Modeling the future of shoulder arthroplasty.

Background: In patients with advanced shoulder pathology requiring arthroplasty, the goal is to restore optimal function and provide sustained pain relief. However, the capacity to select the ideal reconstruction of a specific patient's shoulder and to predict the resulting functional outcome is limited. Computational modeling of the musculoskeletal system has the potential to expand our foundational knowledge of both the native and prosthetic shoulder joint. Methods: The aim of this review is to describe how computational modeling enables more detailed analyses of the interactions between musculoskeletal anatomy and function and to suggest ways in which this approach may be used to optimize outcomes in patients undergoing shoulder arthroplasty. Results: Computational modeling has been used to study shoulder joint biomechanics for more than 30 years. There are specific limitations that need to be addressed to realize the full potential of computational modeling in shoulder arthroplasty. First, more realistic, patient-specific models of the glenohumeral and scapulothoracic joints must be developed. Second, shoulder models must be coupled with accurate in vivo measurements of joint motion to perform more comprehensive analyses of muscle and joint function. Third, model predictions of shoulder biomechanics must be validated against experimental data. Conclusion: Patient-specific musculoskeletal modeling of shoulder joint biomechanics can contribute significantly to predicting pathology and optimizing postoperative function.