title: The effect of glenosphere diameter in reverse shoulder arthroplasty on muscle force, joint load, and range of motion.
abstract: BACKGROUND
  Little is known about the effects of glenosphere diameter on shoulder joint loads. The purpose of this biomechanical study was to investigate the effects of glenosphere diameter on joint load, load angle, and total deltoid force required for active abduction and range of motion in internal/external rotation and abduction.
  
  
  METHODS
  A custom, instrumented reverse shoulder arthroplasty implant system capable of measuring joint load and varying glenosphere diameter (38 and 42 mm) and glenoid offset (neutral and lateral) was implanted in 6 cadaveric shoulders to provide at least 80% power for all variables. A shoulder motion simulator was used to produce active glenohumeral and scapulothoracic motion. All implant configurations were tested with active and passive motion with joint kinematics, loads, and moments recorded.
  
  
  RESULTS
  At neutral and lateralized glenosphere positions, increasing diameter significantly increased joint load (+12 ± 21 N and +6 ± 9 N; P < .01) and deltoid load required for active abduction (+9 ± 22 N and +11 ± 15 N; P < .02), whereas joint load angle was unaffected (P > .8). Passive internal rotation was reduced with increased diameter at both neutral and lateralized glenosphere positions (-6° ± 6° and -12° ± 6°; P < .002); however, external rotation was not affected (P > .05). At neutral glenosphere position, increasing diameter increased the maximum angles of both adduction (+1° ± 1°; P = .03) and abduction (+8° ± 9°; P < .05). Lateralization also increased abduction range of motion compared with neutral (P < .01).
  
  
  CONCLUSIONS
  Although increasing glenosphere diameter significantly increased joint load and deltoid force, the clinical impact of these changes is presently unclear. Internal rotation, however, was reduced, which contradicts previous bone modeling studies, which we postulate is due to increased posterior capsular tension as it is forced to wrap around a larger 42 mm implant assembly.
authors.affiliation: Biomechanics Laboratory, Roth|McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, University of Western Ontario, London, ON, Canada.
authors.forename: G Daniel G
authors.initials: GD
authors.lastname: Langohr
authors.affiliation: Biomechanics Laboratory, Roth|McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, University of Western Ontario, London, ON, Canada.
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Giles
authors.affiliation: Biomechanics Laboratory, Roth|McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, University of Western Ontario, London, ON, Canada. Electronic address: gathwal@uwo.ca.
authors.forename: George S
authors.initials: GS
authors.lastname: Athwal
authors.affiliation: Biomechanics Laboratory, Roth|McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, University of Western Ontario, London, ON, Canada.
authors.forename: James A
authors.initials: JA
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000295:instrumentation* / Q000379:methods; D001696:Biomechanical Phenomena; D002102:Cadaver; D057645:Deltoid Muscle; D006801:Humans; D007595:Joint Prosthesis; D008875:Middle Aged; D011474:Prosthesis Design; D016059:Range of Motion, Articular; D012399:Rotation; D012540:Scapula; D012785:Shoulder Joint / Q000503:physiopathology* / Q000601:surgery*
keywords: Reverse total shoulder arthroplasty; biomechanics; glenosphere; implant size; rotator cuff tear arthropathy; shoulder