title: Reverse total shoulder arthroplasty component center of rotation affects muscle function.
abstract: BACKGROUND
  Medialization of the glenohumeral center of rotation alters the moment arm of the deltoid, can affect muscle function, and increases the risk for scapular notching due to impingement. The objective of this study was to determine the effect of position of the glenosphere on deltoid efficiency and the range of glenohumeral adduction.
  
  
  METHODS
  Scapulohumeral bone models were reconstructed from computed tomography scans and virtually implanted with primary or reverse total shoulder arthroplasty implants. The placement of the glenosphere was varied to simulate differing degrees of "medialization" and inferior placement relative to the glenoid. Muscle and joint forces were computed during shoulder abduction in OpenSim musculoskeletal modeling software.
  
  
  RESULTS
  The average glenohumeral joint reaction forces for the primary total shoulder arthroplasty were within 5% of those previously reported in vivo. Superior placement or full lateralization of the glenosphere increased glenohumeral joint reaction forces by 10% and 18%, respectively, relative to the recommended reverse total shoulder arthroplasty position. The moment arm of the deltoid muscle was the highest at the recommended baseline surgical position. The baseline glenosphere position resulted in a glenohumeral adduction deficit averaging more than 10° that increased to more than 25° when the glenosphere was placed superiorly. Only with full lateralization was glenohumeral adduction unaffected by superoinferior placement.
  
  
  CONCLUSIONS
  Selecting optimum placement of the glenosphere involves tradeoffs in bending moment at the implant-bone interface, risk for impingement, and deltoid efficiency. A viable option is partially medializing the glenosphere, which retains most of the benefits of deltoid efficiency and reduces the risk for scapular notching.
authors.affiliation: Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA.
authors.forename: Heinz R
authors.initials: HR
authors.lastname: Hoenecke
authors.affiliation: Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA.
authors.forename: Cesar
authors.initials: C
authors.lastname: Flores-Hernandez
authors.affiliation: Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA. Electronic address: ddlima@scripps.edu.
authors.forename: Darryl D
authors.initials: DD
authors.lastname: D'Lima
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000379:methods; D002102:Cadaver; D003198:Computer Simulation; D057645:Deltoid Muscle / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000503:physiopathology / Q000601:surgery*; D008953:Models, Anatomic; D016059:Range of Motion, Articular; D012399:Rotation; D012540:Scapula / Q000000981:diagnostic imaging; D012782:Shoulder / Q000601:surgery*; D019534:Shoulder Impingement Syndrome / Q000209:etiology / Q000503:physiopathology*; D012785:Shoulder Joint / Q000503:physiopathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Shoulder arthroplasty; deltoid function; glenohumeral forces; glenosphere; reverse shoulder arthroplasty; shoulder biomechanics