Glenoid implant orientation and cement failure in total shoulder arthroplasty: A finite element analysis

Charlie Yongpravat, Hyun-Min Mike Kim, Thomas R. Gardner, Louis U. Bigliani, William N. Levine, Christopher S. Ahmad

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background: To minimize glenoid implant loosening in total shoulder arthroplasty (TSA), the ideal surgical procedure achieves correction to neutral version, complete implant-bone contact, and bone stock preservation. These goals, however, are not always achievable, and guidelines to prioritize their impact are not well established. The purpose of this study was to investigate how the degree of glenoid correction affects potential cement failure. Methods: Eight patient-specific computer models were created for 4 TSA scenarios with different permutations of retroversion correction and implant-bone contact. Two bone models were used: a homogeneous cortical bone model and a heterogeneous cortical-trabecular bone model. A 750-N load was simulated, and cement stress was calculated. The risk of cement mantle fracture was reported as the percentage of cement stress exceeding the material endurance limit. Results: Orienting the glenoid implant in retroversion resulted in the highest risk of cement fracture in a homogeneous bone model (P<.05). In the heterogeneous bone model, complete correction resulted in the highest risk of failure (P=.0028). A positive correlation (ρ=0.901) was found between the risk of cement failure and amount of exposed trabecular bone. Conclusions: Incorporating trabecular bone into the model changed the effect of implant orientation on cement failure. As exposed trabecular bone increased, the risk of cement fracture increased. This may be due to shifting the load-bearing support underneath the cement from cortical bone to trabecular bone.

Original languageEnglish (US)
Pages (from-to)940-947
Number of pages8
JournalJournal of Shoulder and Elbow Surgery
Volume22
Issue number7
DOIs
StatePublished - Jul 1 2013

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Finite Element Analysis
Arthroplasty
Bone and Bones
Weight-Bearing
Computer Simulation
Cancellous Bone
Guidelines
Cortical Bone

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Yongpravat, Charlie ; Kim, Hyun-Min Mike ; Gardner, Thomas R. ; Bigliani, Louis U. ; Levine, William N. ; Ahmad, Christopher S. / Glenoid implant orientation and cement failure in total shoulder arthroplasty : A finite element analysis. In: Journal of Shoulder and Elbow Surgery. 2013 ; Vol. 22, No. 7. pp. 940-947.
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Glenoid implant orientation and cement failure in total shoulder arthroplasty : A finite element analysis. / Yongpravat, Charlie; Kim, Hyun-Min Mike; Gardner, Thomas R.; Bigliani, Louis U.; Levine, William N.; Ahmad, Christopher S.

In: Journal of Shoulder and Elbow Surgery, Vol. 22, No. 7, 01.07.2013, p. 940-947.

Research output: Contribution to journalArticle

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T1 - Glenoid implant orientation and cement failure in total shoulder arthroplasty

T2 - A finite element analysis

AU - Yongpravat, Charlie

AU - Kim, Hyun-Min Mike

AU - Gardner, Thomas R.

AU - Bigliani, Louis U.

AU - Levine, William N.

AU - Ahmad, Christopher S.

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N2 - Background: To minimize glenoid implant loosening in total shoulder arthroplasty (TSA), the ideal surgical procedure achieves correction to neutral version, complete implant-bone contact, and bone stock preservation. These goals, however, are not always achievable, and guidelines to prioritize their impact are not well established. The purpose of this study was to investigate how the degree of glenoid correction affects potential cement failure. Methods: Eight patient-specific computer models were created for 4 TSA scenarios with different permutations of retroversion correction and implant-bone contact. Two bone models were used: a homogeneous cortical bone model and a heterogeneous cortical-trabecular bone model. A 750-N load was simulated, and cement stress was calculated. The risk of cement mantle fracture was reported as the percentage of cement stress exceeding the material endurance limit. Results: Orienting the glenoid implant in retroversion resulted in the highest risk of cement fracture in a homogeneous bone model (P<.05). In the heterogeneous bone model, complete correction resulted in the highest risk of failure (P=.0028). A positive correlation (ρ=0.901) was found between the risk of cement failure and amount of exposed trabecular bone. Conclusions: Incorporating trabecular bone into the model changed the effect of implant orientation on cement failure. As exposed trabecular bone increased, the risk of cement fracture increased. This may be due to shifting the load-bearing support underneath the cement from cortical bone to trabecular bone.

AB - Background: To minimize glenoid implant loosening in total shoulder arthroplasty (TSA), the ideal surgical procedure achieves correction to neutral version, complete implant-bone contact, and bone stock preservation. These goals, however, are not always achievable, and guidelines to prioritize their impact are not well established. The purpose of this study was to investigate how the degree of glenoid correction affects potential cement failure. Methods: Eight patient-specific computer models were created for 4 TSA scenarios with different permutations of retroversion correction and implant-bone contact. Two bone models were used: a homogeneous cortical bone model and a heterogeneous cortical-trabecular bone model. A 750-N load was simulated, and cement stress was calculated. The risk of cement mantle fracture was reported as the percentage of cement stress exceeding the material endurance limit. Results: Orienting the glenoid implant in retroversion resulted in the highest risk of cement fracture in a homogeneous bone model (P<.05). In the heterogeneous bone model, complete correction resulted in the highest risk of failure (P=.0028). A positive correlation (ρ=0.901) was found between the risk of cement failure and amount of exposed trabecular bone. Conclusions: Incorporating trabecular bone into the model changed the effect of implant orientation on cement failure. As exposed trabecular bone increased, the risk of cement fracture increased. This may be due to shifting the load-bearing support underneath the cement from cortical bone to trabecular bone.

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