Analysis of glenoid fixation for a reversed anatomy fixed-fulcrum shoulder replacement.

The restoration of pain-free stable function in gleno-humeral arthritic cases in various situations such as rotator cuff deficiency, old trauma and failed total shoulder arthroplasty is a challenging clinical dilemma. The Bayley-Walker shoulder has been designed specifically for very difficult cases where surface replacement devices do not provide sufficient stability. This device is a fixed-fulcrum reverse anatomy implant where the centre of rotation is placed medially and distally with respect to the normal shoulder, to increase the lever arm of the abductor muscles. An important problem in devices of this type is obtaining secure and long-lasting fixation of the glenoid component. In this design, fixation is achieved using a tapered screw for engagement with cortical bone and HA coating for subsequent osseointegration. This study presents the results from a three-dimensional finite element analysis conducted on this component for two load cases at 60 degrees and 90 degrees abduction. The results showed that most of the forces were transmitted from the component to the cortical bone of the scapula, the remaining load being transmitted through cancellous bone. Histology from a retrieved case shows evidence of bone remodelling. The retrieval case obtained some time after implantation showed new bone formation had occurred around the threads onto the HA coating. Fixing the component in this way at multiple locations in cortical bone may overcome the problems of glenoid loosening historically associated with cemented constrained devices.