TY - JOUR
T1 - The role of greater tuberosity healing in reverse shoulder arthroplasty
T2 - a finite element analysis
AU - Sabesan, Vani J.
AU - Lima, Diego J.L.
AU - Yang, Yang
AU - Stankard, Matthew C.
AU - Drummond, Mauricio
AU - Liou, William W.
N1 - Funding Information:
Vani J. Sabesan is a paid consultant for Arthrex, Inc, and receives research support from Exactech, Inc. All the other authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
Publisher Copyright:
© 2019
PY - 2020/2
Y1 - 2020/2
N2 - 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.
AB - 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.
KW - Basic Science Study
KW - Case-Control Study
KW - Computer Modeling
KW - Level III
KW - Reverse shoulder arthroplasty
KW - biomechanics of the shoulder
KW - finite element analysis modeling
KW - greater tuberosity healing
KW - joint reaction forces
KW - proximal humerus fracture
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U2 - 10.1016/j.jse.2019.07.022
DO - 10.1016/j.jse.2019.07.022
M3 - Article
C2 - 31606318
AN - SCOPUS:85073020792
SN - 1058-2746
VL - 29
SP - 347
EP - 354
JO - Journal of Shoulder and Elbow Surgery
JF - Journal of Shoulder and Elbow Surgery
IS - 2
ER -