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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 specific implant choices. Larger glenospheres and increased lateralization enhance range of motion (ROM), while higher neck-shaft angles (NSA) limit it.
Area of Science:
- Orthopedic surgery
- Biomechanical engineering
- Medical simulation
Background:
- Three-dimensional (3D) simulation enhances implant placement accuracy.
- The impact of 3D simulation on optimizing postoperative range of motion (ROM) after reverse total shoulder arthroplasty (rTSA) requires further definition.
Purpose of the Study:
- To utilize a 3D simulation model with scapulothoracic motion.
- To evaluate how rTSA implant variables influence standard ROM and functional activities.
Main Methods:
- Included patients undergoing rTSA (August 2025-October 2025).
- Recorded demographics and implant parameters: glenosphere size, eccentricity, lateralization, insert thickness, humeral neck-shaft angle (NSA), stem version, and baseplate version.
- Employed a 3D simulation model (CORIOGRAPH MODELER) to assess impingement-free ROM across 12 motions for all implant configurations.
Main Results:
- Forty-nine patients (median age 70.1 years) were analyzed.
- Larger glenospheres, eccentric positioning, and increased lateralization correlated with greater impingement-free ROM (P < .05).
- Higher NSA was associated with reduced ROM (P < .05); NSA and glenosphere size were key predictors of maximal ROM.
Conclusions:
- 3D simulation incorporating scapulothoracic motion demonstrates implant positioning impacts rTSA impingement-free ROM.
- Specific implant choices, including glenosphere size and lateralization, can improve ROM, while NSA influences motion limitations.
- NSA and glenosphere size are identified as the strongest independent predictors of maximal ROM in rTSA.
