Biomechanical analysis of the humeral tray positioning in reverse shoulder arthroplasty design

摘要

Despite the widespread use of reverse total shoulder arthroplasty, the fundamental effects of implant configuration on certain biomechanical outcomes have not been completely elucidated especially for the most innovative prostheses. Aim of this work is to investigate the behaviour of a new reverse shoulder prosthesis, characterized by a humeral tray with a variable offset, designed to increase the range of motion and to reduce the impingement. The purposes of this study were to evaluate the effect of reverse shoulder implant design parameters on the deltoid muscle forces, required to produce abduction, and on the shoulder range of motion, in order to provide a more systematic understanding of the fundamental effects of humeral component positioning on the implant performances. The study has been implemented using virtual prototypes of the shoulder-prosthesis assembly. The shape of the prosthesis has been digitally acquired via a 3D scanner and the CAD models of all the components have been created. Through CT images, 3-dimensional models of the shoulder bones have been reconstructed and assembled with the prosthesis components. Numerical FEM models have been set up in order to evaluate how the abduction force changes depending on the humeral tray offset. Using the virtual prototypes of the shoulder-prosthesis assembly, a range of motion analysis has been carried out by setting up a collision detection analysis in a 3D parametric modeling environment. Different humeral tray positions were investigated and four different motions of the arm were simulated. Obtained results have demonstrated that a suitable positioning of the humeral tray can offer significant biomechanical advantages in terms of range of motion and abduction force.