Monday, July 22, 2013

Reverse total shoulder - baseplate fixation

Reverse shoulder arthroplasty glenoid fixation: is there a benefit in using four instead of two screws?

The authors used a cadaver model of reverse total shoulder to compare the baseplate mciromotion after fixation with two or four screws. In their model they found no significant difference.

This result may be relevant to implants that depend on osseous integration. However, our preference is for a system that provides immediate secure fixation with a central glenoid screw rather than one that requires bony ingrowth over time for glenoid component fixation.

This article is important, however, in that it indicates that with the Aequalis reversed glenoid baseplate, the micromotion increased with increasing cycles of loading and with increased applied loads. This brings up the question of how long one should wait after implantation of this system before loads are applied and what the maximal allowed loads should be at different times after surgery. Another important finding of this study is that greater deformation was measured during the anterior-to-posterior loading than during the superiorly directed loading. The authors suggest that rehabilitation protocols should limit activities that cause increased anterior–posterior loading after reverse total shoulder arthroplasty.

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