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Analysis of Reverse Total Shoulder Arthroplasty Biomechanics Using a Dynamic Shoulder Simulator

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Reverse Shoulder Arthroplasty

Abstract

Despite the increasing use of reverse total shoulder arthroplasty (rTSA), questions remain regarding optimal implantation techniques to maximize range of motion while minimizing instability and scapular notching. Utilizing a dynamic shoulder simulator, the effects of altering joint tension, humeral version, and glenosphere offset were investigated in cadavers. In addition, common configurations of different implant designs were compared. Increased tension in a Grammont-style rTSA improved implant stability at the cost of reduced range of motion, while humeral version only affected range of motion. Glenosphere lateralization in a Grammont-style rTSA increased implant stability at the cost of greater deltoid force required to elevate the arm. The most commonly implanted configuration of a lateral glenosphere system improved adduction versus a medial glenosphere system, which could result in the reduced scapular notching seen with lateral glenosphere systems in clinical populations. Similarly, a more lateral glenosphere system resulting in a more lateralized humerus might improve posterior rotator cuff efficiency by maintaining a more anatomic muscle length/tension relationship. Translation of these results to the clinical setting provides guidance regarding implant selection and placement that can be used to improve functional outcomes and limit complications after rTSA.

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References

  1. Chalmers PN, Slikker W 3rd, Mall NA, Gupta AK, Rahman Z, Enriquez D, Nicholson GP. Reverse total shoulder arthroplasty for acute proximal humeral fracture: comparison to open reduction-internal fixation and hemiarthroplasty. J Shoulder Elbow Surg. 2014;23:197–204. doi:10.1016/j.jse.2013.07.044.

    Article  PubMed  Google Scholar 

  2. Patel DN, Young B, Onyekwelu I, Zuckerman JD, Kwon YW. Reverse total shoulder arthroplasty for failed shoulder arthroplasty. J Shoulder Elbow Surg. 2012;21:1478–83. doi:10.1016/j.jse.2011.11.004.

    Article  PubMed  Google Scholar 

  3. Wall B, Nove-Josserand L, O’Connor DP, Edwards TB, Walch G. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am. 2007;89:1476–85. doi:10.2106/JBJS.F.00666.

    Article  PubMed  Google Scholar 

  4. Zumstein MA, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg. 2011;20:146–57. doi:10.1016/j.jse.2010.08.001.

    Article  PubMed  Google Scholar 

  5. Boileau P, Moineau G, Roussanne Y, O’Shea K. Bony increased-offset reversed shoulder arthroplasty: minimizing scapular impingement while maximizing glenoid fixation. Clin Orthop Relat Res. 2011;469:2558–67. doi:10.1007/s11999-011-1775-4.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Boileau P, Watkinson D, Hatzidakis AM, Hovorka I. Neer Award 2005: the Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg. 2006;15:527–40. doi:10.1016/j.jse.2006.01.003.

    Article  PubMed  Google Scholar 

  7. Cuff D, Clark R, Pupello D, Frankle M. Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency: a concise follow-up, at a minimum of five years, of a previous report. J Bone Joint Surg Am. 2012;94:1996–2000. doi:10.2106/JBJS.K.01206.

    Article  PubMed  Google Scholar 

  8. Favre P, Sussmann PS, Gerber C. The effect of component positioning on intrinsic stability of the reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2010;19:550–6. doi:10.1016/j.jse.2009.11.044.

    Article  PubMed  Google Scholar 

  9. Kelly JD 2nd, Zhao JX, Hobgood ER, Norris TR. Clinical results of revision shoulder arthroplasty using the reverse prosthesis. J Shoulder Elbow Surg. 2012;21:1516–25. doi:10.1016/j.jse.2011.11.021.

    Article  PubMed  Google Scholar 

  10. Naveed MA, Kitson J, Bunker TD. The Delta III reverse shoulder replacement for cuff tear arthropathy: a single-centre study of 50 consecutive procedures. J Bone Joint Surg Br. 2011;93:57–61. doi:10.1302/0301-620X.93B1.24218.

    Article  CAS  PubMed  Google Scholar 

  11. Werner CM, Steinmann PA, Gilbart M, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am. 2005;87:1476–86. doi:10.2106/JBJS.D.02342.

    Article  CAS  PubMed  Google Scholar 

  12. Valenti P, Sauzieres P, Katz D, Kalouche I, Kilinc AS. Do less medialized reverse shoulder prostheses increase motion and reduce notching? Clin Orthop Relat Res. 2011;469:2550–7. doi:10.1007/s11999-011-1844-8.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Edwards TB, Trappey GJ, Riley C, O’Connor DP, Elkousy HA, Gartsman GM. Inferior tilt of the glenoid component does not decrease scapular notching in reverse shoulder arthroplasty: results of a prospective randomized study. J Shoulder Elbow Surg. 2012;21:641–6. doi:10.1016/j.jse.2011.08.057.

    Article  PubMed  Google Scholar 

  14. Kempton LB, Balasubramaniam M, Ankerson E, Wiater JM. A radiographic analysis of the effects of glenosphere position on scapular notching following reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2011;20:968–74. doi:10.1016/j.jse.2010.11.026.

    Article  PubMed  Google Scholar 

  15. Kowalsky MS, Galatz LM, Shia DS, Steger-May K, Keener JD. The relationship between scapular notching and reverse shoulder arthroplasty prosthesis design. J Shoulder Elbow Surg. 2012;21:1430–41. doi:10.1016/j.jse.2011.08.051.

    Article  PubMed  Google Scholar 

  16. Nicholson GP, Strauss EJ, Sherman SL. Scapular notching: recognition and strategies to minimize clinical impact. Clin Orthop Relat Res. 2011;469:2521–30. doi:10.1007/s11999-010-1720-y.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Ladermann A, Williams MD, Melis B, Hoffmeyer P, Walch G. Objective evaluation of lengthening in reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2009;18:588–95. doi:10.1016/j.jse.2009.03.012.

    Article  PubMed  Google Scholar 

  18. Simovitch RW, Zumstein MA, Lohri E, Helmy N, Gerber C. Predictors of scapular notching in patients managed with the Delta III reverse total shoulder replacement. J Bone Joint Surg Am. 2007;89:588–600. doi:10.2106/JBJS.F.00226.

    Article  PubMed  Google Scholar 

  19. Chou J, Malak SF, Anderson IA, Astley T, Poon PC. Biomechanical evaluation of different designs of glenospheres in the SMR reverse total shoulder prosthesis: range of motion and risk of scapular notching. J Shoulder Elbow Surg. 2009;18:354–9. doi:10.1016/j.jse.2009.01.015.

    Article  PubMed  Google Scholar 

  20. Gutierrez S, Comiskey CA, Luo ZP, Pupello DR, Frankle MA. Range of impingement-free abduction and adduction deficit after reverse shoulder arthroplasty. Hierarchy of surgical and implant-design-related factors. J Bone Joint Surg Am. 2008;90:2606–15. doi:10.2106/JBJS.H.00012.

    Article  PubMed  Google Scholar 

  21. Gutierrez S, Keller TS, Levy JC, Lee WE 3rd, Luo ZP. Hierarchy of stability factors in reverse shoulder arthroplasty. Clin Orthop Relat Res. 2008;466:670–6. doi:10.1007/s11999-007-0096-0.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Gutierrez S, Levy JC, Frankle MA, Cuff D, Keller TS, Pupello DR, Lee WE 3rd. Evaluation of abduction range of motion and avoidance of inferior scapular impingement in a reverse shoulder model. J Shoulder Elbow Surg. 2008;17:608–15. doi:10.1016/j.jse.2007.11.010.

    Article  PubMed  Google Scholar 

  23. Li X, Knutson Z, Choi D, Lobatto D, Lipman J, Craig EV, Warren RF, Gulotta LV. Effects of glenosphere positioning on impingement-free internal and external rotation after reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2013;22:807–13. doi:10.1016/j.jse.2012.07.013.

    Article  PubMed  Google Scholar 

  24. Virani NA, Cabezas A, Gutierrez S, Santoni BG, Otto R, Frankle M. Reverse shoulder arthroplasty components and surgical techniques that restore glenohumeral motion. J Shoulder Elbow Surg. 2013;22:179–87. doi:10.1016/j.jse.2012.02.004.

    Article  PubMed  Google Scholar 

  25. Roche CP, Diep P, Hamilton M, Crosby LA, Flurin PH, Wright TW, Zuckerman JD, Routman HD. Impact of inferior glenoid tilt, humeral retroversion, bone grafting, and design parameters on muscle length and deltoid wrapping in reverse shoulder arthroplasty. Bull Hosp Joint Dis. 2013;2013(71):284–93.

    Google Scholar 

  26. Roche CP, Stroud NJ, Martin BL, Steiler CA, Flurin PH, Wright TW, DiPaola MJ, Zuckerman JD. The impact of scapular notching on reverse shoulder glenoid fixation. J Shoulder Elbow Surg. 2013;22:963–70. doi:10.1016/j.jse.2012.10.035.

    Article  PubMed  Google Scholar 

  27. Ackland DC, Roshan-Zamir S, Richardson M, Pandy MG. Moment arms of the shoulder musculature after reverse total shoulder arthroplasty. J Bone Joint Surg Am. 2010;92:1221–30. doi:10.2106/JBJS.I.00001.

    Article  PubMed  Google Scholar 

  28. Clouthier AL, Hetzler MA, Fedorak G, Bryant JT, Deluzio KJ, Bicknell RT. Factors affecting the stability of reverse shoulder arthroplasty: a biomechanical study. J Shoulder Elbow Surg. 2013;22:439–44. doi:10.1016/j.jse.2012.05.032.

    Article  PubMed  Google Scholar 

  29. Gulotta LV, Choi D, Marinello P, Wright T, Cordasco FA, Craig EV, Warren RF. Anterior deltoid deficiency in reverse total shoulder replacement: a biomechanical study with cadavers. J Bone Joint Surg Br. 2012;94:1666–9. doi:10.1302/0301-620X.94B12.29116.

    Article  CAS  PubMed  Google Scholar 

  30. Henninger HB, Barg A, Anderson AE, Bachus KN, Burks RT, Tashjian RZ. Effect of lateral offset center of rotation in reverse total shoulder arthroplasty: a biomechanical study. J Shoulder Elbow Surg. 2012;21:1128–35. doi:10.1016/j.jse.2011.07.034.

    Article  PubMed  Google Scholar 

  31. Henninger HB, Barg A, Anderson AE, Bachus KN, Tashjian RZ, Burks RT. Effect of deltoid tension and humeral version in reverse total shoulder arthroplasty: a biomechanical study. J Shoulder Elbow Surg. 2012;21:483–90. doi:10.1016/j.jse.2011.01.040.

    Article  PubMed  Google Scholar 

  32. Henninger HB, King FK, Tashjian RZ, Burks RT. Biomechanical comparison of reverse total shoulder arthroplasty systems in soft tissue-constrained shoulders. J Shoulder Elbow Surg. 2014;23:e108–17. doi:10.1016/j.jse.2013.08.008.

    Article  PubMed  Google Scholar 

  33. Frankle M, Levy JC, Pupello D, Siegal S, Saleem A, Mighell M, Vasey M. The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients surgical technique. J Bone Joint Surg Am. 2006;88(Suppl 1 Pt 2):178–90. doi:10.2106/JBJS.F.00123.

    PubMed  Google Scholar 

  34. Gerber C, Pennington SD, Lingenfelter EJ, Sukthankar A. Reverse Delta-III total shoulder replacement combined with latissimus dorsi transfer. A preliminary report. J Bone Joint Surg Am. 2007;89:940–7. doi:10.2106/JBJS.F.00955.

    Article  PubMed  Google Scholar 

  35. Gerber C, Pennington SD, Nyffeler RW. Reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2009;17:284–95.

    PubMed  Google Scholar 

  36. Berhouet J, Garaud P, Favard L. Evaluation of the role of glenosphere design and humeral component retroversion in avoiding scapular notching during reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2014;23:151–8. doi:10.1016/j.jse.2013.05.009.

    Article  PubMed  Google Scholar 

  37. Stephenson DR, Oh JH, McGarry MH, Rick Hatch GF 3rd, Lee TQ. Effect of humeral component version on impingement in reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2011;20:652–8. doi:10.1016/j.jse.2010.08.020.

    Article  PubMed  Google Scholar 

  38. De Wilde L, Plasschaert F. Prosthetic treatment and functional recovery of the shoulder after tumor resection 10 years ago: a case report. J Shoulder Elbow Surg. 2005;14:645–9. doi:10.1016/j.jse.2004.11.001.

    Article  PubMed  Google Scholar 

  39. Saltzman MD, Mercer DM, Warme WJ, Bertelsen AL, Matsen FA 3rd. A method for documenting the change in center of rotation with reverse total shoulder arthroplasty and its application to a consecutive series of 68 shoulders having reconstruction with one of two different reverse prostheses. J Shoulder Elbow Surg. 2010;19:1028–33. doi:10.1016/j.jse.2010.01.021.

    Article  PubMed  Google Scholar 

  40. Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics. 1993;16:65–8.

    CAS  PubMed  Google Scholar 

  41. Guery J, Favard L, Sirveaux F, Oudet D, Mole D, Walch G. Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am. 2006;88:1742–7. doi:10.2106/JBJS.E.00851.

    Article  PubMed  Google Scholar 

  42. Boileau P, Watkinson DJ, Hatzidakis AM, Balg F. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg. 2005;14:147S–61S. doi:10.1016/j.jse.2004.10.006.

    Article  PubMed  Google Scholar 

  43. Flatow EL, Harrison AK. A history of reverse total shoulder arthroplasty. Clin Orthop Relat Res. 2011;469:2432–9. doi:10.1007/s11999-010-1733-6.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Grammont P, Trouilloud P, Laffay J, Deries X. Etude et réalisation d’une nouvelle prothèse d’épaule. Rhumatologie. 1987;39:407–18.

    Google Scholar 

  45. Hamilton MA, Roche CP, Diep P, Flurin PH, Routman HD. Effect of prosthesis design on muscle length and moment arms in reverse total shoulder arthroplasty. Bull Hosp Joint Dis. 2013;2013(71 Suppl 2):S31–5.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedics, University of Utah Orthopaedic Center, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT, 84108, USA

    Robert Z. Tashjian

  2. Department of Orthopaedics, Orthopaedic Research Laboratory, Adjunct, Department of Bioengineering, University of Utah, Salt Lake City, UT, USA

    Heath B. Henninger

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  1. Robert Z. Tashjian
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Correspondence to Robert Z. Tashjian .

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Editors and Affiliations

  1. Florida Orthopedic Institute, Tampa, Florida, USA

    Mark Frankle

  2. Foundation for Orthopedic Research and Education, Tampa, Florida, USA

    Scott Marberry

  3. Foundation for Orthopedic Research and Education, Tampa, Florida, USA

    Derek Pupello

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Tashjian, R.Z., Henninger, H.B. (2016). Analysis of Reverse Total Shoulder Arthroplasty Biomechanics Using a Dynamic Shoulder Simulator. In: Frankle, M., Marberry, S., Pupello, D. (eds) Reverse Shoulder Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-20840-4_9

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  • DOI: https://doi.org/10.1007/978-3-319-20840-4_9

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  • Online ISBN: 978-3-319-20840-4

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