Gutiérrez, J Bone Joint Surg Am 2008 - Range of Impingement-Free Abduction and Adduction Deficit after Reverse Shoulder Arthroplasty

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Range of Impingement-Free Abduction and Adduction Deficit after Reverse Shoulder Arthroplasty

Gutiérrez, Frankle, et al.·J Bone Joint Surg Am·2008·347 citations·Biomechanical study

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Background

Evaluations of functional outcomes of reverse shoulder arthroplasty have revealed variable improvements in the range of motion and high rates of scapular notching. The purpose of this study was to systematically examine the impact of surgical factors (location of the glenosphere on the glenoid and tilt angle of the glenosphere on the glenoid) and implant-related factors (implant size, center-of-rotation offset, and humeral neck-shaft angle) on impingement-free abduction motion.

Methods

A computer model was developed to virtually simulate abduction/adduction motion and its dependence on five surgical and implant-related factors.
Three conditions were tested for each factor, resulting in a total of 243 simulated combinations.
The overall motion was determined from 0 degrees of abduction until maximum abduction, which would be limited by impingement of the humerosocket on the scapula.
In those combinations in which 0 degrees of abduction could not be achieved, the adduction deficit was recorded.

Results

The largest average increase in the range of impingement-free abduction motion resulted from a more lateral center-of-rotation offset: the average increase was 31.9 degrees with a change in the center-of-rotation offset from 0 to 10 mm, and this change resulted in an increase in abduction motion in 80 of the 81 combinations.
The position of the glenosphere on the glenoid was associated with the second largest average increase in abduction motion (28.1 degrees when the glenosphere position was changed from superior to inferior, with the change resulting in an increase in 71 of the 81 combinations).
These factors were followed by glenosphere tilt, humeral neck-shaft angle, and prosthetic size in terms of their effects on abduction motion.
The largest effect in terms of avoiding an adduction deficit was provided by a humeral neck-shaft angle of 130 degrees (the deficit was avoided in 49 of the 81 combinations in which this angle was used), followed by an inferior glenosphere position on the glenoid (deficit avoided in 41 combinations), a 10-mm lateral offset of the center of rotation, inferior tilt of the glenosphere, and a 42-mm-diameter prosthetic size.

Conclusions

An understanding of a hierarchy of prosthetic design and implantation factors may be important to maximize impingement-free abduction motion as well as to avoid inferior impingement.

Copyright remains with the authors and publisher.

Range of Impingement-Free Abduction and Adduction Deficit after Reverse Shoulder Arthroplasty

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Range of Impingement-Free Abduction and Adduction Deficit after Reverse Shoulder Arthroplasty

Gutiérrez, Frankle, et al.·J Bone Joint Surg Am·2008·347 citations·Biomechanical study

|

Background

Evaluations of functional outcomes of reverse shoulder arthroplasty have revealed variable improvements in the range of motion and high rates of scapular notching. The purpose of this study was to systematically examine the impact of surgical factors (location of the glenosphere on the glenoid and tilt angle of the glenosphere on the glenoid) and implant-related factors (implant size, center-of-rotation offset, and humeral neck-shaft angle) on impingement-free abduction motion.

Methods

A computer model was developed to virtually simulate abduction/adduction motion and its dependence on five surgical and implant-related factors.
Three conditions were tested for each factor, resulting in a total of 243 simulated combinations.
The overall motion was determined from 0 degrees of abduction until maximum abduction, which would be limited by impingement of the humerosocket on the scapula.
In those combinations in which 0 degrees of abduction could not be achieved, the adduction deficit was recorded.

Results

The largest average increase in the range of impingement-free abduction motion resulted from a more lateral center-of-rotation offset: the average increase was 31.9 degrees with a change in the center-of-rotation offset from 0 to 10 mm, and this change resulted in an increase in abduction motion in 80 of the 81 combinations.
The position of the glenosphere on the glenoid was associated with the second largest average increase in abduction motion (28.1 degrees when the glenosphere position was changed from superior to inferior, with the change resulting in an increase in 71 of the 81 combinations).
These factors were followed by glenosphere tilt, humeral neck-shaft angle, and prosthetic size in terms of their effects on abduction motion.
The largest effect in terms of avoiding an adduction deficit was provided by a humeral neck-shaft angle of 130 degrees (the deficit was avoided in 49 of the 81 combinations in which this angle was used), followed by an inferior glenosphere position on the glenoid (deficit avoided in 41 combinations), a 10-mm lateral offset of the center of rotation, inferior tilt of the glenosphere, and a 42-mm-diameter prosthetic size.

Conclusions

An understanding of a hierarchy of prosthetic design and implantation factors may be important to maximize impingement-free abduction motion as well as to avoid inferior impingement.

Copyright remains with the authors and publisher.

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