The role of greater tuberosity healing in reverse shoulder arthroplasty: a finite element analysis

Vani J. Sabesan, Diego J.L. Lima, Yang Yang, Matthew C. Stankard, Mauricio Drummond, William W. Liou

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: The lack of greater tuberosity (GT) healing in proximal humerus fractures has been negatively correlated with outcomes for hemiarthroplasty; however, there is still debate regarding the effects of GT healing in reverse shoulder arthroplasty (RSA). Our goal was to examine the effects of GT healing using a kinematic finite element analysis (FEA) model. Material and Methods: Computer-aided design models of a medialized glenoid with a lateralized humerus (MGLH) RSA design were uploaded into an FEA shoulder model in 2 different configurations: healed greater tuberosity (HGT) and nonunion greater tuberosity (NGT). Deltoid muscle forces and joint reaction forces (JRFs) on the shoulder were calculated during abduction (ABD), forward flexion (FF), and external rotation (ER). Results: Force magnitude of the anterior, middle, and posterior deltoid muscle as well as JRFs modeled in both GT scenarios were similar for ABD (muscle forces P =.91, P =.75, P =.71, respectively; and JRF P =.93) and for FF (muscle forces P =.89, P =.83, P =.99, respectively; and JRF P =.90). For ER, the force magnitude between 2 GT settings showed statistically significant differences (HGT: 9.51 N vs. NGT: 6.13 N) (P <.001). Likewise, during ER, JRFs were different, and the NGT group showed a steep drop in JRF after 10° of ER (HGT: 28.4 N vs. NGT: 18.38 N) (P <.001). Conclusion: GT healing does not seem to impact RSA biomechanics during abduction or forward flexion; however, it does affect biomechanics during external rotation. Overall orthopedic surgeons can expect good results for patients after RSA even with poor GT healing.

Original languageEnglish (US)
Pages (from-to)347-354
Number of pages8
JournalJournal of Shoulder and Elbow Surgery
Issue number2
StatePublished - Feb 2020
Externally publishedYes


  • Basic Science Study
  • Case-Control Study
  • Computer Modeling
  • Level III
  • Reverse shoulder arthroplasty
  • biomechanics of the shoulder
  • finite element analysis modeling
  • greater tuberosity healing
  • joint reaction forces
  • proximal humerus fracture

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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