Influence of implant design and parasagittal acromial morphology on acromial and scapular spine strain after reverse total shoulder arthroplasty: a cadaveric and computer-based biomechanical analysis

Shah, Sarav S.; Gentile, Joseph; Chen, Xiang; Kontaxis, Andreas; Dines, David M.; Warren, Russell F.; Taylor, Samuel A.; Jahandar, Amirhossein; Gulotta, Lawrence V.

doi:10.1016/j.jse.2020.04.004

Cited by 35 publications

(36 citation statements)

References 28 publications

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“…Some authors have theorized that acromion fractures are caused by excessive tensioning of the deltoid with RSA that causes significant inferior stress on the acromion 70 , 148 possibly influenced by the anatomic position of the acromion. 227 Excessive lowering of the humerus can lead to arm lengthening and thus increased resting tension of the deltoid on the tip of the acromion. 278 Also, excessive medialization may create a lower deltoid wrapping angle, leading to a more vertical line of pull from the deltoid producing an increased bending moment arm applied to the acromion, further placing the acromion at risk for fracture.…”

Section: Discussionmentioning

confidence: 99%

The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II

Shah

Roche²,

Sullivan³

et al. 2021

JSES International

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Background Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this study was to provide a focused, updated systematic review for each of the most common complications of RSA by limiting each search to publications after 2010. In this part II, the following were examined: (1) instability, (2) humerus/glenoid fracture, (3) acromial/scapular spine fractures (AF/SSF), and (4) problems/miscellaneous. Methods Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Overall, 137 studies for instability, 94 for humerus/glenoid fracture, 120 for AF/SSF, and 74 for problems/miscellaneous were included in each review, respectively. Univariate analysis was performed with chi-square and Fisher exact tests. Results The Grammont design had a higher instability rate vs. all other designs combined (4.0%, 1.3%; P < .001), and the onlay humerus design had a lower rate than the lateralized glenoid design (0.9%, 2.0%; P = .02). The rate for intraoperative humerus fracture was 1.8%; intraoperative glenoid fracture, 0.3%; postoperative humerus fracture, 1.2%; and postoperative glenoid fracture, 0.1%. The rate of AF/SSF was 2.6% (371/14235). The rate for complex regional pain syndrome was 0.4%; deltoid injury, 0.1%; hematoma, 0.3%; and heterotopic ossification, 0.8%. Conclusions Focused systematic reviews of recent literature with a large volume of shoulders demonstrate that using non-Grammont modern prosthesis designs, complications including instability, intraoperative humerus and glenoid fractures, and hematoma are significantly reduced compared with previous studies. As the indications continue to expand for RSA, it is imperative to accurately track the rate and types of complications in order to justify its cost and increased indications.

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Section: Discussionmentioning

confidence: 99%

The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II

Shah

Roche²,

Sullivan³

et al. 2021

JSES International

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“…This study found that RTSA resulted in deltoid lengthening, which was exacerbated by humeral onlay lateralisation and glenosphere lateralisation. Lengthening of deltoid was shown to increase the strains on acromion and scapular spine and may lead to increased risks of acromial and scapular spine fractures, particularly when deltoid lengthening exceeds 25 mm [83]. One study used multi-body modeling to determine the effect of humeral and glenoid component positioning on acromial stresses [50].…”

Section: Acromial and Scapular Spine Fracturesmentioning

confidence: 99%

Complications of Reverse Total Shoulder Arthroplasty: A Computational Modelling Perspective

Huang

Ernstbrunner

Robinson

et al. 2021

JCM

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Reverse total shoulder arthroplasty (RTSA) is an established treatment for elderly patients with irreparable rotator cuff tears, complex proximal humerus fractures, and revision arthroplasty; however, with the increasing indications for RTSA over the last decade and younger implant recipients, post-operative complications have become more frequent, which has driven advances in computational modeling and simulation of reverse shoulder biomechanics. The objective of this study was to provide a review of previously published studies that employed computational modeling to investigate complications associated with RTSA. Models and applications were reviewed and categorized into four possible complications that included scapular notching, component loosening, glenohumeral joint instability, and acromial and scapular spine fracture, all of which remain a common cause of significant functional impairment and revision surgery. The computational shoulder modeling studies reviewed were primarily used to investigate the effects of implant design, intraoperative component placement, and surgical technique on postoperative shoulder biomechanics after RTSA, with the findings ultimately used to elucidate and mitigate complications. The most significant challenge associated with the development of computational models is in the encapsulation of patient-specific anatomy and surgical planning. The findings of this review provide a basis for future direction in computational modeling of the reverse shoulder.

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“…Patient factors such as female gender, osteoporosis, or acromial anatomy have been identified as risk factors for acromial and scapular spine fractures after RTSA [28][29][30]. Implant factors, such as increased lateralization of the glenoid component, were proposed to play a significant role in increasing stress on the acromion [31,32].…”

Section: Introductionmentioning

confidence: 99%

Factors Influencing Acromial and Scapular Spine Strain after Reverse Total Shoulder Arthroplasty: A Systematic Review of Biomechanical Studies

Paszicsnyek,

Jo,

Rupasinghe

et al. 2022

JCM

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Background: Acromial and scapular spine fractures after reverse total shoulder arthroplasty (RTSA) can be devastating complications leading to substantial functional impairments. The purpose of this study was to review factors associated with increased acromial and scapular spine strain after RTSA from a biomechanical standpoint. Methods: A systematic review of the literature was conducted based on PRISMA guidelines. PubMed, Embase, OVID Medline, and CENTRAL databases were searched and strict inclusion and exclusion criteria were applied. Each article was assessed using the modified Downs and Black checklist to appraise the quality of included studies. Study selection, extraction of data, and assessment of methodological quality were carried out independently by two of the authors. Only biomechanical studies were considered. Results: Six biomechanical studies evaluated factors associated with increased acromial and scapular spine strain and stress. Significant increases in acromial and scapular spine strain were found with increasing lateralization of the glenosphere in four of the included studies. In two studies, glenosphere inferiorization consistently reduced acromial strain. The results concerning humeral lateralization were variable between four studies. Humeral component neck-shaft angle had no significant effect on acromial strain as analysed in one study. One study showed that scapular spine strain was significantly increased with a more posteriorly oriented acromion (55° vs. 43°; p < 0.001). Another study showed that the transection of the coracoacromial ligament increased scapular spine strain in all abduction angles (p < 0.05). Conclusions: Glenoid lateralization was consistently associated with increased acromial and scapular spine strain, whereas inferiorization of the glenosphere reduced strain in the biomechanical studies analysed in this systematic review. Humeral-sided lateralization may increase or decrease acromial or scapular spine strain. Independent of different design parameters, the transection of the coracoacromial ligament resulted in significantly increased strains and scapular spine strains were also increased when the acromion was more posteriorly oriented. The results found in this systematic review of biomechanical in-silico and in-vitro studies may help in the surgical planning of RTSA to mitigate complications associated with acromion and scapular spine fracture.

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Influence of implant design and parasagittal acromial morphology on acromial and scapular spine strain after reverse total shoulder arthroplasty: a cadaveric and computer-based biomechanical analysis

Cited by 35 publications

References 28 publications

The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II

The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II

Complications of Reverse Total Shoulder Arthroplasty: A Computational Modelling Perspective

Factors Influencing Acromial and Scapular Spine Strain after Reverse Total Shoulder Arthroplasty: A Systematic Review of Biomechanical Studies

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