Reverse shoulder arthroplasty components and surgical techniques that restore glenohumeral motion

Modifications in reverse shoulder arthroplasty (RSA) have been made with the intent of maximizing motion, although there is little objective evidence outlining their benefit. This study investigated the RSA component combinations that impart the greatest effect on impingement-free glenohumeral motion.

A previously validated virtual shoulder model was implanted with RSA components that varied by humeral implant type (inset/onset), glenosphere diameter (30, 36, and 42 mm), glenosphere placement (inferior/neutral), glenosphere center-of-rotation offset (0, 5, and 10 mm), humeral neck-shaft angle (130° and 150°), and humeral offset (zero, five, and ten mm). Motion was simulated in all technique combinations until the point of impingement in abduction, flexion/extension (F/E), and internal/external rotation (IR/ER). Regression analysis was used to rank combinations based on motion.

Of 216 possible study combinations, 126 constructs (58%) demonstrated no arm-at-side impingement and were included for analysis. Models with the largest motion in abduction, F/E, and IR/ER, respectively, were inset-42-inferior-10-150-zero (107°), inset-36-inferior-10-130-five (146°), and inset-42-inferior-10-130-ten (121°). Humeral neck-shaft angle, glenosphere center-of-rotation offset, glenosphere placement, and glenosphere diameter had a significant effect on motion in all planes tested. Of these variables, humeral neck-shaft angle was most predictive of a change in abduction and F/E motion, whereas glenosphere placement was most predictive of a change in IR/ER motion.

Higher glenosphere center-of-rotation offsets led to an increase in motion in all planes. To maximize motion in abduction, a valgus humeral component should be selected; to maximize F/E, a varus humeral component should be selected; and, to maximize IR/ER, the glenosphere should be placed inferiorly.