Finite element analysis of glenoid-sided lateralization in reverse shoulder arthroplasty

Denard, Patrick J.; Lederman, Evan; Parsons, Bradford O.; Romeo, Anthony A.

doi:10.1002/jor.23394

Cited by 41 publications

(27 citation statements)

References 13 publications

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“…Finite element analysis (FEA) simulations are often used for replicating the test setup per ASTM F2028-14, to determine worst case configuration for physical testing or to make comparisons among different designs or configurations. Several FEA studies have been performed to study the effect of implant designs, lateralization, inferior tilt of glenoid, and degree of joint conformity on glenoid baseplate-bone micromotion ( Hopkins et al, 2008 ; Virani et al, 2008 ; Hopkins and Hansen, 2009 ; Suárez et al, 2012 ; Chae et al, 2016 ; Denard et al, 2017 ; Elwell et al, 2017 ; Geraldes et al, 2017 ). The complexity of the FEA models has increased with time due to improvements in computing power and software technologies.…”

Section: Introductionmentioning

confidence: 99%

“…However, results from FEA can be critically dependent on the modeling assumptions. In particular, one commonly used simplification in rTSA modeling studies is de-featuring of the screw threads from the screw shafts and the screw holes in the bone ( Hopkins et al, 2008 ; Virani et al, 2008 ; Hopkins and Hansen, 2009 ; Suárez et al, 2012 ; Chae et al, 2016 ; Denard et al, 2017 ; Elwell et al, 2017 ; Geraldes et al, 2017 ). The screw shafts are modeled as cylinders, virtually implanted in the cylindrical holes created in the bone.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Modeling Assumptions on Stability Predictions in Reverse Total Shoulder Arthroplasty

Dharia

Bischoff

Schneider³

2018

Front. Physiol.

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Reverse total shoulder arthroplasty (rTSA) is commonly used in the shoulder replacement surgeries for the relief of pain and to restore function, in patients with grossly deficient rotator cuff. Primary instability due to glenoid loosening is one of the critical complications of rTSA; the implants are designed and implanted such that the motion between the glenoid baseplate and underlying bone is minimized to facilitate adequate primary fixation. Finite element analysis (FEA) is commonly used to simulate the test setup per ASTM F2028-14 for comparing micromotion between designs or configurations to study the pre-clinical indications for stability. The FEA results can be influenced by the underlying modeling assumptions. It is a common practice to simplify the screw shafts by modeling them as cylinders and modeling the screw-bone interface using bonded contact, to evaluate micromotion in rTSA components. The goal of this study was to evaluate the effect of three different assumptions for modeling the screw-bone interface on micromotion predictions. The credibility of these modeling assumptions was examined by comparing the micromotion rank order predicted among three different modular configurations with similar information from the literature. Eight configurations were modeled using different number of screws, glenosphere offset, and baseplate sizes. An axial compression and shear load was applied through the glenosphere and micromotion at the baseplate-bone interface was measured. Three modeling assumptions pertaining to modeling of the screw-bone interface were used and micromotion results were compared to study the effect of number of peripheral screws, eccentricities, and baseplate diameter. The relative comparison of micromotion between configurations using two versus four peripheral screws remained unchanged irrespective of the three modeling assumptions. However, the relative comparison between two inferior offsets and baseplate sizes changed depending on the modeling assumptions used for the screw-bone interface. The finding from this study challenges the generally believed hypothesis that FEA models can be used to make relative comparison of micromotion in rTSA designs as long as the same modeling assumptions are used across all models. The comparisons with previously published work matched the finding from this study in some cases, whereas the comparison was contradicting in other cases. It is essential to validate the computer modeling approach with an experiment using similar designs and methods to increase the confidence in the predictions to make design decisions.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of Modeling Assumptions on Stability Predictions in Reverse Total Shoulder Arthroplasty

Dharia

Bischoff

Schneider³

2018

Front. Physiol.

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“…While mechanical tests can be performed extensively to assess the stability of standard implants [10][11][12], for custom implants with a unique design for each patient, it is not practical to use mechanical testing to verify the stability. Alternatively, Finite Element (FE) analysis has been widely used to evaluate the influence of different implant configurations on the initial fixation of an implant [13][14][15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

“…Hopkins et al examined multiple standard designs with different screw angle inclination, concluding that increasing the screw inclination enhanced stability more than using longer and thicker screws [15]. Other studies explored instead the effect of the prosthesis repositioning (using different glenosphere sizes or bone grafting) and found that a lateralization of 10 mm was mechanically acceptable for osseointegration [13,16].…”

Section: Introductionmentioning

confidence: 99%

Finite Element Analysis of Custom Shoulder Implants Provides Accurate Prediction of Initial Stability

et al. 2020

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Custom reverse shoulder implants represent a valuable solution for patients with large bone defects. Since each implant has unique patient-specific features, finite element (FE) analysis has the potential to guide the design process by virtually comparing the stability of multiple configurations without the need of a mechanical test. The aim of this study was to develop an automated virtual bench test to evaluate the initial stability of custom shoulder implants during the design phase, by simulating a fixation experiment as defined by ASTM F2028-14. Three-dimensional (3D) FE models were generated to simulate the stability test and the predictions were compared to experimental measurements. Good agreement was found between the baseplate displacement measured experimentally and determined from the FE analysis (Spearman’s rank test, p < 0.05, correlation coefficient ρs = 0.81). Interface micromotion analysis predicted good initial fixation (micromotion <150 µm, commonly used as bone ingrowth threshold). In conclusion, the finite element model presented in this study was able to replicate the mechanical condition of a standard test for a custom shoulder implants.

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“…23 It also increases back-side forces on the baseplate. 14 In addition, although lateralization may reduce notching, it may not be as effective as inferior overhang. 48 Clinically, lateralization may also be a trade-off.…”

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confidence: 99%

Outcomes after a Grammont-style reverse total shoulder arthroplasty?

Tashjian

Hillyard

Childress

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: The purpose of this study was to determine the factors associated with outcomes after reverse total shoulder arthroplasty (RTSA). Methods: We retrospectively evaluated all RTSAs performed by the senior author between January 1, 2007, and November 1, 2017. We evaluated pain visual analog scale (VAS), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores and complication and reoperation rates at a minimum of 2-year follow-up. We evaluated preoperative and 2-week postoperative radiographs for glenoid inclination (GI), medialization as distance between the center of the humeral head or glenosphere and the line of the deltoid, and distalization via the acromial-greater tuberosity distance. We performed inter-and intrarater reliabilities via intraclass correlation coefficients (ICCs) and conducted a multivariable analysis. Results: We included 230 RTSAs in the analysis, with 70% follow-up at a median of 3.4 years. Reliability was acceptable with all ICCs >.678. Increased postoperative GI was significantly associated with increased VAS pain postoperatively (P ¼ .008). Increased distalization was associated with an increased rate of complications and reoperations (P ¼ .032). Younger age (P ¼ .008), female gender (P ¼ .009), and lower body mass index (BMI) (P ¼.006) were associated with worse ASES scores. Female gender (P <.001) and lower BMI (P ¼.039) were associated with worse SST scores. Female gender (P ¼ .013) and lower BMI (P ¼ .005) were associated with worse VAS-pain scores. Conclusion: Age, gender, and BMI are associated with outcome after RTSA. In this retrospective analysis of a Grammont-style RTSA, superior inclination is associated with increased pain postoperatively, whereas excessive arm lengthening is associated with increased risk for complication or reoperation.

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Finite element analysis of glenoid-sided lateralization in reverse shoulder arthroplasty

Cited by 41 publications

References 13 publications

Impact of Modeling Assumptions on Stability Predictions in Reverse Total Shoulder Arthroplasty

Impact of Modeling Assumptions on Stability Predictions in Reverse Total Shoulder Arthroplasty

Finite Element Analysis of Custom Shoulder Implants Provides Accurate Prediction of Initial Stability

Outcomes after a Grammont-style reverse total shoulder arthroplasty?

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