Biomechanical comparison of zoned-conformity glenoid versus standard glenoid in total shoulder arthroplasty: impact on rotator cuff strain and glenohumeral translation.

Abstract

Current standard total shoulder arthroplasty glenoid implants allow for high levels of glenohumeral mismatch and associated high levels of humeral head translation to improve range of motion and reduce rim stresses on the glenoid. However, high levels of glenohumeral mismatch could also increase glenoid edge loading, eccentric wear, and rotator cuff strain. A zoned-conformity glenoid may be able to reduce the forces on the rotator cuff and glenoid. We compared rotator cuff strain and glenohumeral translation between a standard glenoid (SG) with moderate glenohumeral mismatch and a zoned-conformity glenoid (conforming glenoid [CG]) that limits mismatch. We hypothesized that the CG would have lower levels of strain on the rotator cuff and lower levels of humeral head translation compared with the SG. Eight fresh frozen cadaveric shoulders, aged 72 years (range, 67-76 years), were used in this biomechanical study. The specimens were first tested in the intact state. We cycled them 3 times from 0° to 60° of abduction and measured the superiorly-inferiorly and anteriorly-posteriorly directed forces at the joint, compressive forces applied to the glenoid, and humeral head translation. The specimens were then implanted with a standard press-fit humeral component and a polyethylene glenoid with 3 peripherally cemented pegs and a central press-fit peg. Testing was repeated. Finally, the SG was removed, the CG was implanted, and each specimen was tested a third time. The average superiorly directed force at the glenohumeral joint was significantly lower in the intact and CG groups (18.1 ± 18.6 N and 19.8 ± 16.2 N, respectively) than in the SG group (29.3 ± 21.9 N, P = .024). The maximum force directed against the glenoid was also significantly lower in the CG group (87.6 ± 11.7 N) than in the SG (96.0 ± 7.3 N) and intact (98.9 ± 16.5 N) groups (P = .035). No difference was observed in humeral head translation in the anterior-posterior plane from 0° to 60° of abduction (P = .998) or in the superior-inferior plane (P = .999). A zoned-conformity glenoid was associated with similar humeral head translation but significantly lower superior forces against the rotator cuff and a significantly lower maximum force against the glenoid compared with an SG implant. These biomechanical findings suggest that a zoned-conformity implant warrants further study in the effort to maintain humeral head translation while reducing rotator cuff and glenoid forces for successful outcomes of total shoulder arthroplasty.