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Robotic biomechanical evaluation of six different reverse shoulder implants

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Abstract
Background: The reverse total shoulder arthroplasty is a popular surgical treatment for a degenerative shoulder with a nonfunctional rotator cuff. Currently, more than 36 different brands with small different features are available. This creates choice stress among many surgeons, who no longer know which parameters and surgical factors are important to optimize the placement of the implant. Purpose: The first purpose of this pilot study was to compare the passive range of motion (ROM) of 6 different implant designs implanted following the manufacturer’s guidelines. The second goal was to identify the impingements after implantation which determines the maximal ROM. The last goal of the study was to link the different parameters of an implant with the ROM. Methods: Six implant systems were implanted on identical sawbones. The procedure was repeated 3 times on a different sawbone to objectify the surgical repeatability of the procedures. A Stäubli TX-90 robot was used to perform and control the humerus' kinematic movement. An optical tracking system was used to perform the system's calibrations, track the humerus and scapula in space, and compute the center of rotation. Results: There was a wide ROM in the scapular plane (44.8°-105.5°) while the minimal elevation (adduction) varied between −4.8° and 35.6°. The rotational movements were limited by contact of the superior humeral polyethylene inlay and the inferior scapular neck. The adduction in the coronal and scapular plane was limited by inferior scapular impingement, whereas the maximal abduction was limited either by bony contact between the humerus and acromion or by contact between the humeral polyethylene inlay and the superior glenoid cavity. A bigger radius of the glenosphere resulted in a larger passive humeroscapular ROM (P < .001). A larger Neck-Shaft-Angle results in a better abduction (P < .001) but compromised adduction (P < .001). The localization of the center of rotation has a significant impact on the ROM. The medialized designs have larger abduction and rotational angles (P < .001). Conclusion: There is a wide variation in the measured glenohumeral ROM between the 6 frequently implanted prostheses. The most important factor to optimize the impingement-free ROM in all types of prostheses is the creation of the prosthetic overhang of the glenosphere to the bone. Too much lateralization of the center of the glenosphere with or without lateralization of the humeral stem can create a subacromial and/or subcoracoidal impingement.
Keywords
Reverse shoulder implant, Range of motion, Robotic evaluation, Biomechanical evaluation, Impingements, Center of rotation

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MLA
Herregodts, Jan, et al. “Robotic Biomechanical Evaluation of Six Different Reverse Shoulder Implants.” SEMINARS IN ARTHROPLASTY : JSES, vol. 33, no. 2, 2023, pp. 270–79, doi:10.1053/j.sart.2022.11.004.
APA
Herregodts, J., Verhaeghe, M., Poncet, D., De Wilde, L., Van Tongel, A., & Herregodts, S. (2023). Robotic biomechanical evaluation of six different reverse shoulder implants. SEMINARS IN ARTHROPLASTY : JSES, 33(2), 270–279. https://doi.org/10.1053/j.sart.2022.11.004
Chicago author-date
Herregodts, Jan, Mathijs Verhaeghe, Didier Poncet, Lieven De Wilde, Alexander Van Tongel, and Stijn Herregodts. 2023. “Robotic Biomechanical Evaluation of Six Different Reverse Shoulder Implants.” SEMINARS IN ARTHROPLASTY : JSES 33 (2): 270–79. https://doi.org/10.1053/j.sart.2022.11.004.
Chicago author-date (all authors)
Herregodts, Jan, Mathijs Verhaeghe, Didier Poncet, Lieven De Wilde, Alexander Van Tongel, and Stijn Herregodts. 2023. “Robotic Biomechanical Evaluation of Six Different Reverse Shoulder Implants.” SEMINARS IN ARTHROPLASTY : JSES 33 (2): 270–279. doi:10.1053/j.sart.2022.11.004.
Vancouver
1.
Herregodts J, Verhaeghe M, Poncet D, De Wilde L, Van Tongel A, Herregodts S. Robotic biomechanical evaluation of six different reverse shoulder implants. SEMINARS IN ARTHROPLASTY : JSES. 2023;33(2):270–9.
IEEE
[1]
J. Herregodts, M. Verhaeghe, D. Poncet, L. De Wilde, A. Van Tongel, and S. Herregodts, “Robotic biomechanical evaluation of six different reverse shoulder implants,” SEMINARS IN ARTHROPLASTY : JSES, vol. 33, no. 2, pp. 270–279, 2023.
@article{01GTWF9E4YBAJMJF6HNS8KAAC9,
  abstract     = {{Background: The reverse total shoulder arthroplasty is a popular surgical treatment for a degenerative shoulder with a nonfunctional rotator cuff. Currently, more than 36 different brands with small different features are available. This creates choice stress among many surgeons, who no longer know which parameters and surgical factors are important to optimize the placement of the implant.
Purpose: The first purpose of this pilot study was to compare the passive range of motion (ROM) of 6 different implant designs implanted following the manufacturer’s guidelines. The second goal was to identify the impingements after implantation which determines the maximal ROM. The last goal of the study was to link the different parameters of an implant with the ROM.
Methods: Six implant systems were implanted on identical sawbones. The procedure was repeated 3 times on a different sawbone to objectify the surgical repeatability of the procedures. A Stäubli TX-90 robot was used to perform and control the humerus' kinematic movement. An optical tracking system was used to perform the system's calibrations, track the humerus and scapula in space, and compute the center of rotation.
Results: There was a wide ROM in the scapular plane (44.8°-105.5°) while the minimal elevation (adduction) varied between −4.8° and 35.6°. The rotational movements were limited by contact of the superior humeral polyethylene inlay and the inferior scapular neck. The adduction in the coronal and scapular plane was limited by inferior scapular impingement, whereas the maximal abduction was limited either by bony contact between the humerus and acromion or by contact between the humeral polyethylene inlay and the superior glenoid cavity. A bigger radius of the glenosphere resulted in a larger passive humeroscapular ROM (P < .001). A larger Neck-Shaft-Angle results in a better abduction (P < .001) but compromised adduction (P < .001). The localization of the center of rotation has a significant impact on the ROM. The medialized designs have larger abduction and rotational angles (P < .001).
Conclusion: There is a wide variation in the measured glenohumeral ROM between the 6 frequently implanted prostheses. The most important factor to optimize the impingement-free ROM in all types of prostheses is the creation of the prosthetic overhang of the glenosphere to the bone. Too much lateralization of the center of the glenosphere with or without lateralization of the humeral stem can create a subacromial and/or subcoracoidal impingement.}},
  author       = {{Herregodts, Jan and Verhaeghe, Mathijs and Poncet, Didier and De Wilde, Lieven and Van Tongel, Alexander and Herregodts, Stijn}},
  issn         = {{1045-4527}},
  journal      = {{SEMINARS IN ARTHROPLASTY : JSES}},
  keywords     = {{Reverse shoulder implant,Range of motion,Robotic evaluation,Biomechanical evaluation,Impingements,Center of rotation}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{270--279}},
  title        = {{Robotic biomechanical evaluation of six different reverse shoulder implants}},
  url          = {{http://doi.org/10.1053/j.sart.2022.11.004}},
  volume       = {{33}},
  year         = {{2023}},
}

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