CLINICAL USE OF A WIRELESS LOAD-SENSING HUMERAL LINER TRIAL IN REVERSE TOTAL SHOULDER ARTHROPLASTY: REPORTED LOAD DIFFERENCES BETWEEN 38 MM AND 42 MM LINER SIZES

Greene A, Verstraete M, Roche C, et al. CLINICAL USE OF A WIRELESS LOAD-SENSING HUMERAL LINER TRIAL IN REVERSE TOTAL SHOULDER ARTHROPLASTY: REPORTED LOAD DIFFERENCES BETWEEN 38 MM AND 42 MM LINER SIZES. Orthop Procs. 2021;103-B(SUPP_9):9-9. doi:10.1302/1358-992X.2021.9.009

Greene, A., et al. “CLINICAL USE OF A WIRELESS LOAD-SENSING HUMERAL LINER TRIAL IN REVERSE TOTAL SHOULDER ARTHROPLASTY: REPORTED LOAD DIFFERENCES BETWEEN 38 MM AND 42 MM LINER SIZES.” Orthopaedic Proceedings, vol. 103-B, no. SUPP_9, 2021, pp. 9-9., https://doi.org/10.1302/1358-992X.2021.9.009

Greene, A., Verstraete, M., Roche, C., Conditt, M., Youderian, A., Parsons, M., Jones, R., Flurin, P., Wright, T., & Zuckerman, J. (2021). CLINICAL USE OF A WIRELESS LOAD-SENSING HUMERAL LINER TRIAL IN REVERSE TOTAL SHOULDER ARTHROPLASTY: REPORTED LOAD DIFFERENCES BETWEEN 38 MM AND 42 MM LINER SIZES. Orthopaedic Proceedings, 103-B(SUPP_9), 9-9. https://doi.org/10.1302/1358-992X.2021.9.009

Greene, A., Verstraete, M., Roche, C., Conditt, M., Youderian, A., Parsons, M. et al. (2021) “CLINICAL USE OF A WIRELESS LOAD-SENSING HUMERAL LINER TRIAL IN REVERSE TOTAL SHOULDER ARTHROPLASTY: REPORTED LOAD DIFFERENCES BETWEEN 38 MM AND 42 MM LINER SIZES.” Orthopaedic Proceedings, 103-B(SUPP_9), pp. 9-9. Available at: https://doi.org/10.1302/1358-992X.2021.9.009

Greene, A., M. Verstraete, C. Roche, M. Conditt, A. Youderian, M. Parsons, R. Jones, P.H. Flurin, T. Wright, and J. Zuckerman. “CLINICAL USE OF A WIRELESS LOAD-SENSING HUMERAL LINER TRIAL IN REVERSE TOTAL SHOULDER ARTHROPLASTY: REPORTED LOAD DIFFERENCES BETWEEN 38 MM AND 42 MM LINER SIZES.” Orthopaedic Proceedings 103-B, no. SUPP_9 (2021): 9-9. https://doi.org/10.1302/1358-992X.2021.9.009

Greene A, Verstraete M, Roche C, Conditt M, Youderian A, Parsons M, et al. CLINICAL USE OF A WIRELESS LOAD-SENSING HUMERAL LINER TRIAL IN REVERSE TOTAL SHOULDER ARTHROPLASTY: REPORTED LOAD DIFFERENCES BETWEEN 38 MM AND 42 MM LINER SIZES. Orthop Procs. 2021 Jun 1;103-B(SUPP_9):9-9. https://doi.org/10.1302/1358-992X.2021.9.009

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Abstract

INTRODUCTION

Determining proper joint tension in reverse total shoulder arthroplasty (rTSA) can be a challenging task for shoulder surgeons. Often, this is a subjective metric learned by feel during fellowship training with no real quantitative measures of what proper tension encompasses. Tension too high can potentially lead to scapular stress fractures and limitation of range of motion (ROM), whereas tension too low may lead to instability. New technologies that detect joint load intraoperatively create the opportunity to observe rTSA joint reaction forces in a clinical setting for the first time. The purpose of this study was to observe the differences in rTSA loads in cases that utilized two different humeral liner sizes.

METHODS

Ten different surgeons performed a total of 37 rTSA cases with the same implant system. During the procedure, each surgeon reconstructed the rTSA implants to his or her own preferred tension. A wireless load sensing humeral liner trial (VERASENSE for Equinoxe, OrthoSensor, Dania Beach, FL) was used in lieu of a traditional plastic humeral liner trial to provide real-time load data to the operating surgeon during the procedure. Two humeral liner trial sizes were offered in 38mm and 42mm curvatures and were selected each case based on surgeon preference. To ensure consistent measurements between surgeons, a standardized ROM assessment consisting of four dynamic maneuvers (maximum internal to external rotation at 0°, 45°, and 90° of abduction, and a maximum flexion/extension maneuver) and three static maneuvers (arm overhead, across the body, and behind the back) was completed in each case. Deidentified load data in lbf was collected and sorted based on which size liner was selected. Differences in means for minimum and maximum load values for the four dynamic maneuvers and differences in means for the three static maneuvers were calculated using 2-tailed unpaired t-tests.

RESULTS

No significant differences were observed for the flexion/extension maneuver between the 38mm and 42mm liner sizes, but a significant difference was observed for every internal/external rotation assessment at 0°, 45°, and 90° of abduction. No significant differences were observed for the across the body and overhead maneuvers, but a significant difference was observed for the behind the back maneuver (p = 0.015). Standard deviations were pronounced across all maneuvers.

CONCLUSION

This study observed significant differences in intraoperative load values in rTSA when comparing different humeral liner sizes. Limitations of this study include the small sample sizes and large standard deviations observed, as well as comparing across multiple patients and multiple surgeons. Area for future work includes comparing load values with postoperative functional results and complication risks for short, midterm, and long-term outcomes in efforts to find the optimal load range for a given patient.