Factors Affecting Stability of the Reverse Total Shoulder Arthroplasty: A Cadaveric Biomechanical Study

Ryan Bicknell1, *, Michael Furlan2, Alexander Bertelsen3, Frederick Matsen3
1 Department of Surgery, Queen's University, Kingston, Canada
2 Department of Physics, Queen's University, Engineering Physics and Astronomy, Kingston, Canada
3 Department of Orthopaedics and Sports Medicine, University of Washingston, Seattle, Washington, USA

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Creative Commons License
© 2020 Bicknell et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Surgery, Queen's University, Kingston, Canada; E-mail:



The overall objective of this study was to investigate whether a reverse shoulder arthroplasty could provide adequate stability to a shoulder even with extreme soft tissue loss. The specific objectives of this study were: to determine if just the deltoid, conjoined tendon, and triceps are sufficient soft tissues to allow a Reverse Shoulder Arthroplasty (RSA) to provide shoulder stability and to determine the influence of load direction, rotation, shoulder position, and polyethylene thickness on RSA stability in this soft-tissue deficient model.


This study utilized six cadaveric shoulders that had all soft tissue removed, with the exception of the deltoid, conjoint tendon, and long head of triceps. A reverse shoulder arthroplasty was then performed (Delta III, DePuy Inc., Warsaw, IN) and an increasing dislocation force was applied perpendicular to the humeral socket centerline until dislocation occurred, or a maximum load of 100 N was reached. This was repeated to measure the effect of four factors: load direction, arm position, polyethylene thickness, and arm rotation on force to dislocation.


For load direction, there was an increase in force to dislocate an inferior load direction (p=0.01). There was a lower not dislocated percentage and lower survival for a posterior load direction (p=0.02). For arm position, there was a decrease in force for dislocation and lower survival for both abduction and extension arm positions. There was a higher not dislocated percentage for a flexion arm position (p=0.01). For arm rotation, there was a lower not dislocated percentage and lower survival for an external rotation arm position (p=0.03). There was no statistically significant influence of polyethylene thickness (p=0.26).


The deltoid, conjoined tendon, and triceps are sufficient to stabilize an RSA. Load direction, arm position, and arm rotation were all shown to significantly affect stability. Finally, polyethylene thickness may not affect overall RSA stability in this soft-tissue deficient model.

Level of Evidence:

Basic science study, Biomechanical study.

Keywords: Reverse shoulder arthroplasty, Stability, Dislocation, Simulator, Biomechanics, Polyethylene.