Min Zhang1, Sarah Junaid2, Thomas Gregory3, Ulrich Hansen4, Cheng-Kung Cheng5. 1. Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China; Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, China; Mechanical Engineering Department, Imperial College London, UK. Electronic address: m.zhang@buaa.edu.cn. 2. Mechanical Engineering Department, Imperial College London, UK; Engineering and Applied Sciences, Aston University, Birmingham, UK. Electronic address: s.junaid@aston.ac.uk. 3. Mechanical Engineering Department, Imperial College London, UK; Department of Orthopaedic Surgery, Avicenne Teaching Hospital, APHP, University Paris XIII, Bobigny, France. Electronic address: tms.gregory@gmail.com. 4. Mechanical Engineering Department, Imperial College London, UK. Electronic address: u.hansen@imperial.ac.uk. 5. Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China; Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, China. Electronic address: ckcheng2009@gmail.com.
Abstract
BACKGROUND: The glenoid component in reverse total shoulder arthroplasty is recommended to be positioned inferiorly or with a downward tilt with the intention of reducing scapular notching. However, it is still unclear whether modifying the position of the glenoid prosthesis affects implant stability. The aim of this study was to determine the association between implant positioning and glenoid prosthesis fixation using Grammont reverse total shoulder arthroplasty. METHODS: Four positions for the glenoid prosthesis were studied using the finite element method. The glenosphere was positioned as follows: 1) in the middle of the glenoid fossa, 2) flush with the inferior glenoid rim, 3) with an inferior overhang, 4) with a 15° inferior inclination. Bone-prosthesis micromotions and strain-induced bone adaptations were quantified during five daily activities. FINDINGS: When the glenoid component was tilted inferiorly, the activities producing anterior-posterior shear forces (e.g. standing up from an armchair) caused an increase in peak micromotions. In the lateral-middle glenoid, inferior positioning caused a 64.6% reduction in bone apparent density. In the lateral-inferior glenoid, central positioning led to the most severe bone resorption, reaching 43.9%. INTERPRETATION: Reducing activities which generate anterior-posterior shear forces on the shoulder joint will increase bone formation and may improve the primary stability of the implant when fixed in the position with an inferior tilt. Postoperative bone resorption is highly dependent on implant positioning. Understanding the relationship between bone resorption and implant positioning will help surgeons improve the long-term stability of reverse total shoulder arthroplasty.
BACKGROUND: The glenoid component in reverse total shoulder arthroplasty is recommended to be positioned inferiorly or with a downward tilt with the intention of reducing scapular notching. However, it is still unclear whether modifying the position of the glenoid prosthesis affects implant stability. The aim of this study was to determine the association between implant positioning and glenoid prosthesis fixation using Grammont reverse total shoulder arthroplasty. METHODS: Four positions for the glenoid prosthesis were studied using the finite element method. The glenosphere was positioned as follows: 1) in the middle of the glenoid fossa, 2) flush with the inferior glenoid rim, 3) with an inferior overhang, 4) with a 15° inferior inclination. Bone-prosthesis micromotions and strain-induced bone adaptations were quantified during five daily activities. FINDINGS: When the glenoid component was tilted inferiorly, the activities producing anterior-posterior shear forces (e.g. standing up from an armchair) caused an increase in peak micromotions. In the lateral-middle glenoid, inferior positioning caused a 64.6% reduction in bone apparent density. In the lateral-inferior glenoid, central positioning led to the most severe bone resorption, reaching 43.9%. INTERPRETATION: Reducing activities which generate anterior-posterior shear forces on the shoulder joint will increase bone formation and may improve the primary stability of the implant when fixed in the position with an inferior tilt. Postoperative bone resorption is highly dependent on implant positioning. Understanding the relationship between bone resorption and implant positioning will help surgeons improve the long-term stability of reverse total shoulder arthroplasty.
Authors: Alexandre Almeida; Daniel C Agostini; Pietro Ft Nesello; Nayvaldo C de Almeida; Rafael Mioso; Ana Paula Agostini Journal: J Shoulder Elb Arthroplast Date: 2021-02-15