The effect of load and plane of elevation on acromial stress after reverse shoulder arthroplasty.

Background: Acromial fractures are a substantial complication following reverse shoulder arthroplasty, reported to affect up to 7% of patients. Previous studies have shown that implant placement affects acromial stress during elevation of the arm in the scaption plane. The purpose of this study was to investigate the results of arm loading and variation in plane of elevation on acromial stresses.
Methods: Nine elevation angles (0°-120°), in three planes of elevation (abduction (0°), scaption (30°), and forward elevation (60°)), and three hand loads (0, 2.5, 5 kg) were investigated. Finite element models were generated using computed tomography data from 10 cadaveric shoulders (age 68 ± 19 yrs) to determine acromial stress distributions. Models were created for a lateralized glenosphere (0, 5, 10 mm), inferiorized glenosphere (0, 2.5, 5 mm), and humeral offset (-5, 0, 5 mm).
Results: For all planes of elevation (0°, 30°, 60°) and hand loads (0, 2.5, 5 kg) investigated, glenoid lateralization consistently increased acromial stress, glenoid inferiorization consistently decreased acromial stress, and humeral offset proved to be insignificant in altering acromial stress. Abduction resulted in significantly higher peak acromial stresses (p = 0.002) as compared to scaption and forward elevation.
Conclusions: In addition to implant position and design, patient activity, such as plane of elevation and hand loads, has substantial effects on acromial stresses.
Level of Evidence: Basic science study.
Competing Interests: Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: George S. Athwal is a consultant for Wright Medical and Exactech. No company was involved with this study.
(© 2020 The British Elbow & Shoulder Society.)