Tyler W Knighton1, Peter N Chalmers2, Hema J Sulkar3, Klevis Aliaj3, Robert Z Tashjian2, Heath B Henninger4. 1. Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA. 2. Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA. 3. Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA. 4. Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA. Electronic address: heath.henninger@utah.edu.
Abstract
BACKGROUND: Although typically favorable in outcome, anatomic total shoulder arthroplasty (aTSA) can require long-term revision. The most common cause for revision is glenoid loosening, which may result from eccentric cyclic forces and joint translations. "Rocking" of the glenoid component may be exacerbated by the joint geometry, such as glenoid inclination and version. Restoration of premorbid glenoid inclination may be preferable, although laboratory and computational models indicate that both superior inclination and inferior inclination have benefits. This discrepancy may arise because previous studies were limited by a lack of physiological conditions to test inclination. Therefore, a cadaveric shoulder simulator with 3-dimensional human motion was used to study joint contact and muscle forces with isolated changes in glenoid inclination. METHODS: Eight human cadaveric shoulders were tested before and after aTSA. Scapular-plane abduction kinematics from human subjects were used to drive a cadaveric shoulder simulator with 3-dimensional scapulothoracic and glenohumeral motion. Glenoid inclination was varied from -10° to +20°, whereas compressive, superior-inferior shear, and anterior-posterior shear forces were collected with a 6-df load cell during motion. Outputs also included muscle forces of the deltoid and rotator cuff. Data were evaluated with statistical parametric mapping repeated-measures analysis of variance and t tests. RESULTS: Inferior glenoid inclination (-10°) reduced both compressive and superior-inferior shear forces vs. neutral 0° inclination by up to 40%, and even more when compared with superior inclination (P < .001). Superior inclinations (+10° and +20°) tended to increase deltoid and rotator cuff forces vs. neutral 0° inclination or inferior inclination, on the order of 20%-40% (P ≤ .045). All force metrics except anterior-posterior shear were lowest for inferior inclination. Most aTSA muscle forces for neutral 0° inclination were not significantly different from native shoulders and decreased 45% and 15% in the posterior deltoid and supraspinatus, respectively (P ≤ .003). Joint translations were similar to prior reports in aTSA patients and did not differ between any inclinations or compared with native shoulders. Joint reaction forces were similar to those observed in human subjects with instrumented aTSA implants, providing confidence in the relative magnitude of our results. CONCLUSIONS: Inferior inclination reduces overall forces in the shoulder. Superior inclinations increase the muscle effort required for the shoulder to achieve similar motion, thus increasing the forces exerted on the glenoid component. These results suggest that a preference toward aTSA glenoid components in inferior inclination may reduce the likelihood of glenoid loosening by reducing excessive muscle and joint contact forces.
BACKGROUND: Although typically favorable in outcome, anatomic total shoulder arthroplasty (aTSA) can require long-term revision. The most common cause for revision is glenoid loosening, which may result from eccentric cyclic forces and joint translations. "Rocking" of the glenoid component may be exacerbated by the joint geometry, such as glenoid inclination and version. Restoration of premorbid glenoid inclination may be preferable, although laboratory and computational models indicate that both superior inclination and inferior inclination have benefits. This discrepancy may arise because previous studies were limited by a lack of physiological conditions to test inclination. Therefore, a cadaveric shoulder simulator with 3-dimensional human motion was used to study joint contact and muscle forces with isolated changes in glenoid inclination. METHODS: Eight human cadaveric shoulders were tested before and after aTSA. Scapular-plane abduction kinematics from human subjects were used to drive a cadaveric shoulder simulator with 3-dimensional scapulothoracic and glenohumeral motion. Glenoid inclination was varied from -10° to +20°, whereas compressive, superior-inferior shear, and anterior-posterior shear forces were collected with a 6-df load cell during motion. Outputs also included muscle forces of the deltoid and rotator cuff. Data were evaluated with statistical parametric mapping repeated-measures analysis of variance and t tests. RESULTS: Inferior glenoid inclination (-10°) reduced both compressive and superior-inferior shear forces vs. neutral 0° inclination by up to 40%, and even more when compared with superior inclination (P < .001). Superior inclinations (+10° and +20°) tended to increase deltoid and rotator cuff forces vs. neutral 0° inclination or inferior inclination, on the order of 20%-40% (P ≤ .045). All force metrics except anterior-posterior shear were lowest for inferior inclination. Most aTSA muscle forces for neutral 0° inclination were not significantly different from native shoulders and decreased 45% and 15% in the posterior deltoid and supraspinatus, respectively (P ≤ .003). Joint translations were similar to prior reports in aTSA patients and did not differ between any inclinations or compared with native shoulders. Joint reaction forces were similar to those observed in human subjects with instrumented aTSA implants, providing confidence in the relative magnitude of our results. CONCLUSIONS: Inferior inclination reduces overall forces in the shoulder. Superior inclinations increase the muscle effort required for the shoulder to achieve similar motion, thus increasing the forces exerted on the glenoid component. These results suggest that a preference toward aTSA glenoid components in inferior inclination may reduce the likelihood of glenoid loosening by reducing excessive muscle and joint contact forces.
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