Analysis of Glenoid Fixation with Anatomic Total Shoulder Arthroplasty in an Extreme Cyclic Loading Scenario

ASTM F2028-14 was adopted to recom mend a cyclic eccentric glenoid edge loading test that simulates the rocking horse loading mechanism beleived to cause aTSA glenoid loosening. While this method accurately simulates that failure mechanism, the recommended 750 N load may not be sufficient to simulate worst-case loading magnitudes, and the recommended 100,000 cycles may not be sufficient to simulate device fatigue-related failure modes. Finally, if greater loading magnitude or a larger number of cycles is performed, the recommended substrate density may not be sufficiently strong to support the elevated loads and cycles. To this end, a new test method is proposed to supplement ASTM F2028-14.A series of cyclic tests were performed to evaluate the long-term fixation strength of two different hybrid glenoid designs in both low (15 pcf) and high (30 pcf) density polyurethane blocks at elevated loads relative to ASTM F2028-14. To simulate a worst case clinical condition in which the humeral head is superiorly migrated, a cyclic load was applied to the superior glenoid rim to induce a maximum torque on the fixation pegs for three different cyclic loading tests: 1. 1,250 N load for 0.75 M cycles in a 15 pcf block, 2. 1,250 N load for 1.5 M cycles in a 30 pcf block, and 3. 2,000 N load for 0.65 M cycles in a 30 pcf block.All devices completed cyclic loading without failure, fracture, or loss of fixation regardless of glenoid design, polyurethane density, loading magnitude, or cycle length. No significant difference in post-cyclic displacement was noted between designs in any of the three tests. Post-cyclic radiographs demonstrated that each device maintained fixa - tion with the metal pegs within the bone-substitute blocks with no fatigue related failures.These results demonstrate that both cemented hybrid glenoids maintained fixation when tested according to each cyclic loading scenario, with no difference in post-cyclic displacement observed between designs. The lack of fatigue-related failures in these elevated load and high cycle test scenarios are promising, as are the relatively low displacements given the extreme nature of each test. This cyclic loading method is intended to supplement the ASTM F2028-14 standard that adequately simulates the rocking horse loading mechanism but may not adequately simulate the fatigue-related failure modes.