Effect of rotator cuff dysfunction on the initial mechanical stability of cementless glenoid components

The functional outcome of shoulder replacement is related to the condition of the rotator cuff. Rotator cuff disease is a common problem in candidates for total shoulder arthroplasty; this study relates the functional status of the rotator cuff to the initial stability of a cementless glenoid implant. A 3D finite element model of a complete scapula was used to quantify the effect of a dysfunctional rotator cuff in terms of bone-implant interface micromotions when the implant is physiologically loaded shortly after surgery. Four rotator cuff conditions (from fully intact to progressively ruptured rotator cuff tendons) as well as two bone qualities were simulated in a model. Micromotions were significantly larger in the worst modeled cuff dysfunction (i.e. the supraspinatus and infraspinatus tendons were fully dysfunctional). Micromotions were also significantly different between conditions with healthy and poor bone quality. The implant's initial stability was hardly influenced by a dysfunctional supraspinatus alone. However, when the infraspinatus was also affected, the glenohumeral joint force was displaced to the component's rim resulting in larger micromotions and instability of the implant.