Varying degrees of posterior glenoid bone loss occurs in patients with end stage osteoarthritis and can result in increased glenoid retroversion. The excessive retroversion can affect implant stability, eccentric glenoid loading, and fixation stresses. Ultimately, the goal is to correct retroversion to restore normal biomechanics of the glenohumeral joint. The objective of this study was to identify the optimal augmented glenoid design based on finite element analysis (FEA) modeling which will provide key insights into implant loosening mechanisms and stability. Two different augmented glenoid designs, posterior wedge and posterior step- were created as a computer model by a computer aided design software (CAD). These implant CAD models were created per precise manufacturers dimensions and sizes of the augmented implant designs. These implants were virtually implanted to correct 20° glenoid retroversion and the different mechanical parameters were calculated including: the glenohumeral subluxation force, relative micromotion at the bone-cement interface the glenoid, implant and cement mantle stress levels. The FEA model was then utilized to make measurements while the simulating abduction with the different implant designs. The biomechanical response parameters were compared between the models at comparable retroversion correction.Introduction
Materials and Methods
Augmented glenoid implants provide a new avenue to correct glenoid bone loss and can possibly reconcile current prosthetic failures and improve long-term performance. Biomechanical implant studies have suggested benefits from augmented glenoid components but limited evidence exists on optimal design of these augmented glenoid components. The aim of this study was to use integrated kinematic finite element analysis (FEA) model to evaluate the optimal augmented glenoid design based on biomechanical performance in extreme conditions for failure. Computer aided design software (CAD) models of two different commercially available augmented glenoid designs - wedge (Equinox®, Exactech, Inc.) and step (Steptech®, Depuy Synthes) were created per precise manufacturer's dimensions and sizes of the implants. Using FE modeling, these implants were virtually implanted to correct 20° of glenoid retroversion. Two glenohumeral radial mismatches (RM) (3.5/4mm and 10 mm) were evaluated for joint stability and implant fixation to simulate high risk conditions for failure. The following variables were recorded: glenohumeral force ratio, relative micromotion (distraction, translation and compression), and stress on the implant and at the cement mantle interface.Introduction
Materials and Methods
Manufacturers of reverse shoulder arthroplasty (RSA) implants have recently designed innovative implants to optimise performance in rotator cuff deficient shoulders. These advancements are not without tradeoff and can have negative biomechanical effects. The objective of this study was to develop an integrated FEA kinematic model to compare the muscle forces and joint reaction force (JRF) of 3 different RSA designs. A kinematic model of a normal shoulder joint was adapted from the Delft model and integrated with the OpenSim shoulder model. Static optimisations then allowed for calculation of the individual muscle forces, moment arms and JRF relative to net joint moments. Three dimensional computer models of humeral lateralised design (HLD), glenoid lateral design (GLD), and Grammont design (GD) RSA were integrated and parametric studies were performed. Overall there were decreases in deltoid and rotator cuff muscle forces for all 3 RSA designs. These decreases were greatest in the middle deltoid of the HLD model for abduction and flexion and in the rotator cuff muscles under both internal and external rotation. The joint reactive forces in abduction and flexion decreased similarly for all RSA designs compared to the normal shoulder model, with the greatest decrease seen in the HLD model. These findings demonstrate that the design characteristics implicit in these modified RSA prostheses result in kinematic differences most prominently seen in the deltoid muscle and overall joint reactive forces. Further research utilising this novel integrated model can help guide continued optimisation of RSA design and clinical outcomes.
Varying degrees of posterior glenoid bone loss occurs in patients with end stage osteoarthritis and can result in increased glenoid retroversion. Ultimately, the goal is to correct retroversion to restore normal biomechanics of the glenohumeral joint. The goal of this study was to identify the optimal augmented glenoid design based on finite element model analysis which will provide key insights into implant loosening mechanisms and stability. Two different augmented glenoid designs, posterior wedge and posterior step- were created as a computer model by a computer aided design software (CAD). These implants were virtually implanted to correct 20° glenoid retroversion and the different mechanical parameters were calculated including: the glenohumeral contact pressure, the cement stress, the shear stress, and relative micromotions at the bone cement interface.Introduction
Materials and Methods
A challenge to obtaining proper glenoid placement in total shoulder arthroplasty is eccentric posterior bone loss and associated glenoid retroversion. This bone loss can lead to poor stability and perforation of the glenoid during arthroplasty. The purpose of this study was to evaluate the three dimensional morphology of the glenoid with associated bone loss for a spectrum of osteoarthritis patients using 3-D computed tomography imaging and simulation software. This study included 29 patients with advanced glenohumeral osteoarthritis treated with shoulder arthroplasty. Three-dimensional (3D) reconstruction of preoperative CT images was performed using image analysis software. Glenoid bone loss was measured at ten, vertically equidistant axial planes along the glenoid surface at four distinct anterior-posterior points on each plane for a total of 40 measurements per glenoid. The glenoid images were also fitted with a modeled pegged glenoid implant to predict glenoid perforation.Background
Methods
Malposition of the glenoid component in total shoulder arthroplasty (TSA) is associated with higher strain patterns and can result in component loosening. Glenoid hardware placement and optimal size remain challenging due to the difficult joint exposure and visualization of anatomical reference landmarks during the procedure. Therefore, understanding both normal and variant patterns of glenoid anatomy is imperative for success in TSA. To better understand individual variations in glenoid morphology, this study aimed to compare the glenoid anatomy in a cohort of male and female patients from the United States (US) and Australia (AUS). Computed tomography (CT) data were analyzed from 41 male and 35 female shoulders; 39 of which were from a US population and 37 from an AUS population. These data were used to create statistical shape models (SSM) representing the average and ±1 standard deviations of the first mode of variation of each group (Materialise, Leuven, Belgium). All measurements were performed with 3-matic computer assisted design software (Materialise, Leuven, Belgium). On each model, glenoid height was measured as the distance from the most superior to the most inferior point on the glenoid face. Glenoid width was measured as the distance from the most anterior to the most posterior point on the glenoid face. Surface area was measured as the concave surface of the glenoid face (Figure 1). Glenoid vault depth was measured in the midsection of the glenoid face.Background
Methods
With growing attention being paid to quality and cost effectiveness in healthcare, outcome evaluations are becoming increasingly important. This determination can be especially difficult in reverse shoulder arthroplasty (RSA) given the complex pathology and extensive disabilities in this patient population. Several different scoring systems have been developed and validated for use in various shoulder pathologies. The purpose of this study was to assess the use three outcome scores in a population of patients undergoing RSA. We aim to demonstrate the validity of three outcome scores in patients undergoing RSA, and to determine if one score or a combination of scores is superior to others. Using a database of patients treated with RSA, we assessed preoperative and postoperative Constant Scores, American Shoulder and Elbow Surgeons (ASES) scores, and subjective shoulder values (SSV) in 148 shoulders. The outcomes at each scoring period were described and the scores were compared to one another as well as to active range of motion using linear regression modeling.Purpose
Methods
Reverse Shoulder Arthroplasty (RSA) improves the mechanics of rotator cuff deficient shoulders. To optimize functional outcomes and minimize failures of the RSA manufacturers have recently made innovative design modifications with lateralized components. However, these innovations have their own set of biomechanical trade-offs, such as increased shear forces along the glenoid bone interface. The objective of this study was to develop an efficient musculoskeletal model to evaluate and compare both the muscle forces and joint reactive force of a normal shoulder to those implanted with varied RSA implant designs. We believe these findings will provide valuable insight into possible advantages or shortcomings of this new RSA design. A kinematic model of a normal shoulder joint was adapted from publically available musculoskeletal modeling software. Static optimizations then allowed for calculation of the individual muscle forces, moment arms and joint reactive forces relative to net joint moments. An accurate 3D computer models of humeral lateralized design (HLD) (Equinoxe, Exactech, Gainesville FL, USA), glenoid lateral design (GLD) (Encore, DJO Global, Vista CA, USA), and Grammont design (GD) (Aequalis, Tornier, Amsterdam, NV) reverse shoulder prostheses was also developed and parametric studies were performed based on the numerical simulation platform.Introduction
Methods
Recent literature has shown that RSAs successfully improve pain and functionality, however variability in range of motion and high complication rates persist. Biomechanical studies suggest that tensioning of the deltoid, resulting from deltoid lengthening, improves range of motion by increasing the moment arm. This study aims to provide clinical significance for deltoid tensioning by comparing postoperative range of motion measurements with deltoid length for 93 patients. Deltoid length measurements were performed radiographically for 93 patients. Measurements were performed on both preoperative and postoperative x-rays in order to assess deltoid lengthening. The deltoid length was measured as the distance from the infeolateral tip of the acromion to the deltoid tuberosity on the humerus for both pre- and post- x-rays. For preoperative center of rotation measurements, the distance extended from the center of humeral head (estimated as radius of best fit circle) to deltoid length line. For postoperative measurements, the distance was from the center of glenosphere implant to deltoid length line. Forward flexion and external rotation was measured for all patients.Introduction
Methods
There has been increased focus on understanding the risk factors associated with scapular notching in reverse shoulder arthroplasty (RSA). The purpose of this study is to evaluate the effect of scapular morphology and surgical technique on the occurrence of scapular notching using the notching index as a comprehensive predictive tool. Ninety-one patients treated with a primary RSA were followed for a minimum of 24 months. Using a previously published notching index formula ((PSNA × 0.13) + (PGRD)), a notching index value for all patients was calculated. Radiographic assessment of patients were grouped by Nerot grade of scapular notching, group mean differences for prosthetic scapular neck angle (PSNA), peg glenoid rim distance (PGRD), preoperative scapular neck angle (SNA), notching index and clinical outcomes were compared.Background
Methods
The optimal degree of conformity between the glenoid and humeral components in cemented total shoulder arthroplasty (TSA) has not been established. Glenoid component stability is thought to be at risk due to the “rocking-horse” phenomenom, which, can lead to increased micromotion and loosening in response to humeral head edge loading. The goal of this biomechanical study is to investigate the influence of glenohumeral mismatch on bone-implant interface micromotion in a cemented glenoid implant model. Twenty-Five cemented glenoid components (Affiniti, Tornier, Inc., Bloomington, MN, USA) were implanted in polyurethane foam biomechanics testing blocks. Five glenoid sizes, 40 mm, 44 mm, 48 mm, 52 mm and 55 mm (n = 5 per glenoid size), were cyclically tested according to ASTM Standard F-2028-08. A 44 mm humeral head (Affiniti, Tornier, Inc., Bloomington, MN, USA) was positioned centrally within the glenoid fixed to a materials testing frame (MTS Mini-Bionix II, Eden Prairie, MN, USA). Phase I testing (n = 3 per glenoid size) involved a subluxation test for determination of the humeral head translation distance which would be used for phase II cyclic testing. During cyclic loading, the humeral head was translated ± distance for 50,000 cycles at a frequency of 2 Hz, simulating approximately 5 years of device use. Glenoid compression, distraction, and superior-inferior glenoid translation were measured throughout testing via two differential variable reluctance transducers.Purpose:
Methods:
Total shoulder arthroplasty is technically demanding in regards to implantation of the glenoid component, especially in the setting of increased glenoid deformity and posterior glenoid wear. Augmented glenoid implants are an important and innovative option; however, there is little evidence accessible to surgeons to guide in the selection of the appropriate size augmented glenoid. Solid computer models of a commercially available augmented glenoid components (+3, +5, +7) contained within the software allowed for placement of the best fit glenoid component within the 3D reconstruct of each patient's scapula. Peg perforation, amount of bone reamed and amount of medialization were recorded for each augment size.Background
Methods
accessory naviculars of adequate size underwent an ORIF (10), and accessory naviculars of smaller size underwent a modified Kidner procedure (7). Corrective osteotomies and/or soft-tissue procedures were performed concomitantly in nine patients to address pes planus. Pre- and postoperatively, patients were assessed radiographically. Preoperative MRI scans were analyzed to see if there was any correlation between MRI findings and success of ORIF. Patients were evaluated with the AOFAS midfoot clinical rating system (max 100 points).
