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Optimization of implant selection and positioning for reverse total shoulder arthroplasty using three-dimensional
Katelyn E Parsons1, Devika A Shenoy1, Samuel G Lorentz1
1Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.
Journal of Shoulder and Elbow Arthroplasty
|July 24, 2026
Summary
Optimizing reverse total shoulder arthroplasty (rTSA) involves selecting implants that enhance range of motion (ROM). Larger glenospheres and specific positioning improve ROM, while neck-shaft angle (NSA) impacts it significantly.
Area of Science:
- Orthopedic surgery
- Biomechanical engineering
- Medical simulation
Background:
- Three-dimensional (3D) simulation enhances implant placement accuracy but its effect on postoperative range of motion (ROM) needs further definition.
- Reverse total shoulder arthroplasty (rTSA) aims to restore shoulder function, with implant choice influencing patient outcomes.
Purpose of the Study:
- To utilize a 3D simulation model with scapulothoracic motion to assess how reverse total shoulder arthroplasty (rTSA) implant variables affect range of motion (ROM) and daily living activities.
- To identify key implant parameters that optimize functional ROM after rTSA.
Main Methods:
- A 3D simulation model (CORIOGRAPH MODELER) integrated scapulothoracic and glenohumeral motion.
- Evaluated impingement-free ROM across various implant parameters including glenosphere size, eccentricity, lateralization, insert thickness, neck-shaft angle (NSA), and stem/baseplate versions.
- Analyzed ROM data from 49 patients undergoing rTSA.
Main Results:
- Larger glenospheres, eccentric positioning, and increased lateralization correlated with greater impingement-free ROM (P < .05).
- A higher humeral neck-shaft angle (NSA) was associated with reduced ROM (P < .05).
- Multivariable regression identified NSA and glenosphere size as the strongest independent predictors of maximal ROM.
Conclusions:
- 3D simulation incorporating scapulothoracic motion demonstrates that rTSA implant positioning significantly influences impingement-free ROM.
- Specific implant choices, such as larger/eccentric glenospheres with greater lateralization, enhance ROM, whereas higher NSAs can limit it.
- NSA and glenosphere size are critical determinants of maximal ROM in rTSA.
