Primary stability in reversed-anatomy glenoid components

Abstract

Reversed-anatomy shoulder replacement is advocated for patients with poor rotator cuff condition, for whom an anatomical reconstruction would provide little or no stability. Modern generations of this concept appear to be performing well in the short-term to midterm clinical follow-up. These designs are almost always non-cemented, requiring a high degree of primary stability to encourage bone on-growth and so to establish long-term fixation. Six different inverse-anatomy glenoid implants, currently on the market and encompassing a broad range of geometrical differences, were compared on the basis of their ability to impart primary stability through the minimization of interface micromotions. Fixing screws were only included in the supero-inferior direction in appropriate implants and were always inclined at the steepest available angle possible during surgery (up to a maximum of 30 degrees). The extent of predicted bony on-growth was, of course, highly dependent on the threshold for interface micromotion. In some instances an additional 30 per cent of the interface was predicted to promote bone on-growth when the threshold was raised from 20 microm to 50 microm. With maximum thresholds of micromotion for bone on-growth set to 30 microm, the Zimmer Anatomical device was found to be the most stable of the series of the six designs tested herein, achieving an additional 3 per cent (by surface area) of bone on-growth above the closest peer product (Biomet Verso). When this threshold was raised to 50 microm, the Biomet Verso design was most stable (3 per cent above the second-most stable design, the Zimmer Anatomical). Peak micromotions were not a good indicator of the predicted area of bone on-growth and could lead to some misinterpretation of the implant's overall performance. All but one of the implants tested herein provided primary stability sufficient to resist motions in excess of 150 microm at the interface.