Étude numérique de l'impact des paramètres chirurgicaux de l'arthroplastie totale anatomique sur les risques de complications postopératoires

Abstract

In anatomical total shoulder arthroplasty, the loosening of the glenoid implant is the most common complication. It can be caused by high shear forces applied to the glenoid or by an eccentric loading of the glenoid implant provoking the “rocking” of the glenoid. The critical shoulder angle (CSA) is a geometrical measure that was correlated with earlier radiological signs of glenoid loosening. This angle varies with the glenoid inclination and the acromion length. However, the mechanism linking the CSA with glenoid loosening remains unclear due to the limitations of experimental and computational studies to evaluate the position of the force applied to the glenoid. The main purpose of this thesis was to develop a musculoskeletal model to study the impact of the CSA on biomechanical risk factors of glenoid loosening. An already developed musculoskeletal model of the shoulder with anatomical shoulder implants was used in AnybodyTM. Multiple CSA configurations were simulated by varying the acromion length and the glenoid inclination during an abduction. In this study, increasing the CSA with an upward-tilted glenoid and a longer acromion, increased the superior humeral displacement, leading to a more eccentric force and to higher moment and shear applied to the glenoid. The increased moment and shear could lead more “rocking” of the glenoid implant leading to higher risks of its loosening. These results suggest that correcting down the CSA by reducing the glenoid inclination or the acromion length with acromioplasty could reduce the risks of glenoid loosening.

Date	28 Oct 2024
Original language	French
Awarding Institution	École de technologie supérieure
Supervisor	Nicola Hagemeister (Supervisor) & Mickael Begon (Co-supervisor)