Analysis of the coaptation role of the deltoid in reverse shoulder arthroplasty. A preliminary biomechanical study

BACKGROUND: Lateralization of the glenoid implant improves functional outcomes in Reverse Shoulder Arthroplasty. Lateralization does not appear to impact the Deltoid’s Moment Arm. Therefore, the stabilizing effect described in the literature would not be the result of an increase this moment arm. A static biomechanical model, derived from Magnetic Resonance Imaging, can be used to assess the coaptation effect of the Middle Deltoid. The objective of this study was to analyze the impact of increasing amounts of glenoid lateralization on the moment arm but also on its coaptation effect. METHODS: Eight patients (72.6 ± 6.5 years) operated for Reverse Shoulder Arthroplasty were included in the study. Three-dimensional models of each shoulder were created based on imaging taken at 6 months postoperative. A least square sphere representing the prosthetic implant was added to each 3D models. A static biomechanical model was then applied to different planar portions of the Middle Deltoid (from 3D models), first without lateralization and then with simulated lateralization of 6, 9 and 12mm. This static model enables to compute a Coaptation/Elevation Ratio and to measure the Deltoid’s Moment Arm. The inter- and intra-rater agreement of the 3D models was evaluated. RESULTS: One patient was excluded due to motion during imaging. The inter- and intra-rater agreement was over 0.99. The ratio increased starting at 6 mm of lateralization (p<0.05), compared to the initial position. The moment arm was not affected by lateralization (p<0.05), except in two slices starting at 9 mm (S1 p<0.05 and S2 p<0.05). CONCLUSION: Our hypothesis that the Middle Deltoid’s coaptation role would be greater with glenosphere lateralization was confirmed. This trend was not found in the moment arm, which showed little sensitivity to lateralization. The stabilizing effect therefore appears to stem from the coaptation role of the Middle Deltoid.