Analysis of glenoid fixation for a reversed anatomy fixed-fulcrum shoulder replacement

Ahir, S.P.; Walker, Peter S.; Squire-Taylor, C.J.; Blunn, Gordon; Bayley, J. I. L.

doi:10.1016/j.jbiomech.2004.01.031

Cited by 61 publications

(51 citation statements)

References 30 publications

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“…These design changes were made in an attempt to achieve secure glenoid fixation without a concomitant increase in loosening. In a total of 124 Bayley-Walker shoulders, no radiolucencies were noted after 5 years [1].…”

Section: Reverse Total Shoulder Arthroplastymentioning

confidence: 91%

“…Proponents for this design argued this change would allow improved motion and strength without the increased risk of dislocation and loosening. A number of reverse implant systems were designed beginning in the 1970s with variable designs for scapular fixation [1,3,4,6,7,13,16,17,25,41,42] (Table 1). These prostheses created a foundation for reverse shoulder arthroplasty and made important contributions to our understanding of the reverse concept.…”

Section: Reverse Total Shoulder Arthroplastymentioning

confidence: 99%

“…In 1973, the Bayley-Walker system made advancements in both design and fixation [1]. This implant was similar to the Kessel prosthesis but sought to improve the design by coating the large central screw with hydroxyapatite and increasing the screw thread diameter.…”

Section: Reverse Total Shoulder Arthroplastymentioning

confidence: 99%

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A History of Reverse Total Shoulder Arthroplasty

Flatow

Harrison

2011

Clinical Orthopaedics &Amp; Related Research

179

108

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Background Management of the cuff-deficient arthritic shoulder has long been challenging. Early unconstrained shoulder arthroplasty systems were associated with high complication and implant failure rates. The evolution toward the modern reverse shoulder arthroplasty includes many variables of constrained shoulder arthroplasty designs. Questions/purposes This review explores the development of reverse shoulder arthroplasty, specifically describing (1) the evolution of reverse shoulder arthroplasty designs, (2) the biomechanical variations in the evolution of this arthroplasty, and (3) the current issues relevant to reverse shoulder arthroplasty today. Methods Using a PubMed search, the literature was explored for articles addressing reverse shoulder arthroplasty, focusing on those papers with historical context. Results Results of the early designs were apparently poor, although they were not subjected to rigorous clinical research and usually reported only in secondary literature. We identified a trend of glenoid component failure in the early reverse designs. This trend was recognized and reported by authors as the reverse shoulder evolved.Authors reported greater pain relief and better function in reverse shoulder arthroplasty with the fundamental change of Grammont's design (moving the center of rotation medially and distally). However, current reports suggest lingering concerns and challenges with today's designs. Conclusions The history of reverse shoulder arthroplasty involves the designs of many forward-thinking surgeons. Many of these highly constrained systems failed, although more recent designs have demonstrated improved longevity and implant performance. Reverse shoulder arthroplasty requires ongoing study, with challenges and controversies remaining around present-day designs.

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Section: Reverse Total Shoulder Arthroplastymentioning

confidence: 91%

Section: Reverse Total Shoulder Arthroplastymentioning

confidence: 99%

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A History of Reverse Total Shoulder Arthroplasty

Flatow

Harrison

2011

Clinical Orthopaedics &Amp; Related Research

179

108

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“…The B-W implant addressed this issue by using a tapered helical screw with a larger thread pitch and depth for engagement into mainly cortical bone, gaining stable fixation in cases with poor bone quality and quantity. 13 The B-W implant was also hydroxyapatite (HA) coated along the screw, which no doubt contributed to the integration. In a finite element analysis (FEA) study of the scapula implanted with a B-W glenoid component, 13 under various loading conditions, most of the load was transmitted to the cortical bone in the glenoid vault via the screw threads, although the rim remained lightly loaded.…”

mentioning

confidence: 99%

“…13 The B-W implant was also hydroxyapatite (HA) coated along the screw, which no doubt contributed to the integration. In a finite element analysis (FEA) study of the scapula implanted with a B-W glenoid component, 13 under various loading conditions, most of the load was transmitted to the cortical bone in the glenoid vault via the screw threads, although the rim remained lightly loaded. Early clinical and radiographic data for the B-W implant suggest the observed radiolucent lines can be reduced to 20% at a minimum of 5 years follow-up, compared to 80% with the Kessel design.…”

mentioning

confidence: 99%

An experimental glenoid rim strain analysis for an improved reverse anatomy shoulder implant fixation

Mordecai

Lambert

Meswania

et al. 2011

Journal Orthopaedic Research

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Loosening of glenoid components in TSA is a main cause of failure. In reverse anatomy TSA designs used for unstable joints, fixation is particularly demanding. Strains developed around the glenoid rim of biomechanical sawbone scapulae implanted with (a) the original fixed-fulcrum Bayley-Walker glenoid prosthesis in current clinical use, and (b) a revised version with conical crosssection, were compared. The conical shape of the revised design was hypothesized to produce greater strains in the glenoid rim than the original tapered screw design. The 2D strain field at three accessible locations around the rim of each scapula was measured with three-element rosette strain gauges for two types of simulated cancellous bone fill under applied physiologically relevant loads. The average strain energy densities around the rim for the conical design were greater than for the original design by a factor of 1.55-2.25 for all loading conditions. Results indicate that a significantly greater proportion of load was directed toward cortical bone in the conical design, thus promoting cortical bone loading.

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Effect of reverse shoulder design philosophy on muscle moment arms

Hamilton

Diep

Roche

et al. 2015

Journal Orthopaedic Research

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This study analyzes the muscle moment arms of three different reverse shoulder design philosophies using a previously published method. Digital bone models of the shoulder were imported into a 3D modeling software and markers placed for the origin and insertion of relevant muscles. The anatomic model was used as a baseline for moment arm calculations. Subsequently, three different reverse shoulder designs were virtually implanted and moment arms were analyzed in abduction and external rotation. The results indicate that the lateral offset between the joint center and the axis of the humerus specific to one reverse shoulder design increased the external rotation moment arms of the posterior deltoid relative to the other reverse shoulder designs. The other muscles analyzed demonstrated differences in the moment arms, but none of the differences reached statistical significance. This study demonstrated how the combination of variables making up different reverse shoulder designs can affect the moment arms of the muscles in different and statistically significant ways. The role of humeral offset in reverse shoulder design has not been previously reported and could have an impact on external rotation and stability achieved post-operatively. ß

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Analysis of glenoid fixation for a reversed anatomy fixed-fulcrum shoulder replacement

Cited by 61 publications

References 30 publications

A History of Reverse Total Shoulder Arthroplasty

A History of Reverse Total Shoulder Arthroplasty

An experimental glenoid rim strain analysis for an improved reverse anatomy shoulder implant fixation

Effect of reverse shoulder design philosophy on muscle moment arms

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