Thursday, April 21, 2016

Platform systems in shoulder arthroplasty

Platform systems in shoulder arthroplasty

These authors review the concept of a platform system for shoulder arthroplasty which may include a convertible modular humeral stem and/or a metal-backed glenoid component to facilitate conversion from either a hemiarthroplasty or anatomic total shoulder arthroplasty to a subsequent anatomic total shoulder arthroplasty or reverse total shoulder arthroplasty without revision to the stem and/or glenoid baseplate.

An example of a converted stem is shown below.


Comment: Such a system may indeed facilitate conversion assuming that (1) infection and or loosening are not present and (2) that the position and orientation of the stem and baseplate enable the desired reconstruction. A detailed discussion of platform systems can be found at this link. The use of a platform constrains the design selection and the placement of a reverse prosthesis, which may not be ideal

This article does not clarify the cost differential between platform prostheses and standard prostheses. This information coupled with knowledge of the rate at which anatomic prosthesis need to be converted to reverse prostheses would help clarify the value of the platform approach.

Another approach for facilitating the conversion of an anatomic arthroplasty to a reverse is to fix a basic anatomic humeral component with impaction grafting, rather than with a tight diaphyseal press fit, bone ingrowth or cement. Since humeral component removal is straightforward, the arthroplasty can be converted to the reverse of choice put in the position of choice and again fixed with impaction grafting.



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