Reverse Total Shoulder Arthroplasty (rTSA) kinematics derived from radiographic and optical motion analysis

Page 1 of 5 Reverse Total Shoulder Arthroplasty (rTSA) kinematics derived from radiographic and optical motion analysis (v1.1) Henninger Lab, Harold K. Dunn Orthopaedic Research Laboratory University of Utah, Salt Lake City, UT https://medicine.utah.edu/orthopaedics/research/labs/harold-dunn/groups/henninger This repository contains an expanded release (second of three planned) of anatomies and kinematics from patients post-operative to (Grammont style) rTSA, including static poses and dynamic motions for up to 11 activities including arm rotations and unweighted and weighted elevation trials. Future releases will include timepoints from pre-op through 52 weeks of post-op recovery for a limited cohort. The data is formatted in the same manner as a prior release of data from healthy shoulders: (https://doi.org/10.5281/zenodo.10972004). Specific to the contents of this repository: 1. File naming convention a. Group_subject ID#_sex_age_side_activity_trial#_data i. E.g., Reverse_002_F_64_R_ERaR_t01_output.xlsx – this is a subject with Reverse total shoulder arthroplasty, subject #2, that is Female, 64 years old, Right side imaged, performing External Rotation at Rest, during trial #1, and this file contains all data relevant to the subject and/or activity 1. Note: Some subjects have the additional qualifier “_52wk”. These subjects were part of a study that collected both preand post-op timepoints to be released at a later time. 2. Activities provided were captured from seated subjects and include the following: a. Static poses i. Static – a resting neutral pose while seated upright, with elbows flexed 90 degrees, hands forward, thumbs up ii. IRaM – Internal rotation in adduction to maximum (e.g., thoracic reach with the hand behind the back [if possible]) iii. IRaB – a generic ‘belt-level’ internal rotation in adduction task (note: if the IRaB trial is absent then the IRaM did not reach to or beyond the belt level) b. Dynamic activities i. CA – coronal plane ab/adduction, elbow extended, thumb up ii. ERaR – Internal to max external rotation and back, with the arm hanging at the side, elbow flexed 90 degrees, thumb up iii. ERa90 - Internal to max external rotation and back, with the arm at roughly 90 degrees of humerothoracic coronal plane elevation, elbow flexed 90 degrees iv. FE – forward elevation/depression, elbow extended, thumb up v. SA – scapular plane ab/adduction (scaption), elbow extended, thumb up Page 2 of 5 vi. WCA – CA with a 2.2 kg handheld weight vii. WFE – FE with a 2.2. kg handheld weight viii. WSA – SA with a 2.2. kg handheld weight 3. Database contents: a. Models_and_anatomic_landmarks_(CT_coordinate_system) i. *.csv - anatomic landmarks for the scapula and humerus as posed in the pre-operative CT (scapula) or a resliced local coordinate system used for tracking of radiographic data (humerus). There are 6 scapular, and 5 humeral landmarks. 1. Note: Clinical patients had pathology often affecting the shape of the glenoid and humeral head, and did not have a CT scan to the elbow per standard clinical practice. Therefore, landmarks at the glenoid center should be interpreted with caution, and no landmarks derived from medical imaging for the humeral head center or epicondyles of the elbow are provided. The glenosphere center is provided as calculated relative to the scapula from postoperative dynamic imaging. ii. *.stl – 3D models of both the scapula and humerus 1. Notes for the scapula: Pre-operative bone models are provided in the native CT orientation with a generic glenosphere attached (accurate in diameter to the clinical case), as solved from the relative position and orientation to the bone in biplane fluoroscopy/dynamic stereoradiography. Given that these bone models were derived from pre-op scans, no glenoid baseplates or augments/grafts are shown, and osteophytes are not removed. 2. Notes for the humerus: Pre-operative bone models are provided in a resliced and reoriented local coordinate system used in tracking the kinematic data. A humeral osteotomy was created from the relative position and orientation of the plane of the metaphyseal component. A generic cylinder represents the position and orientation of the metaphyseal component and polymer insert, but not necessarily the true poly size/depth. The axisymmetric nature of the humerus and humeral implant means that subtle misalignment was possible when creating the combined bone-implant model for tracking. Similarly, the exact osteotomy plane could not be determined, nor could the extent of bone preparation and osteophyte removal. In some cases, there was clear visual evidence that stress shielding had also occurred around the proximal humeral metaphysis and stem. These cut planes and implant cylinders are provided for visualization only. b. Kinematic_output_database_(BF_coordinate_system) i. Output files are organized in folders by subject Page 3 of 5 ii. All data were collected at 100 Hz, co-calibrated in the local dynamic radiographic coordinate system (i.e., Vicon markers are already transformed into the fluoro system), and synchronized by a system trigger. iii. An output file in *.xlsx format for each activity performed by the subject: 1. Sheet 1 – demographics, pathology, and implant configuration 2. scapula – time-dependent positions of the scapula landmarks 3. humerus – time-dependent positions of the humerus landmarks 4. vicon – time-dependent positions of all Vicon markers collected a. Note that the system(s) these data were collected on had lines of sight that were potentially blocked during capture. These blocked data contain static values denoting the relative position of the Vicon calibration wand, and do not change relative to the subject activity. b. Use caution with T10. This marker was the most subject to blocking by the close proximity of the thorax to the image intensifiers, and in many cases was rigid-body filled from markers: Sternal Notch, Xyphoid Process, T5, and/or C7. c. In regions where a marker disappears mid-activity, filtering may have slightly influenced the boundary points in the trajectory. d. Data entered as “0” are placeholders since these markers are being used in ongoing kinematic studies and are thus included for consistency to future data releases. c. FEBio_kinemat_visualization_files_(BF_coordinate_system) i. Kinematic visualization files are organized in folders by subject ii. These files are intended to be utilized in FEBio 1. https://pubmed.ncbi.nlm.nih.gov/22482660/ 2. Free downloads can be found at: https://febio.org/ iii. *.k – scapula and humerus models posed together as a single model in their CT and/or local coordinate system(s). The scapula was loaded first, then the humerus geometry was imported second. Ordering is important for the *.txt. Note that in some cases the humerus model was segmented from a resliced local coordinate system (for ease of tracking) and will have no logical position and orientation relative to the scapula. In these models the *_kinemat.txt automatically corrects for this transformation. iv. *.txt – kinematics of the scapula and humerus as derived from the output files, transforming the static *.k bones into the dynamic radiography coordinate system. The format is two 4x4 transformation matrices laid out sequentially by row (i.e., 32 components per row) where the scapula comes first, followed by the humerus. v. *.fsps – xml model files loadable into FEBio that reference the *.k and *.txt files. These files are readable/editable using Notepad. d. Transforms_(vicon_to_fluoro) Page 4 of 5 i. *.xlsx – data for transformation between Vicon and radiography systems in the event a user desires to transform data back into the optical tracking coordinate system. This is useful to reference gravity since it cannot be assured that the fluoroscopy calibration cube was perfectly horizontal during imaging. 4. Notes specific to this repository a. The Grammont style implant systems represent those used in clinical practice from manufacturers including Stryker/Tornier, Depuy, and Zimmer-Biomet. b. Bones and implants are presented as external surfaces of the combined models so as not to share proprietary information on the respective implant designs. True implant models were aligned to bones during tracking to ensure accurate solutions that considered the position and orientation of both elements simultaneously. As mentioned previously, the glenosphere, humeral metaphysis, and polymer insert are modeled as a simple hemisphere and cylinder for visual referencing to the bone. c. Reverse_001 – this participant had a fracture of the acromion prior to surgery. Each fragment was segmented but in the interest of accuracy only the scapular body and intact partial acromion was used for fluoroscopic tracking in the event that the fragments were mobile. Interestingly, this subject had excellent humerothoracic elevation range of motion, even with the prior acromial and deltoid injury. d. Reverse_006 – short humerus model e. Reverse_007 – short humerus model f. Reverse_010 – this subject could not perform the CA or WCA activities, therefore no data for those trials are provided. g. Reverse_014 – this participant did not complete the 52-week arc of the enrolled study and was therefore omitted from this release since stable outcomes may not yet have been achieved at the latest timepoint h. Reverse_016 – short humerus model Data provided in this repository were generated with support from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) of the National Institutes of Health under award numbers R01 and R56 AR067196, and a Shared Instrumentation Grant S10 OD021644. Development of FEBio (Finite Elements for Biomechanics and Biophysics) was supported by the National Institute of General Medical Sciences (NIGMS) of the National Institutes of Health under award number R01 GM083925. Refer to the following publications for detailed methods of data collection and prior analyses using data from this repository in studies performed by our team: 1. Kolz CW, Sulkar HJ, Aliaj K, Tashjian RZ, Chalmers PN, Qiu Y, Zhang Y, Foreman KB, Anderson AE, Henninger HB. Reliable interpretation of scapular kinematics depends on coordinate system Page 5 of 5 definition. Gait Posture. 2020 Sep;81:183-190. doi: 10.1016/j.gaitpost.2020.07.020. Epub 2020 Jul 25. PMID: 32758918; PMCID: PMC7484087. 2. Kolz CW, Sulkar HJ, Aliaj K, Tashjian RZ, Chalmers PN, Qiu Y, Zhang Y, Bo Foreman K, Anderson AE, Henninger HB. Age-related differences in humerothoracic, scapulothoracic, and glenohumeral kinematics during elevation and rotation motions. J Biomech. 2021 Mar 5;117:110266. doi: 10.1016/j.jbiomech.2021.110266. Epub 2021 Jan 23. PMID: 33517243; PMCID: PMC7924070. 3. Aliaj K, Foreman KB, Chalmers PN, Henninger HB. Beyond Euler/Cardan analysis: True glenohumeral axial rotation during arm elevation and rotation. Gait Posture. 2021 Jul;88:28-36. doi: 10.1016/j.gaitpost.2021.05.004. Epub 2021 May 8. PMID: 33989999; PMCID: PMC8316370. 4. Aliaj K, Henninger HB. Kinematics-vis: A Visualization Tool for the Mathematics of Human Motion. J Open Source Softw. 2021;6(68):3490. doi: 10.21105/joss.03490. Epub 2021 Dec 21. PMID: 35079685; PMCID: PMC8786220. 5. Sulkar HJ, Zitnay JL, Aliaj K, Henninger HB. Proximal humeral coordinate systems can predict humerothoracic and glenohumeral kinematics of a full bone system. Gait Posture. 2021 Oct;90:380387. doi: 10.1016/j.gaitpost.2021.09.180. Epub 2021 Sep 20. PMID: 34564010; PMCID: PMC8585709. 6. Aliaj K, Lawrence RL, Bo Foreman K, Chalmers PN, Henninger HB. Kinematic coupling of the glenohumeral and scapulothoracic joints generates humeral axial rotation. J Biomech. 2022 May;136:111059. doi: 10.1016/j.jbiomech.2022.111059. Epub 2022 Mar 24. PMID: 35367838; PMCID: PMC9081276. 7. Knighton TW, Chalmers PN, Sulkar HJ, Aliaj K, Tashjian RZ, Henninger HB. Anatomic total shoulder glenoid component inclination affects glenohumeral kinetics during abduction: a cadaveric study. J Shoulder Elbow Surg. 2022 Oct;31(10):2023-2033. doi: 10.1016/j.jse.2022.03.028. Epub 2022 May 10. PMID: 35550434; PMCID: PMC9481675. 8. Knighton TW, Chalmers PN, Sulkar HJ, Aliaj K, Tashjian RZ, Henninger HB. Reverse total shoulder glenoid component inclination affects glenohumeral kinetics during abduction: a cadaveric study. J Shoulder Elbow Surg. 2022 Dec;31(12):2647-2656. doi: 10.1016/j.jse.2022.06.016. Epub 2022 Aug 2. PMID: 35931329; PMCID: PMC9669184. 9. Sulkar HJ, Knighton TW, Amoafo L, Aliaj K, Kolz CW, Zhang Y, Hermans T, Henninger HB. In Vitro Simulation of Shoulder Motion Driven by Three-Dimensional Scapular and Humeral Kinematics. J Biomech Eng. 2022 May 1;144(5):051008. doi: 10.1115/1.4053099. PMID: 34817051; PMCID: PMC8822462. 10. Sulkar HJ, Aliaj K, Tashjian RZ, Chalmers PN, Foreman KB, Henninger HB. Reverse Total Shoulder Arthroplasty Alters Humerothoracic, Scapulothoracic, and Glenohumeral Motion During Weighted Scaption. Clin Orthop Relat Res. 2022 Nov 1;480(11):2254-2265. doi: 10.1097/CORR.0000000000002321. Epub 2022 Jul 20. PMID: 35857295; PMCID: PMC9555951. 11. Sulkar HJ, Aliaj K, Tashjian RZ, Chalmers PN, Foreman KB, Henninger HB. High and low performers in internal rotation after reverse total shoulder arthroplasty: a biplane fluoroscopic study. J Shoulder Elbow Surg. 2023 Apr;32(4):e133-e144. doi: 10.1016/j.jse.2022.10.009. Epub 2022 Nov 5. PMID: 36343789; PMCID: PMC10023281. 12. Zitnay JL, Tashjian RZ, Walch G, Chalmers PN, Joyce CD, Henninger HB. Inlay vs. onlay humeral components in reverse total shoulder arthroplasty: a biorobotic shoulder simulator study. J Shoulder Elbow Surg. 2023 Nov 28:S1058-2746(23)00831-5. doi: 10.1016/j.jse.2023.10.015. Epub ahead of print. PMID: 38036254. 13. Zitnay JL, Stout MR, Percin B, Tashjian RZ, Chalmers PN, Joyce CD, Walch G, Henninger HB. Isolated humeral distalization in reverse total shoulder arthroplasty: a biorobotic shoulder simulator study. 2024 (Epub ahead of print). J Shoulder Elbow Surg.