Increased Deltoid and Acromial Stress with Glenoid Lateralization and Onlay Humeral Stem Constructs in Reverse Shoulder Arthroplasty.

Abstract

Background: Reverse shoulder arthroplasty (RSA) designs include multiple options for glenoid component lateralization, and humeral component lateralization and distalization (inlay/onlay constructs). The influence of combined glenoid lateralization, and humeral distalization on acromial and deltoid stresses is not well understood. The purpose of this study was to evaluate changes in deltoid and acromial stresses with variations in glenoid lateralization, and with inlay versus onlay humeral components in RSA.

Methods: Finite element analysis was performed using a RSA system with both inlay and onlay configurations. Variations in total glenoid lateralization from 3 to 9 mm were evaluated. Deltoid and acromial stresses were determined following virtual implantation and with 50° of external rotation.

Results: Increased glenoid lateralization resulted in greater stress of the deltoid and acromion. There was a modest increase in deltoid stress with glenoid lateralization alone (7% and 7.5% with progressive lateralization from 3 to 6 mm and 6 to 9 mm, respectively), but deltoid stress increased substantially with use of an onlay construct (60% at 9 mm of glenoid lateralization). Acromial stress correspondingly increased 37% with glenoid lateralization, and up to 117% with an onlay humeral construct.

Discussion: Increased lateralization of the glenoid component resulted in increased levels of deltoid and acromial stress. For a given amount of glenoid lateralization, utilization of an inlay stem decreased acromial and deltoid stresses compared to onlay constructs. These data allow surgeons to better understand the interactions of glenoid and humeral lateralization and distalization in the setting of contemporary RSA systems.Level of Evidence: Basic Science Study: Computer Modeling.