Three-Dimensional Finite Element Analysis of a Notched Insert Design for Reverse Total Shoulder Arthroplasty to Prevent Scapular Notching

ZİROĞLU N., Balin H., UÇAN V., Bozdağ S. E., KAPICIOĞLU M., Bilsel K.

Indian Journal of Orthopaedics, 2023 (SCI-Expanded) identifier

  • Publication Type: Article / Article
  • Publication Date: 2023
  • Doi Number: 10.1007/s43465-023-00975-7
  • Journal Name: Indian Journal of Orthopaedics
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CAB Abstracts, CINAHL
  • Keywords: Cuff tear arthropathy, Finite element analysis, Insert, Notched insert, Reverse total shoulder arthroplasty, Scapular notching
  • Istanbul Technical University Affiliated: Yes


Purpose: Reverse total shoulder arthroplasty (RSA) is an effective treatment option for rotator cuff arthropathy. Scapular notching following RSA remains a major complication and has a high incidence. This finite element analysis (FEA) study provides a future reference for the optimal design of the insert component of RSA. This study aims to clarify the effect of a new design RSA with a notched insert on the range of adduction, scapular notching, and stress variation of its insert component using three-dimensional (3D) FEA. Methods: 3D nominal Grammont-type monobloc RSA implant components are modeled on the sawbones glenohumeral joint. The polyethylene insert is redesigned with notching of the inferior part. The comparison of standard and notched designs was performed by FEA for stress pressure of scapular notching and the degree of adduction. 3D mesh models are created for stress analysis to compare the results between standard and notched inserts for the adduction. Results: The redesigned notched inserts had an additional ~ 11.2° on adduction and prevented scapular notching. The stress analysis results for the notched insert design were lower than the standard ones (4.7 vs 22.4 Kpa). Conclusions: Notched insert design of Grammont-type RSA could provide additional adduction with lower stress on the glenoid, leading to less scapular notching. Further experimental and clinical studies on different RSA types are needed to verify this effect. Study Design: Basic Science Study; Biomechanics and Computer Modeling.