Optimizing Deltoid Efficiency with Reverse Shoulder Arthroplasty Using a Novel Inset Center of Rotation Glenosphere Design.

Paul Grammont's hemispherical gleno sphere concept medializes the center of rotation (CoR) to the glenoid face to increase deltoid abductor moment arms and improve muscle efficiency. Reducing glenosphere thickness to less than half its spherical radius further medializes the CoR and offers the potential for even greater improvements in efficiency. To that end, this study quantifies deltoid abducttor moment arms for six different rTSA prostheses during scapular abduction from 0° to 140°.A 3D computer model was developed in Uni graphics to quantify deltoid moment arms during scapular abduction for the normal anatomic shoulder, the 36 mm Grammont Delta III (Depuy, Inc.), 36 mm BIO-RSA ® (Tornier, Inc.), the 32 mm RSP® (DJO, Inc.), and the Equinoxe® rTSA (Exactech, Inc.) with three different glenosphere geometries: 38 mm x 21 mm, 46 mm x 25 mm, and the novel 46 mm x 21 mm. Each muscle was simulated as three lines from origin to insertion as the arm was elevated; positional data was exported to Matlab where the abductor moment arms were calculated for the anterior, middle, and posterior deltoid from 0° to 140° humeral abduction in the scapular plane using a 1.8:1 scapular rhythm.The 46 mm x 21 mm glenosphere had the larg est average abductor moment arms and also the largest efficiency for all three heads of the deltoid, having a 4.8% to 40.7% increase in the average deltoid efficiency relative to all other designs tested. The glenosphere design with the next most efficient deltoid was the 36 mm Delta III, which had the next most medialized CoR. The two least efficient designs were the BIO-RSA ® and the DJO RSP® , which had the most lateral CoR.These results provide new biomechanical insights on the impact of glenosphere geometry on deltoid abductor moment arms and demonstrate that subtle changes in rTSA prosthesis design can result in dramatic improvements. Increasing glenosphere diameter while also decreasing thickness to be less than half its spherical radius may minimize the muscle forces required to perform activities of daily living. Clinical follow-up is necessary to demonstrate a reduction in complications related to joint over-loading and also demonstrate greater increases in range of motion for patients with weak musculature.