Development of Smart Implants for Shoulder Arthroplasty - PROJECT SUMMARY In the United States, it is estimated that more than 800,000 individuals were living with total shoulder arthroplasty (TSA) in 2017. The number of shoulder arthroplasty procedures have continued to increase in recent years with projections as high as 235% (350,000+ procedures) by 2025. With the increase in the aging population and the demand for better mobility and quality of life, shoulder arthroplasty is also commonly used for the management of cuff tear arthropathy and for proximal humerus fractures offering a treatment option to improve range of motion, strength, and pain relief. However, biomechanical problems are often associated with TSA, and instability and loosening are common causes for revision surgery. Understanding and preventing instability and loosening requires more information about the post-operative loading conditions during daily life throughout the life of the prosthesis. Thus, there is a need for load sensing components that can be routinely implanted during TSA and remain within the joint for the life of the implant. To address this gap, Scripps Health proposes to develop smart implants capable of continuously monitoring prosthesis loading conditions in real-time throughout the implant's lifespan, aiming to revolutionize the field of biomedical implants by providing valuable feedback to patients and healthcare providers. We will design, manufacture, and test smart, self-powered implant prototypes for total shoulder replacement. To the best of our knowledge, we will be developing a prosthesis that can measure in vivo shoulder biomechanics (forces and kinematics), provide biofeedback to the patient in real-time, and send data to the healthcare provider. Our implants will enable sensors to continuously sample loading data in a self- powered operation mode, and provide alerts when abnormalities are detected. This R21 will focus on the following specific aims for proof of concept. Aim 1: Development and testing of smart humeral stem prototypes for partial, anatomic, or reverse shoulder arthroplasty. Aim 2: Development and testing of smart glenosphere implant prototypes for reverse shoulder arthroplasty. By leveraging previous successes in knee joint technology, the project aims to create self-powered smart implants for both humeral stem and glenosphere components, offering versatile monitoring solutions for various shoulder replacement procedures and potentially reducing the need for revision surgeries. Our technology can revolutionize the biomedical implant field as an affordable, low- cost method for patient self-care that can be used worldwide.