urvoy: Employee for IMASCAP. Gilles Walch, M.D.: Payed Consultant and receives royalties related to the study from Wright Medical Inc.

Ethical approval

This study was approved by the local committee. Number: IRB00010835 (file attached).

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Informed consent was given prior to the study.

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Raiss, P., Wittmann, T., Blakeney, W. et al. Validation of the distal filling ratio in uncemented convertible short-stem shoulder arthroplasty. Arch Orthop Trauma Surg 143, 1833–1839 (2023). https://doi.org/10.1007/s00402-022-04389-2

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  • DOI: https://doi.org/10.1007/s00402-022-04389-2

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