title: Wear rates of retentive versus nonretentive reverse total shoulder arthroplasty liners in an in vitro wear simulation.
abstract: BACKGROUND
  Although short-term outcomes of reverse total shoulder arthroplasty (rTSA) remain promising, the most commonly cited complication remains prosthetic instability. A retentive rTSA liner is commonly used to increase system constraint; however, no studies have evaluated the rate of polyethylene wear. Our hypothesis was that more constrained retentive liners would have higher wear rates than nonretentive liners.
  
  
  METHODS
  Six nonretentive and six retentive rTSA non-cross-linked polyethylene liners were subjected to 4.5 million cycles of alternating cycles of abduction-adduction and flexion-extension motion loading profiles. The rTSA liners were assessed for gravimetric wear loss, 3-dimensional volumetric loss by novel micro-computed tomography analysis, and particulate wear debris analysis.
  
  
  RESULTS
  Volumetric wear rates were significant at 7 specific time points (1.0, 2.0, 2.5, 3.25, 3.75, 4.0, and 4.5 million cycles) throughout testing between nonretentive and retentive liners; however, overall mean volumetric wear rate was not statistically significant (P = .076). Total volume loss between liner test groups was found to be significant starting after 3.5 million cycles of testing. Maximum and mean surface deviations were found to be larger for retentive liners vs. nonretentive liners by micro-computed tomography analysis across the entire articulation surface.
  
  
  CONCLUSIONS
  Retentive liners undergo significantly greater volume loss and greater surface deviation compared with nonretentive liners, most notably at later time points representing extended implantation times. Additional stability afforded by retentive liners should be balanced against the potential for increased wear and potential for subsequent polyethylene wear-induced aseptic loosening.
authors.affiliation: Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Carpenter
authors.affiliation: Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA.
authors.forename: Daphne
authors.initials: D
authors.lastname: Pinkas
authors.affiliation: Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Newton
authors.affiliation: Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA; Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kurdziel
authors.affiliation: Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA; Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Baker
authors.affiliation: Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA; Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI, USA. Electronic address: mwiater@beaumont.edu.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Wiater
mesh_terms: D019412:Anatomy, Cross-Sectional; D019643:Arthroplasty, Replacement / Q000295:instrumentation*; D001672:Biocompatible Materials; D003198:Computer Simulation; D019544:Equipment Failure Analysis; D006801:Humans; D020959:Polyethylene; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012785:Shoulder Joint / Q000601:surgery; D055114:X-Ray Microtomography
chemical_list: D001672:Biocompatible Materials; D020959:Polyethylene
keywords: Retentive humeral liners; in vitro wear simulation; micro-CT surface deviation analysis; reverse total shoulder arthroplasty; wear particle analysis