title: Tightening force and torque of nonlocking screws in a reverse shoulder prosthesis.
abstract: BACKGROUND
  Reversed shoulder arthroplasty is an accepted treatment for glenohumeral arthritis associated to rotator cuff deficiency. For most reversed shoulder prostheses, the baseplate of the glenoid component is uncemented and its primary stability is provided by a central peg and peripheral screws. Because of the importance of the primary stability for a good osteo-integration of the baseplate, the optimal fixation of the screws is crucial. In particular, the amplitude of the tightening force of the nonlocking screws is clearly associated to this stability. Since this force is unknown, it is currently not accounted for in experimental or numerical analyses. Thus, the primary goal of this work is to measure this tightening force experimentally. In addition, the tightening torque was also measured, to estimate an optimal surgical value.
  
  
  METHODS
  An experimental setup with an instrumented baseplate was developed to measure simultaneously the tightening force, tightening torque and screwing angle, of the nonlocking screws of the Aquealis reversed prosthesis. In addition, the amount of bone volume around each screw was measured with a micro-CT. Measurements were performed on 6 human cadaveric scapulae.
  
  
  RESULTS
  A statistically correlated relationship (p<0.05, R=0.83) was obtained between the maximal tightening force and the bone volume. The relationship between the tightening torque and the bone volume was not statistically significant.
  
  
  CONCLUSIONS
  The experimental relationship presented in this paper can be used in numerical analyses to improve the baseplate fixation in the glenoid bone.
authors.affiliation: Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland. alexander.terrier@epfl.ch
authors.forename: A
authors.initials: A
authors.lastname: Terrier
authors.forename: S H
authors.initials: SH
authors.lastname: Kochbeck
authors.forename: F
authors.initials: F
authors.lastname: Merlini
authors.forename: M
authors.initials: M
authors.lastname: Gortchacow
authors.forename: D P
authors.initials: DP
authors.lastname: Pioletti
authors.forename: A
authors.initials: A
authors.lastname: Farron
mesh_terms: D000465:Algorithms; D019643:Arthroplasty, Replacement / Q000379:methods*; D001696:Biomechanical Phenomena; D015519:Bone Density; D001863:Bone Screws; D001842:Bone and Bones / Q000601:surgery; D002102:Cadaver; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans; D007595:Joint Prosthesis; D012785:Shoulder Joint / Q000601:surgery*; D019415:Torque; D055114:X-Ray Microtomography / Q000379:methods*