Managing glenoid bone loss virtual surgery—A software solution

Inaccurate placement of glenoid prosthesis in shoulder arthroplasty can lead to early loosening, instability, and failure. To address difficult glenoid morphology, patient-specific instrumentation and navigation techniques have been developed. Advanced imaging data has demonstrated utility in preoperative decision making. Cadaveric studies have subsequently shown that the application of advancing imaging and navigation can lead towards increased accuracy with prosthesis placement. Clinical trials have also shown increased accuracy with navigation and advanced imaging, but data demonstrating improved long-term outcomes and decreased complication rates is not yet available. This technology continues to evolve as a method to address glenoid bone loss and abnormal morphology.     

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

The purpose of this study was to evaluate glenoid‐sided lateralization in reverse shoulder arthroplasty (RSA), and compare bony and prosthetic lateralization. The hypothesis was that stress and displacement would increase with progressive bony lateralization, and be lower with prosthetic lateralization. A 3D finite element analysis (FEA) was performed on a commercially available RSA prosthesis. Stress and displacement were evaluated at baseline and following 5, 10, and 15 mm of bony or prosthetic lateralization. Additional variables included glenosphere size, baseplate orientation, and peripheral screw orientation. Maximum stress for a 36 mm glenosphere without bone graft increased by 137% for the 5 mm graft, 187% for the 10 mm graft, and 196% for the 15 mm graft. Likewise, displacement progressively increased with increasing graft thickness. Stress and displacement were reduced with a smaller glenosphere, inferior tilt of the baseplate, and divergent peripheral screws. Compared to bony lateralization, stress was lower with prosthetic lateralization through the glenosphere or baseplate. Displacement with 5 mm of bony lateralization reached recommended maximal amounts for osseous integration, whereas, this level was not reached until 10–15 mm of prosthetic lateralization. Baseplate stress and displacement in an FEA model is lower with a smaller glenosphere, inferior tilt, and divergent screws. Bony lateralization increases stress and displacement to a greater degree than prosthetic lateralization. It appears that at least 10 mm of prosthetic lateralization is mechanically acceptable during RSA, but only 5 mm of bony lateralization is advised. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1548–1555, 2017.