A Robotic Glenohumeral Simulator for Investigating Prosthetic Implant Subluxation

Abstract Total shoulder arthroplasty (TSA) is an effective treatment for glenohumeral (GH) osteoarthritis. However, it still suffers from a substantial rate of mechanical failure, which may be related to cyclic off-center loading of the humeral head on the glenoid. In this work, we present the design and evaluation of a GH joint robotic simulator developed to study GH translations. This five-degree-of-freedom robot was designed to replicate the rotations (±40 deg, accuracy 0.5 deg) and three-dimensional (3D) forces (up to 2 kN, with a 1% error settling time of 0.6 s) that the humeral implant exerts on the glenoid implant. We tested the performances of the simulator using force patterns measured in real patients. Moreover, we evaluated the effect of different orientations of the glenoid implant on joint stability. When simulating realistic dynamic forces and implant orientations, the simulator was able to reproduce stable behavior by measuring the translations of the humeral head of less than 24 mm with respect to the glenoid implant. Simulation with quasi-static forces showed dislocation in extreme ranges of implant orientation. The robotic GH simulator presented here was able to reproduce physiological GH forces and may therefore be used to further evaluate the effects of glenoid implant design and orientation on joint stability.

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Anatomic humeral head replacement with a press-fit prosthesis: An in vivo radiographic study

Orthopedic Reviews ◽

10.4081/or.2017.7168 ◽

2017 ◽

Vol 9 (3) ◽

Author(s):

Bryan Vopat ◽

Jeremy Truntzer ◽

Daniel Aaron ◽

Jack Anavian ◽

Joel Schwartz ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Humeral Head ◽

Total Shoulder Arthroplasty ◽

Anatomic Reconstruction ◽

Implant Design ◽

Design Parameters ◽

Press Fit ◽

Humeral Component ◽

Glenohumeral Osteoarthritis ◽

The Mean

Successful total shoulder arthroplasty is, in part, dependent on anatomic reconstruction of the glenohumeral joint. The purpose of this study was to evaluate the post-operative anatomy of total shoulder arthroplasty with an anatomic implant design in patients with primary glenohumeral osteoarthritis and compare it to published normative anatomic measurements. Fifty-one patients (56 shoulders) with primary glenohumeral osteoarthritis were treated with a press-fit humeral component as part of a total shoulder arthroplasty (Aequalis, Tornier, Edina, Minnesota). Analysis of postoperative true anterior posterior radiographs was performed with use of a custom software algorithm. The mean humeral inclination (head-shaft angle), mean humeral implant anatomical humeral axis, mean greater tuberosity height, and mean humeral head center offset (medial offset) were 135.4±5.1°, 1.73±1.7°, 6.9±2.4 mm, and 3.8±1.8 mm, respectively. All parameters were within the ranges reported in the literature for normal shoulders except the mean humeral head center offset, which was less than reported in the literature. Anatomic parameters of a total shoulder arthroplasty can be achieved with an anatomically designed, modular adaptable press-fit design. Reduced medial humeral head center offset was likely dependent upon implant specific design parameters.

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Static posterior humeral head subluxation and total shoulder arthroplasty

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2009.03.003 ◽

2009 ◽

Vol 18 (4) ◽

pp. 505-510 ◽

Cited By ~ 106

Author(s):

Christian Gerber ◽

John G. Costouros ◽

Atul Sukthankar ◽

Sandro F. Fucentese

Keyword(s):

Shoulder Arthroplasty ◽

Humeral Head ◽

Total Shoulder Arthroplasty

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Prosthetic Humeral Head Center of Rotation Shift from Ideal is Associated with Inferior Clinical Outcomes after Anatomic Total Shoulder Arthroplasty

Seminars in Arthroplasty ◽

10.1053/j.sart.2021.04.004 ◽

2021 ◽

Author(s):

Brian C. Werner ◽

R. Alexander Creighton ◽

Patrick J. Denard ◽

Evan Lederman ◽

Anthony Romeo ◽

...

Keyword(s):

Clinical Outcomes ◽

Shoulder Arthroplasty ◽

Humeral Head ◽

Total Shoulder Arthroplasty ◽

Center Of Rotation

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The role of eccentric and offset humeral head variations in total shoulder arthroplasty

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2012.09.008 ◽

2013 ◽

Vol 22 (7) ◽

pp. 886-893 ◽

Cited By ~ 12

Author(s):

Adam Sassoon ◽

Bradley Schoch ◽

Peter Rhee ◽

Cathy D. Schleck ◽

William S. Harmsen ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Humeral Head ◽

Total Shoulder Arthroplasty

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Postarthroscopic Humeral Head Osteonecrosis Treated With Reverse Total Shoulder Arthroplasty

Orthopedics ◽

10.3928/01477447-20130222-30 ◽

2013 ◽

Vol 36 (3) ◽

pp. e377-e380 ◽

Cited By ~ 11

Author(s):

Matthew F. Dilisio ◽

Jeffrey S. Noble ◽

Robert H. Bell ◽

Curtis R. Noel

Keyword(s):

Shoulder Arthroplasty ◽

Humeral Head ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Reverse Total Shoulder

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Joint stability after total shoulder arthroplasty in a cadaver model

Journal of Shoulder and Elbow Surgery ◽

10.1016/s1058-2746(97)90082-3 ◽

1997 ◽

Vol 6 (6) ◽

pp. 506-511 ◽

Cited By ~ 64

Author(s):

Andrew R. Karduna ◽

Gerald R. Williams ◽

John L. Williams ◽

Joseph P. Iannotti

Keyword(s):

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Joint Stability

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Reverse total shoulder arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.103b.bjj-2020-2101 ◽

2021 ◽

pp. 1-9

Author(s):

Eleanor G. Burden ◽

Timothy J. Batten ◽

Christopher D. Smith ◽

Jonathan P. Evans

Keyword(s):

Systematic Review ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Implant Design ◽

Complication Rates ◽

Scapular Notching ◽

Cuff Tear ◽

Patient Reported ◽

Reverse Total Shoulder

Aims This systematic review asked which patterns of complications are associated with the three reverse total shoulder arthroplasty (RTSA) prosthetic designs, as classified by Routman et al, in patients undergoing RTSA for the management of cuff tear arthropathy, massive cuff tear, osteoarthritis, and rheumatoid arthritis. The three implant design philosophies investigated were medial glenoid/medial humerus (MGMH), medial glenoid/lateral humerus (MGLH), and lateral glenoid/medial humerus (LGMH). Methods A systematic review of the literature was performed via a search of MEDLINE and Embase. Two reviewers extracted data on complication occurrence and patient-reported outcome measures (PROMs). Meta-analysis was conducted on the reported proportion of complications, weighted by sample size, and PROMs were pooled using the reported standardized mean difference (SMD). Quality of methodology was assessed using Wylde’s non-summative four-point system. The study was registered with PROSPERO (CRD42020193041). Results A total of 42 studies met the inclusion and exclusion criteria. Rates of scapular notching were found to be significantly higher in MGMH implants (52% (95% confidence interval (CI) 40 to 63)) compared with MGLH ((18% (95% CI 6 to 34)) and LGMH (12% (95% CI 3 to 26)). Higher rates of glenoid loosening were seen in MGMH implants (6% (95% CI 3 to 10)) than in MGLH implants (0% (95% CI 0 to 2)). However, strength of evidence for this finding was low. No significant differences were identified in any other complication, and there were no significant differences observed in PROMs between implant philosophies. Conclusion This systematic review has found significant improvement in PROMS and low complication rates across the implant philosophies studied. Scapular notching was the only complication found definitely to have significantly higher prevalence with the MGMH implant design.

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Eccentric Reaming for B2 Glenoids: History, Preoperative Planning, Surgical Technique, and Outcome

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/2471549219870348 ◽

2019 ◽

Vol 3 ◽

pp. ???

Author(s):

Matthew J Smith ◽

Christopher M Loftis ◽

Nathan W Skelley

Keyword(s):

Surgical Technique ◽

Cortical Bone ◽

Shoulder Arthroplasty ◽

Humeral Head ◽

Preoperative Planning ◽

Total Shoulder Arthroplasty ◽

Joint Line ◽

Neutral Position ◽

Anterior Portion ◽

Surgical Options

Background The biconcave (B2) glenoid is characterized by preservation of the anterior portion of the native glenoid with asymmetric wear of the posterior glenoid. Surgical options for glenoid correction have evolved. The goal of shoulder arthroplasty is to place the implants in such a manner to return the humeral head to a centered position and restore the joint line to a neutral position. There is no current consensus on method of treatment and correction. Methods The current and historical literature on total shoulder arthroplasty was used to examine technique viability. Results Asymmetric remaining can be used to address up to 15° of version correction without compromise of cortical bone. It is important to have the proper presurgical planning, to understand the limitations of correction, and to have other options available to treat the biconcave glenoid.

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