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 Shoulder/Elbow Test 3: The Shoulder: Arthroplasty, Cuff Arthroplasty
CME 1: January, February, March 2004
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The Journal of Bone and Joint Surgery (American) 86:575-580 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Influence of Humeral Prosthesis Height on Biomechanics of Glenohumeral Abduction

An In Vitro Study

Richard W. Nyffeler, MD1, Ralph Sheikh, MD2, Hilaire A.C. Jacob, PhD2 and Christian Gerber, MD2

1 Orthopaedic Hospital, University of Lausanne, Avenue Pierre-Decker 4, 1005 Lausanne, Switzerland. E-mail address: richard.nyffeler{at}bluewin.ch
2 Department of Orthopaedic Surgery, University of Zurich, Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland

Investigation performed at the Department of Orthopaedic Surgery, University of Zurich, Balgrist, Zurich, Switzerland

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: During shoulder replacement surgery, the normal height of the proximal part of the humerus relative to the tuberosities frequently is not restored because of differences in prosthetic geometry or problems with surgical technique. The purpose of the present study was to determine the effect of humeral prosthesis height on range of motion and on the moment arms of the rotator cuff muscles during glenohumeral abduction.

Methods: Tendon excursions and abduction angles were recorded simultaneously in six cadaveric specimens during passive glenohumeral abduction in the scapular plane. Moment arms were calculated for each muscle by computing the slope of the tendon excursion-versus-glenohumeral abduction angle relationship. The experiments were carried out with the intact joint and after replacement of the humeral head with a prosthesis that was inserted in an anatomically correct position as well as 5 and 10 mm too high.

Results: Insertion of the prosthesis in positions that were 5 and 10 mm too high resulted in significant and marked reductions of the maximum abduction angle of 10° (range, 5° to 18°) and 16° (range, 12° to 20°), respectively. In addition, the moment arms of the infraspinatus and subscapularis decreased by 4 to 10 mm. This corresponded to a 20% to 50% decrease of the abduction moment arms of the infraspinatus and an approximately 50% to 100% decrease of the abduction moment arms of the subscapularis, depending on the abduction angle and the part of the muscle being considered.

Conclusions: If a humeral head prosthesis is placed too high relative to the tuberosities, shoulder function is impaired by two potential mechanisms: (1) the inferior capsule becomes tight at lower abduction angles and limits abduction, and (2) the center of rotation is displaced upward in relation to the line of action of the rotator cuff muscles, resulting in smaller moment arms and decreased abduction moments of the respective muscles.

Clinical Relevance: In patients managed with shoulder replacement surgery, limitation of range of motion, loss of abduction strength, and overload with long-term failure of the supraspinatus tendon are potential consequences of positioning the humeral head of the prosthesis proximal to the anatomic position.


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