Instability of the shoulder after arthroplasty.

Moeckel, Bruce H.; Altchek, David W.; Warren, Russell F.; Wickiewicz, Thomas L.; Dines, David M.

doi:10.2106/00004623-199304000-00003

Cited by 243 publications

(142 citation statements)

References 5 publications

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“…In particular, the problem of rotator cuff tears or muscle deficiencies has also been investigated with numerical tools. Because of their stabilizing function, deficiencies of the rotator cuff muscles are associated with glenohumeral instability and loosening of the glenoid component (Franklin et al, 1988;Moeckel et al, 1993;Wirth and Rockwood, 1996). The effect of rotator cuff tears on glenohumeral stability has been evaluated using an inverse dynamics model (Steenbrink et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Importance of the subscapularis muscle after total shoulder arthroplasty

Terrier

Larrea

Camine

et al. 2013

Clinical Biomechanics

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Background: The rotator cuff muscles are the main stabilizer of the glenohumeral joint. After total shoulder arthroplasty using anterior approaches, a dysfunction of the subscapularis muscle has been reported. In the present paper we tested the hypothesis that a deficient subscapularis following total shoulder arthroplasty can induce joint instability. Methods: To test this hypothesis we have developed an EMG-driven musculoskeletal model of the glenohumeral joint. The model was based on an algorithm that minimizes the difference between measured and predicted muscular activities, while satisfying the mechanical equilibrium of the glenohumeral joint. A movement of abduction in the scapular plane was simulated. We compared a normal and deficient subscapularis. Muscle forces, joint force, contact pattern and humeral head translation were evaluated. Findings: To satisfy the mechanical equilibrium, a deficient subscapularis induced a decrease of the force of the infraspinatus muscle. This force decrease was balanced by an increase of the supraspinatus and middle deltoid. As a consequence, the deficient subscapularis induced an upward migration of the humeral head, an eccentric contact pattern and higher stress within the cement. Interpretation: These results confirm the importance of the suscapularis for the long-term stability of total shoulder arthroplasty.

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Section: Introductionmentioning

confidence: 99%

Importance of the subscapularis muscle after total shoulder arthroplasty

Terrier

Larrea

Camine

et al. 2013

Clinical Biomechanics

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“…Rotator cuff dysfunction may lead to uncontrolled humeral head translation, resulting in subluxation or even dislocation of the shoulder. 2 This mode of dysfunction is one of the primary indicators for revision surgery. [3][4][5] Proper joint balancing during arthroplasty has been advocated, 5,6 as development of abnormal postoperative kinematics often limits functional success.…”

Section: Introductionmentioning

confidence: 99%

Glenohumeral kinematics following total shoulder arthroplasty: A finite element investigation

Hopkins

Hansen

Amis

et al. 2006

Journal Orthopaedic Research

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ABSTRACT:The osseous geometry of the glenohumeral joint is naturally nonconforming and minimally constrained, and the joint's stability is maintained by action of the rotator cuff muscles. Damage to these muscles is often associated with joint degeneration, and a variety of glenoid prostheses have been developed to impart varying degrees of stability postoperatively. The issues of conformity and constraint within the artificial shoulder have been addressed through in vivo and in vitro studies, although few computational models have been presented. The current investigation presents the results of three-dimensional finite element analyses of the total shoulder joint and the effects of design parameters upon glenohumeral interaction. Conformity was shown not to influence the loads required to destabilize the joint, although it was the principal factor determining the magnitude of humeral head translation. Constraint was found to correlate linearly with the forces required to dislocate the humeral head, with higher constraint leading to slightly greater humeral migration at the point of joint instability. The model predicts that patients with a dysfunctional supraspinatus would experience frequent eccentric loading of the glenoid, especially in the superior direction, which would likely lead to increased fixation stresses, and hence, a greater chance of loosening. For candidates with an intact rotator cuff, the models developed in this study predict that angular constraints of at least 148 and 6.58 in the superoinferior and anteroposterior axes are required to provide stable unloaded abduction of the humerus, with larger constraints of 188 and 108 necessitated by a dysfunctional supraspinatus. The tools developed during this study can be used to determine the capacity for different implant designs to provide resistance to excessive glenohumeral translations and reduce the potential for instability of the joint, allowing surgeons to optimize postoperative functional gains on a patient by patient basis. ß

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“…In general, the factors affecting the range of motion after prosthetic reconstruction of the shoulder include the preoperative diagnosis [6], the preoperative complications, the preoperative state of soft tissue [3,8,9,29], the length of the lever arm of the deltoid muscle and rotator cuff [14,15,33,36], the tension of soft tissue [7,25,26,32], joint stability [ 19,20,23,29,31,37,38], rehabilitation [6], and skills of the surgeon [16]. Among these factors, the length of the lever arm and joint stability are the factor that the postoperative state can be changed by a selected prosthetic component.…”

Section: Introductionmentioning

confidence: 99%

The radiographic study in the relationship of the glenohumeral joint

Takase¹,

Yamamoto²,

Imakiire³

et al. 2004

Journal Orthopaedic Research

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Accurate reproduction of anatomic relationship is important in non‐constrained prosthetic arthroplasty. The accurate lateral glenohumeral offset, which indicates a parameter of the lever arm of the deltoid and supraspinatus muscles, is one of the most important elements in achieving the efficient shoulder functions after prosthetic reconstruction. However, to our knowledge, there has been no detailed study on the influence of minute changes in the neck shaft angle, within the normal range, on lateral glenohumeral offset. In this study, we evaluated the relationship between the neck shaft angle and various geometric measurement values in the glenohumeral joint. Radiographs of 471 shoulders without osseous lesions in the glenohumeral joint and greater tuberosity were reviewed. There were 265 males and 206 females, and a mean age was 53.5 years old. The final diagnosis was impingement syndrome in 269 patients, rotator cuff tear in 147, and control group in 55 patients. Eight parameters were measured on true anteroposterior radiographs. The lateral glenohumeral offset correlated with the radius of the curvature of the humeral head and the humeral head diameter. The neck shaft angle was not correlated with the offset value. However, when the offset value was divided by the humeral head diameter, to eliminate the affection of the size of the humeral head toward the offset, a correlation was observed with the neck shaft angle. Based on these correlations, we could obtain the equation of the lateral glenohumeral offset according to the neck shaft angle. Using the equation, when the neck shaft angle is decided, the lateral glenohumeral offset can be estimated based on the correlation between the parameters, which achieve the efficient shoulder functions after prosthetic components. Therefore, inaccurate determination of the neck shaft angle in the humeral head component design and selection may induce dysfunction of the abductor muscles. © 2003 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.

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Instability of the shoulder after arthroplasty.

Cited by 243 publications

References 5 publications

Importance of the subscapularis muscle after total shoulder arthroplasty

Importance of the subscapularis muscle after total shoulder arthroplasty

Glenohumeral kinematics following total shoulder arthroplasty: A finite element investigation

The radiographic study in the relationship of the glenohumeral joint

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