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Software simulations of changing offsets and thus soft tissue tension when revising anatomic to reverse total shoulder arthroplasty in convertible platform systems

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Revision shoulder arthroplasty may involve the need to remove a well-fixed humeral stem. To avoid this, convertible platform systems have been introduced. The biomechanics of reverse total shoulder arthroplasty (rTSA) differs from anatomic shoulder arthroplasty (aTSA). The different humeral osteotomy and soft tissue tension may jeopardize the optimal results of the converted rTSA.

The aim was to evaluate the radiographic parameters of soft tissue distraction when converting an aTSA to rTSA in a platform system and assess the capability of conversion without “over-stuffing” the shoulder in the “best-case scenario”.

Methods

Radiographic analysis of soft tissue distraction parameters: difference in acromio-humeral distance, difference in lateral humeral offset and difference in latero-inferior displacement were evaluated in aTSA and in the converted rTSA in six different implants. Image analysing software was used on 10 non-deformed osteoarthritic shoulder X-rays to simulate conversion.

Results

The greatest increase in arm length was found for Tornier Ascend Flex (26.8 ± 3.6 mm) while the smallest increase was observed with Lima SMR (19.3 ± 4 mm).

The humerus remained most lateralized with the Zimmer Anatomical/Inverse ( − 1.4 ± 2.9 mm) while Lima SMR ( − 15.8 ± 2.7 mm) was more medialized. The greatest increase in latero-inferior distance was found in the onlay systems.

A group analysis of onlay rTSA showed an increase of 46% in arm length (p < 0.0001), 83% larger humeral offset (p < 0.0001) and 144% increase in latero-inferior distraction (p < 0.0001) when compared to inlay rTSA.

Conclusion

The conversion of aTSA to rTSA using a convertible platform system may lead to significant increase in radiographic parameters corresponding to soft tissue tension. This may alter the biomechanics, restrict the convertibility or jeopardize the optimal clinical outcome of rTSA even in the best-case scenario.

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Funding

Albert Ferrando did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Luis Natera did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Berta Buch did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Paolo Consigliere reports grants from Arthrex, outside the submitted work. Mr. G. Sforza reports other from IDO Innovative Design Orthopaedics, during the conduct of the study; non-financial support from Arthrex, outside the submitted work; Dr. Atoun reports personal fees from Minivasive, outside the submitted work. Prof. Levy reports other from Innovative design orthopaedics (IDO), during the conduct of the study; personal fees from Collplant, personal fees from Estar-Medical, personal fees from Minivasive, outside the submitted work.

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Authors and Affiliations

  1. Traumatology and Orthopaedic Surgery Department, Hospital Universitari Sant Joan de Reus, Avinguda del Doctor Josep Laporte 2, 43204, Tarragona, Reus, Spain

    Albert Ferrando

  2. Hospital General de Granollers, Avinguda Francesc Ribas S/N, 08402, Granollers, Spain

    Luis Natera & Berta Buch

  3. Hospital Asepeyo Sant Cugat, Av. Alcalde Barnils, 54, 60, 08174, Barcelona, Spain

    Luis Natera

  4. Universitat Autònoma de Barcelona, Campus Bellaterra, Cerdanyola del Vallès, Barcelona, Spain

    Berta Buch

  5. Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital Reading, Berkshire, RG1 6UZ, UK

    Paolo Consigliere, Juan Bruguera, Giuseppe Sforza & Ofer Levy

  6. Hospital San Juan de Dios Pamplona, Sreet Beloso Alto 3, 31006, Pamplona (Navarra), Spain

    Juan Bruguera

  7. Faculty of Health Sciences, Barzilai Medical Center Campus, Ben-Gurion University, Ashkelon, Israel

    Ehud Atoun

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  1. Albert Ferrando
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Correspondence to Luis Natera.

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Ferrando, A., Natera, L., Buch, B. et al. Software simulations of changing offsets and thus soft tissue tension when revising anatomic to reverse total shoulder arthroplasty in convertible platform systems. Eur J Orthop Surg Traumatol 31, 611–619 (2021). https://doi.org/10.1007/s00590-020-02812-1

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  • DOI: https://doi.org/10.1007/s00590-020-02812-1

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