Reverse Shoulder Arthroplasty Biomechanics

Roche, Christopher P.

doi:10.3390/jfmk7010013

Cited by 30 publications

(18 citation statements)

References 81 publications

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“…JFMK. 2022;7:1-17 [4] bony impingement and polyethelene particulate-induced osteolysis as it progresses [10]. Over time scapular notching can lead to failure of glenoid baseplate fixation, decreased range of motion, and worse clinical outcomes [11,12].…”

Section: Disadvantagesmentioning

confidence: 99%

“…In 1991, Paul Grammont designed the Delta III prosthesis, which utilized a hemispherical glenosphere and a humeral component with 155° neck-shaft angle to medialize the COR and distalize the humerus. These changes provided multiple benefits, including decreasing the shear forces through the glenoid bone-implant interface, as well as increasing the deltoid abductor moment arm [ 4 ]. Furthermore, distalization of the humerus by increasing the neck shaft angle to 155° increased the deltoid tension across the glenohumeral joint, which improves stability of the prosthesis [ 5 ].…”

Section: Reverse Total Shoulder Biomechanicsmentioning

confidence: 99%

“…The first disadvantage is related to the medialization of the COR and resulting medialization of the humerus. Medialization of the humerus shortens the length-tension relationship of the remaining rotator cuff muscles, impairing function for internal and external rotation of the shoulder [ 4 , 5 , 7 ]. Another important disadvantage to this medialized COR in combination with a 155° humeral neck shaft angle in the original Grammont design was the occurrence of scapular notching as a complication of RTSA (Fig.…”

Section: Reverse Total Shoulder Biomechanicsmentioning

confidence: 99%

“…3 ). Greater implant diameters alone result in more lateralization by increasing the radius of the glenosphere, and if used in combination with a more constrained socket will also have a greater jump distance, conferring more inherent joint stability by both soft tissue tension and increased constraint [ 4 , 20 , 21 ]. Increasing implant offset through the baseplate or glenosphere further lateralizes its COR, which has the advantage of restoring native rotator cuff moment arms, but it does decrease the deltoid moment arm and increases shear forces at the glenoid-implant interface [ 22 ].…”

Section: Effect Of Implant Design On Functionmentioning

confidence: 99%

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The Influence of Reverse Total Shoulder Arthroplasty Implant Design on Biomechanics

Cogan

Entezari

et al. 2023

Curr Rev Musculoskelet Med

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Purpose of Review As reverse total shoulder arthroplasty indications have expanded and the incidence of its use has increased, developments in implant design have been a critical component of its success. The purpose of this review is to highlight the recent literature regarding the effect of implant design on reverse total shoulder arthroplasty biomechanics. Recent Findings Implant design for reverse total shoulder arthroplasty has evolved considerably from the modern design developed by Paul Grammont. The Grammont design had a medialized center of rotation and distalized humerus resulting from a 155° humeral neck shaft angle. These changes intended to decrease the forces on the glenoid component, thereby decreasing the risk for implant loosening and improving the deltoid moment arm. However, these features also led to scapular notching. The Grammont design has been modified over the last 20 years to increase the lateral offset of the glenosphere and decrease the prosthetic humeral neck shaft angle to 135°. These changes were made to optimize functional range of motion while minimizing scapular notching and improving active external rotation strength. Lastly, the introduction of preoperative planning and patient-specific instrumentation has improved surgeon ability to accurately place implants and optimize impingement-free range of motion. Summary Success and durability of the reverse total shoulder arthroplasty has been contingent upon changes in implant design, starting with the Grammont-style prosthesis. Current humeral and glenoid implant designs vary in parameters such as humeral and glenoid offset, humeral tray design, liner thickness, and neck-shaft angle. A better understanding of the biomechanical implications of these design parameters will allow us to optimize shoulder function and minimize implant-related complications after reverse total shoulder arthroplasty.

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Section: Disadvantagesmentioning

confidence: 99%

Section: Reverse Total Shoulder Biomechanicsmentioning

confidence: 99%

Section: Reverse Total Shoulder Biomechanicsmentioning

confidence: 99%

Section: Effect Of Implant Design On Functionmentioning

confidence: 99%

See 2 more Smart Citations

The Influence of Reverse Total Shoulder Arthroplasty Implant Design on Biomechanics

Cogan

Entezari

et al. 2023

Curr Rev Musculoskelet Med

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“…Therefore, before using a thicker lateralized glenosphere, this complication should be considered ( Fig. 3 ) [ 47 , 48 ]. A glenosphere with a larger diameter also can maintain the tension of rotator cuffs and improve deltoid muscle coverage.…”

Section: Implant Design and Surgical Techniquementioning

confidence: 99%

Implant selection for successful reverse total shoulder arthroplasty

Jeong

Won

2022

Clin Shoulder Elbow

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Reverse total shoulder arthroplasty (RTSA) emerged as a new concept of arthroplasty that does not restore normal anatomy but does restore function. It enables the function of the torn rotator cuff to be performed by the deltoid and shows encouraging clinical outcomes. Since its introduction, various modifications have been designed to improve the outcome of the RTSA. From the original cemented baseplate with peg or keel, a cementless baseplate was designed that could be fixed with central and peripheral screws. In addition, a modular-type glenoid component enabled easier revision options. For the humeral component, the initial design was an inlay type of long stem with cemented fixation. However, loss of bone stock from the cemented stem hindered revision surgery. Therefore, a cementless design was introduced with a firm metaphyseal fixation. Furthermore, to prevent complications such as scapular notching, the concept of lateralization emerged. Lateralization helped to maintain normal shoulder contour and better rotator cuff function for improved external/internal rotation power, but excessive lateralization yielded problems such as subacromial notching. Therefore, for patients with pseudoparalysis or with risk of subacromial notching, a medial eccentric tray option can be used for distalization and reduced lateralization of the center of rotation. In summary, it is important that surgeons understand the characteristics of each implant in the various options for RTSA. Furthermore, through preoperative evaluation of patients, surgeons can choose the implant option that will lead to the best outcomes after RTSA.

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Scapular morphology variation affects reverse total shoulder arthroplasty biomechanics. A predictive simulation study using statistical and musculoskeletal shoulder models

Silvestros,

Athwal,

Giles

2024

Journal Orthopaedic Research

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Reverse total shoulder arthroplasty (RTSA) accounts for over half of shoulder replacement surgeries. At present, the optimal position of RTSA components is unknown. Previous biomechanical studies have investigated the effect of construct placement to quantify mobility, stability and functionality postoperatively. While studies have provided valuable information on construct design and surgical placement, they have not systematically evaluated the importance of scapular morphology on biomechanical outcomes. The aim of this study was to assess the influence of scapular morphology variation on RTSA biomechanics using statistical models, musculoskeletal modeling and predictive simulation. The scapular geometry of a musculoskeletal model was altered across six modes of variation at four levels (±1 and ±3 SD) from a clinically derived statistical shape model. For each model, a standardized virtual surgery was performed to place RTSA components in the same relative position on each model then implemented in 50 predictive simulations of upward and lateral reaching tasks. Results showed morphology affected functional changes in the deltoid moment arms and recruitment for the two tasks. Variation of the anatomy that reduced the efficiency of the deltoids showed increased levels of muscle force production, joint load magnitude and shear. These findings suggest that scapular morphology plays an important role in postoperative biomechanical function of the shoulder with an implanted RTSA. Furthermore a “one‐size‐fits‐all” approach for construct surgical placement may lead to suboptimal patient outcomes across a clinical population. Patient glenoid as well as scapular anatomy may need to be carefully considered when planning RTSA to optimize postoperative success.

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Reverse Shoulder Arthroplasty Biomechanics

Cited by 30 publications

References 81 publications

The Influence of Reverse Total Shoulder Arthroplasty Implant Design on Biomechanics

The Influence of Reverse Total Shoulder Arthroplasty Implant Design on Biomechanics

Implant selection for successful reverse total shoulder arthroplasty

Scapular morphology variation affects reverse total shoulder arthroplasty biomechanics. A predictive simulation study using statistical and musculoskeletal shoulder models

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