Maximizing range of motion of reverse total shoulder arthroplasty using design optimization techniques

Elwell, Josie A.; Athwal, George S.; Willing, Ryan

doi:10.1016/j.jbiomech.2021.110602

Cited by 8 publications

(2 citation statements)

References 29 publications

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“…Reverse total shoulder arthroplasty (rTSA) was developed to restore shoulder function in the setting of rotator cuff deficiency and osteoarthritis [39]. The nonanatomic design manipulates glenohumeral relationships via positioning and orientation of the glenosphere and humeral components [11,36], altering the moment arms of the deltoid and intact rotator cuff musculature [15,17,38]. Although rTSA reliably restores arm elevation, patients often experience limited internal and external rotation [8,18].…”

Section: Introductionmentioning

confidence: 99%

Reverse Total Shoulder Arthroplasty Alters Humerothoracic, Scapulothoracic, and Glenohumeral Motion During Weighted Scaption

Sulkar

Aliaj

Tashjian

et al. 2022

Clin Orthop Relat Res

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BackgroundReverse total shoulder arthroplasty (rTSA) typically restores active arm elevation. Prior studies in patients with rTSA during tasks that load the arm had limitations that obscured underlying three-dimensional (3D) kinematic changes and the origins of motion restrictions. Understanding the scapulothoracic and glenohumeral contributions to loaded arm elevation will uncover where functional deficits arise and inform strategies to improve rTSA outcomes.Questions/purposesIn a cohort of patients who had undergone rTSA and a control cohort, we asked: (1) Is there a difference in maximum humerothoracic elevation when scapular plane elevation (scaption) is performed with and without a handheld weight? (2) Is maximum humerothoracic elevation related to factors like demographics, patient-reported outcome scores, isometric strength, and scapular notching (in the rTSA group only)? (3) Are there differences in underlying 3D scapulothoracic and glenohumeral motion during scaption with and without a handheld weight?MethodsTen participants who underwent rTSA (six males, four females; age 73 ± 8 years) were recruited at follow-up visits if they were more than 1 year postoperative (24 ± 11 months), had a BMI less than 35 kg/m2 (29 ± 4 kg/m2), had a preoperative CT scan, and could perform pain-free scaption. Data from 10 participants with a nonpathologic shoulder, collected previously (five males, five females; age 58 ± 7 years; BMI 26 ± 3 kg/m2), were a control group with the same high-resolution quantitative metrics available for comparison. Participants in both groups performed scaption with and without a 2.2-kg handheld weight while being imaged with biplane fluoroscopy. Maximum humerothoracic elevation and 3D scapulothoracic and glenohumeral kinematics across their achievable ROM were collected via dynamic imaging. In the same session the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST), and isometric strength were collected. Data were compared between weighted and unweighted scaption using paired t-tests and linear mixed-effects models.ResultsWhen compared with unweighted scaption, maximum humerothoracic elevation decreased during weighted scaption for patients who underwent rTSA (-25° ± 30°; p = 0.03) but not for the control group (-2° ± 5°; p = 0.35). In the rTSA group, maximum elevation correlated with the ASES score (r = 0.72; p = 0.02), and weighted scaption correlated with BMI (r = 0.72; p = 0.02) and the SST (r = 0.76; p = 0.01). Scapular notching was observed in three patients after rTSA (Grades 1 and 2). Four of 10 patients who underwent rTSA performed weighted scaption to less than 90° humerothoracic elevation using almost exclusively scapulothoracic motion, with little glenohumeral contribution. This manifested as changes in the estimated coefficient representing mean differences in slopes in the humerothoracic plane of elevation (-12° ± 2°; p < 0.001) and true axial rotation (-16° ± 2°; p < 0.001), scapulothoracic upward rotation (7° ± 1°; p < 0.001), and glenohume...

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Section: Introductionmentioning

confidence: 99%

Reverse Total Shoulder Arthroplasty Alters Humerothoracic, Scapulothoracic, and Glenohumeral Motion During Weighted Scaption

Sulkar

Aliaj

Tashjian

et al. 2022

Clin Orthop Relat Res

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“…[3][4][5][6] Medical research has shown that increasing the range of joint training could expand the patient's joint mobility, improve muscle tendon extensibility and nerve stiffness, and facilitate the recovery of muscle strength. [7][8][9] Therefore, the study of the movement 1 range of upper extremity exoskeleton rehabilitation robots has become an urgent problem.…”

Section: Introductionmentioning

confidence: 99%

Design, optimization, and analysis of a human-machine compatibility upper extremity exoskeleton rehabilitation robot

Ning

Wang

Tian

et al. 2022

Proceedings of the Institution of Mechanical Engineers, Part C:

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For rehabilitation therapy robots, the movement range, and comfort of rehabilitation are crucial to the patient’s training and recovery and are also key factors in the design and performance evaluation of rehabilitation robots. In this paper, a highly harmonized upper extremity rehabilitation robot was proposed based on the human-machine coupling system model. Meanwhile, the shoulder joint structure of the rehabilitation robot was optimized to study the workspace range of this robot, the workspace of the upper extremity rehabilitation robot was fitted based on kinematic equations and the workspace volume size for different shoulder joint angles was analyzed. Finally, the upper extremity exoskeleton rehabilitation robot prototype was used to conduct the movement range tracking experiment and human-machine compatibility experiment in healthy volunteers to verify the rehabilitation training range and movement comfort of the rehabilitation robot. The experimental results show that when the optimized upper extremity exoskeleton rehabilitation robot was used to move in the coronal plane and sagittal plane of the human body, the overlaps of the movement range of the upper extremity wrist point W and the movement range of the healthy person was 97.23% and 97.66%, respectively, while the human-machine interaction force generated during the movement was mainly concentrated in the range of 0–10 kPa, which belongs to the low-pressure range of human-machine interaction. Therefore, this upper extremity rehabilitation robot can increase the movement range of patients’ upper extremities and improve the comfort of rehabilitation training.

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Design and analysis of a compatible exoskeleton rehabilitation robot system based on upper limb movement mechanism

Ning,

Wang,

Liu

et al. 2023

Med Biol Eng Comput

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Maximizing range of motion of reverse total shoulder arthroplasty using design optimization techniques

Cited by 8 publications

References 29 publications

Reverse Total Shoulder Arthroplasty Alters Humerothoracic, Scapulothoracic, and Glenohumeral Motion During Weighted Scaption

Reverse Total Shoulder Arthroplasty Alters Humerothoracic, Scapulothoracic, and Glenohumeral Motion During Weighted Scaption

Design, optimization, and analysis of a human-machine compatibility upper extremity exoskeleton rehabilitation robot

Design and analysis of a compatible exoskeleton rehabilitation robot system based on upper limb movement mechanism

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