Development and Application of a Novel Metric to Characterize Comprehensive Range of Motion of Reverse Total Shoulder Arthroplasty.

Active range of motion (ROM) of reverse total shoulder arthroplasty (rTSA) can be limited by bony impingement, muscle inability, and joint instability. The aim of this study was to develop a novel metric representative of comprehensive ROM of rTSA, which is evaluated in the context of all three factors. It was hypothesized that the metric, termed global circumduction ROM (GC-ROM), would capture differences resulting from directional changes in rTSA design parameters known to increase ROM. GC-ROM was calculated for a set of 18 rTSA configurations with humeral polyethylene cup depths of 6 and 8.1 mm, glenosphere lateralization (GLat) distances of 0, 5, and 10 mm, and neck-shaft angles (NSA) of 135°, 145°, and 155°. For any implant configuration, arm positions were defined by internal/external (IE) rotation angle and two spherical coordinates representing the elevation plane angle and elevation angle. At each IE rotation angle, incremental positions with variable elevation plane and elevation angles were checked for feasibility based on impingement, muscle ability, and risk of instability. Coordinates of feasible positions were mapped to unit spheres and connected to form regions, of which the surface area was calculated to represent allowable circumduction ROM. ROMs were averaged across all IE rotation angles to produce a single metric, GC-ROM. The results showed that decreasing cup depth and increasing GLat and NSA increased GC-ROM. In conclusion, a novel metric to characterize comprehensive ROM, evaluated based on several ROM-limiting factors, was developed as a performance metric through which rTSA designs can be compared.