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Thomas LG, Chalmers PN, Henninger HB, Davis EW, Tashjian RZ. Preoperative Planning Software Does Not Accurately Predict Range of Motion in Reverse Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2024; 32:e378-e386. [PMID: 37797249 PMCID: PMC10995102 DOI: 10.5435/jaaos-d-23-00519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/21/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine whether preoperative planning software (PPS) accurately predicts clinical range of motion (ROM) in patients with reverse total shoulder arthroplasty 1 year postoperatively with preoperative and postoperative computed tomography (CT) scans. METHODS This was a retrospective study of 16 reverse total shoulder arthroplasty patients with preoperative and postoperative (CT) scans obtained at least 1 year postoperatively. Clinical ROM was measured in abduction, external rotation at resting abduction, extension, and flexion at a minimum of 1 year postoperatively. All clinical measurements were obtained before generation of PPS ROM values. Using postoperative CT scans, the achieved implant component positions were quantified and then replicated in PPS on the preoperative CT scans. The preoperative predicted ROM was then recorded, both with and without osteophyte removal. Bland-Altman plots were generated within each motion comparing the differences between clinically measured motion and software-predicted motion. RESULTS The variation in clinically measured ROM in abduction, external rotation at resting abduction, extension, and flexion were 118 ± 27 (65° to 180°), 33 ± 16 (10° to 75°), 56 ± 8 (50° to 65°), and 137 ± 25 (80° to 160°), respectively. Clinically measured motion differed greatly from PPS-predicted ROM, with mean differences of 33 ± 29 (-32 to 93) for abduction, 44 ± 25 (-38 to 57) for external rotation, 44 ± 25 (-35 to 65) for extension, and 54 ± 50 (-51 to 147) for flexion with no significant correlations between clinically measured and PPS-predicted ROM ( P > 0.05). With humeral or humeral and glenoid osteophyte resection, correlations for only flexion became significant ( P = 0.002 for both). CONCLUSION The passive glenohumeral impingement-free ROM generated from PPS incompletely predicts clinically measured active humerothoracic ROM, possibly because of the unmeasured factors of soft-tissue tension, muscular strength, humeral torsion, resting scapular posture, and, most importantly, scapulothoracic motion. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Logan G Thomas
- From the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
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Dasari SP, Menendez ME, Espinoza Orias A, Khan ZA, Vadhera AS, Ebersole JW, White GM, Forsythe B, Cole BJ, Nicholson GP, Garrigues GE, Verma NN. 3-dimensionally printed patient-specific glenoid drill guides vs. standard nonspecific instrumentation: a randomized controlled trial comparing the accuracy of glenoid component placement in anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2024; 33:223-233. [PMID: 37774830 DOI: 10.1016/j.jse.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Traditional, commercially sourced patient-specific instrumentation (PSI) systems for shoulder arthroplasty improve glenoid component placement but can involve considerable cost and outsourcing delays. The purpose of this randomized controlled trial was to compare the accuracy of glenoid component positioning in anatomic total shoulder arthroplasty (aTSA) using an in-house, point-of-care, 3-dimensionally (3D) printed patient-specific glenoid drill guide vs. standard nonspecific instrumentation. METHODS This single-center randomized controlled trial included 36 adult patients undergoing primary aTSA. Patients were blinded and randomized 1:1 to either the PSI or the standard aTSA guide groups. The primary endpoint was the accuracy of glenoid component placement (version and inclination), which was determined using a metal-suppression computed tomography scan taken between 6 weeks and 1 year postoperatively. Deviation from the preoperative 3D templating plan was calculated for each patient. Blinded postoperative computed tomography measurements were performed by a fellowship-trained shoulder surgeon and a musculoskeletal radiologist. RESULTS Nineteen patients were randomized to the patient-specific glenoid drill guide group, and 17 patients were allocated to the standard instrumentation control group. There were no significant differences between the 2 groups for native version (P = .527) or inclination (P = .415). The version correction was similar between the 2 groups (P = .551), and the PSI group was significantly more accurate when correcting version than the control group (P = .042). The PSI group required a significantly greater inclination correction than the control group (P = .002); however, the 2 groups still had similar accuracy when correcting inclination (P = .851). For the PSI group, there was no correlation between the accuracy of component placement and native version, native inclination, or the Walch classification of glenoid wear (P > .05). For the control group, accuracy when correcting version was inversely correlated with native version (P = .033), but accuracy was not correlated with native inclination or the Walch classification of glenoid wear (P > .05). The intraclass correlation coefficient was 0.703 and 0.848 when measuring version and inclination accuracy, respectively. CONCLUSION When compared with standard instrumentation, the use of in-house, 3D printed, patient-specific glenoid drill guides during aTSA led to more accurate glenoid component version correction and similarly accurate inclination correction. Additional research should examine the influence of proper component position and use of PSI on clinical outcomes.
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Affiliation(s)
- Suhas P Dasari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Mariano E Menendez
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Zeeshan A Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA; Rush Medical College, Chicago, IL, USA
| | - Amar S Vadhera
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - John W Ebersole
- Department of Radiology, Rush University Medical Center, Chicago, IL, USA
| | - Gregory M White
- Department of Radiology, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Gregory P Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
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Filho CWLS, Pontes MDDS, Ramos CH, Cunha LAMD. Methodology for Preoperative Planning of Bone Deformities Using Three-dimensional Modeling Software. Rev Bras Ortop 2024; 59:e130-e135. [PMID: 38524711 PMCID: PMC10957277 DOI: 10.1055/s-0044-1779700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/25/2023] [Indexed: 03/26/2024] Open
Abstract
Rapid prototyping technology, known as three-dimensional (3D) printing, and its use in the medical field are advancing. Studies on severe bone deformity treatment with 3D printing showed benefits in postoperative outcomes thanks to this technology. Even so, preoperative planning guidance for surgeons is lacking. This technical note describes a practical step-by-step guide to help surgeons use this technology to optimize the therapeutic plan with free license software and an intuitive interface. This study aims to organize the 3D modeling process using a preoperative computed tomography (CT) scan. This technology allows a deeper understanding of the case and its particularities, such as the direction, planes, and dimensions of the deformity. Planning considering these topics may reduce the surgical time and result in better functional outcomes by understanding the deformity and how to correct it. Associating planning via software with 3D printing can further enhance this therapeutic method.
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Affiliation(s)
| | | | - Carlos Henrique Ramos
- Serviço de Ortopedia e Traumatologia, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR, Brasil
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Al-Omairi S, Albadran A, Dagher D, Leroux T, Khan M. Glenoid bone loss in shoulder arthroplasty: a narrative review. ANNALS OF JOINT 2024; 9:8. [PMID: 38529296 PMCID: PMC10929280 DOI: 10.21037/aoj-23-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/04/2023] [Indexed: 03/27/2024]
Abstract
Background and Objective Crucial to the success of any total or reverse shoulder arthroplasty (RSA) is the stability of the glenoid component fixation. Instability can lead to early implant failure and unsatisfactory results. Patients often present with varying forms of glenoid bone loss (GBL) in both the primary and revision settings, which can be a challenge for the treating surgeon. Severe cases of GBL can increase the risk of potential complications and diminish implant longevity. The use of the reverse total shoulder replacement has been particularly helpful when addressing significant glenoid bony defects. Various approaches have been proposed to deal with GBL, all of which require an individualized assessment of the specifics of the defect in order to provide maximal fixation and thereby optimize the longevity of the shoulder arthroplasty. This article aims to review the recent literature on GBL in shoulder arthroplasty to provide guidance when considering treatment based on the best available evidence. Methods PubMed, MEDLINE, EMBASE, AccessMedicine, ClinicalKey, DynaMed, and Micromedex were queried for publications utilizing the following keywords: "glenoid bone loss" AND "glenoid bone deficiency" AND "shoulder arthroplasty" AND "classification". The search was restricted to research published between 2004 and 2023. There were no restrictions on study type or language. Key Content and Findings GBL should be critically evaluated prior to undertaking total shoulder arthroplasty (TSA). The treating surgeon should be aware of various methods of addressing bone defects. Conclusions The use of TSA is increasing to address various shoulder pathologies. Addressing glenoid bone defects is of critical importance to maximize the longevity and outcome of TSA.
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Affiliation(s)
- Sultan Al-Omairi
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- Orthopedic Surgery Department, Sohar hospital, Sohar, Oman
| | - Adeeba Albadran
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- Section of Orthopaedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital (KAAUH), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Danielle Dagher
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Moin Khan
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
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Rachuene PA, Dey R, Sivarasu S, du Plessis JP, Roche S, Vrettos B. A narrative review of treatment strategies for major glenoid defects during primary reverse shoulder arthroplasty, with a focus on the use of structural bone graft. EFORT Open Rev 2023; 8:759-770. [PMID: 37787496 PMCID: PMC10562945 DOI: 10.1530/eor-22-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Structural glenoid defects are common during primary reverse shoulder arthroplasty (RSA) and are often associated with poor outcomes. The lack of pre-operative imaging protocols for determining the depth and degree of glenoid wear hinders our ability to accurately plan and correct these defects. Although bone grafting has been reported to be effective in reducing glenoid wear during RSA, there is limited information on when to utilise it and how to prepare the graft. We conducted this review to assess the evidence for the management of glenoid defects, with an emphasis on bone grafts to treat structural glenoid bone loss in primary RSA patients.
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Affiliation(s)
- Pududu Archie Rachuene
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Roopam Dey
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, South Africa
| | - Sudesh Sivarasu
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, South Africa
| | - Jean-Pierre du Plessis
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Stephen Roche
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Basil Vrettos
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
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Twomey-Kozak J, Hurley E, Levin J, Anakwenze O, Klifto C. Technological innovations in shoulder replacement: current concepts and the future of robotics in total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:2161-2171. [PMID: 37263482 DOI: 10.1016/j.jse.2023.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) has been rapidly evolving over the last several decades, with innovative technological strategies being investigated and developed in order to achieve optimal component precision and joint alignment and stability, preserve implant longevity, and improve patient outcomes. Future advancements such as robotic-assisted surgeries, augmented reality, artificial intelligence, patient-specific instrumentation (PSI) and other peri- and preoperative planning tools will continue to revolutionize TSA. Robotic-assisted arthroplasty is a novel and increasingly popular alternative to the conventional arthroplasty procedure in the hip and knee but has not yet been investigated in the shoulder. Therefore, the purpose of this study was to conduct a narrative review of the literature on the evolution and projected trends of technological advances and robotic assistance in total shoulder arthroplasty. METHODS A narrative synthesis method was employed for this review, rather than a meta-analysis or systematic review of the literature. This decision was based on 2 primary factors: (1) the lack of eligible, peer-reviewed studies with high-quality level of evidence available for review on robotic-assisted shoulder arthroplasty, and (2) a narrative review allows for a broader scope of content analysis, including a comprehensive review of all technological advances-including robotics-within the field of TSA. A general literature search was performed using PubMed, Embase, and Cochrane Library databases. These databases were queried by 2 independent reviewers from database inception through November 11, 2022, for all articles investigating the role of robotics and technology assistance in total shoulder arthroplasty. Inclusion criteria included studies describing "shoulder arthroplasty" and "robotics." RESULTS After exclusion criteria were applied, 4 studies on robotic-assisted TSA were described in the review. Given the novelty of this technology and limited data on robotics in TSA, these studies consisted of a literature review, nonvalidated experimental biomechanical studies in sawbones models, and preclinical proof-of-concept cadaveric studies using prototype robotic technology primarily in conjunction with PSI. The remaining studies described the technological advancements in TSA, including PSI, computer-assisted navigation, artificial intelligence, machine learning, and virtual, augmented, and mixed reality. Although not yet commercially available, robotic-assisted TSA confers the theoretical advantages of precise humeral head cuts for restoration of proximal humerus anatomy, more accurate glenoid preparation, and improved soft-tissue assessment in limited early studies. CONCLUSION The evidence for the use of robotics in total hip arthroplasty and total knee arthroplasty demonstrates improved component accuracy, more precise radiographic measurements, and improved early/mid-term patient-reported and functional outcomes. Although no such data currently exist for shoulder arthroplasty given that the technology has not yet been commercialized, the lessons learned from robotic hip and knee surgery in conjunction with its rapid adoption suggests robotic-assisted TSA is on the horizon of innovation. By achieving a better understanding of the past, present, and future innovations in TSA through this narrative review, orthopedic surgeons can be better prepared for future applications.
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Affiliation(s)
- Jack Twomey-Kozak
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Eoghan Hurley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jay Levin
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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de Marinis R, Contreras JJ, Vidal C, Palma C, Angulo M, Valenzuela A, Jaña R, Calvo C, Liendo R, Soza F. The Reverse Shoulder Arthroplasty Angle in MRI: Impact of the Articular Cartilage in the Estimated Inclination of the Inferior Glenoid. J Shoulder Elb Arthroplast 2023; 7:24715492231167110. [PMID: 37008200 PMCID: PMC10064160 DOI: 10.1177/24715492231167110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
Purpose To describe the reverse shoulder arthroplasty angle (RSA angle) in magnetic resonance imaging (MRI) and compare the angle formed using bony landmarks (Bony RSA angle or B-RSA angle) with another angle formed using the cartilage margin as reference (Cartilage RSA angle or C-RSA angle). Methods Adult patients with a shoulder MRI obtained in our hospital between July 2020 and July 2021 were included. The C-RSA angle and B-RSA angle were measured. All images were independently assessed by 4 evaluators. Intraclass correlation coefficient (ICC) was determined for the B-RSA and C-RSA to evaluate interobserver agreement. Results A total of 61 patients were included with a median age of 59 years (17-77). C-RSA angle was significantly higher than B-RSA (25.4° ± 0.7 vs 19.5° ± 0.7, respectively) with a P-value <.001. The overall agreement was considered “good” for C-RSA (ICC = 0.74 [95% CI 0.61-0.83]) and “excellent” for B-RSA angle (ICC = 0.76 [95% CI 0.65-0.85]). Conclusions C-RSA angle is significantly higher than B-RSA angle. In cases without significant glenoid wear neglecting to account for the remaining articular cartilage at the inferior glenoid margin may result in superior inclination of standard surgical guides.
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Affiliation(s)
- Rodrigo de Marinis
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Shoulder and Elbow Unit, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
- Rodrigo de Marinis, Diagonal Paraguay 362, 3er piso, Región Metropolitana, Santiago, Chile.
| | - Julio J. Contreras
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catalina Vidal
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristóbal Palma
- Radiology Department, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Manuela Angulo
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alfonso Valenzuela
- Shoulder and Elbow Unit, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Ricardo Jaña
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudio Calvo
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Liendo
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Soza
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Wittmann T, Befrui N, Rieger T, Raiss P. Stem size prediction in shoulder arthroplasty with preoperative 3D planning. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04571-6. [PMID: 35963979 DOI: 10.1007/s00402-022-04571-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Three-dimensional surgical planning software provides virtual reconstructions of the shoulder with automated joint indices for a preoperative case assessment. The aim of this single center study was to evaluate the concordance between the preoperatively selected humeral components and the final implants used in shoulder arthroplasty. METHODS 129 cases who had undergone anatomic (n = 16) or reverse shoulder arthroplasty (n = 117) using the same type of uncemented short stem implant and were included for review in this study. The type of arthroplasty, stem size, stem inclination, tray-offset and liner-thickness were noted preoperatively and compared to the final implant specifications used in surgery. RESULTS The type of arthroplasty matched the surgical plan in 99.2% of cases, as one case was converted from RSA to TSA. The concordance of planned to implanted stem size was 44.2% and the planned size was in range of one adjacent size in 87.6% of cases. Stem inclination in TSA matched the surgical plan in 50% of cases. Tray offset in RSA was predicted correctly in 65% and liner-thickness matched the surgical plan in 98.3% of cases. CONCLUSION Despite a low degree of concordance of planned to implanted stem sizes of 44.2%, the choice of stem size was found to be in range of one adjacent size in 87.6% of cases. Further investigations of other contributing factors are necessary to increase the accuracy of the preoperative selection of humeral implants. LEVEL OF EVIDENCE level IV, retrospective case study.
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Affiliation(s)
- Thomas Wittmann
- OCM (Orthopädische Chirurgie München) Clinic, Steinerstrasse 6, 81369, Munich, Germany.
| | - Nima Befrui
- OCM (Orthopädische Chirurgie München) Clinic, Steinerstrasse 6, 81369, Munich, Germany
| | - Tim Rieger
- OCM (Orthopädische Chirurgie München) Clinic, Steinerstrasse 6, 81369, Munich, Germany
| | - Patric Raiss
- OCM (Orthopädische Chirurgie München) Clinic, Steinerstrasse 6, 81369, Munich, Germany
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Preuss FR, Day HK, Peebles AM, Mologne MS, Provencher MT. Reverse Total Shoulder Arthroplasty for Treatment of Massive, Irreparable Rotator Cuff Tear. Arthrosc Tech 2022; 11:e1133-e1139. [PMID: 35782844 PMCID: PMC9244853 DOI: 10.1016/j.eats.2022.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/09/2022] [Indexed: 02/03/2023] Open
Abstract
Massive tears of the rotator cuff can result in severe functional deficits due to loss of the axial force couple and effective fulcrum that the intact cuff normally provides. For massive, irreparable rotator cuff tears, especially in the setting of early to moderate degenerative changes, reverse total shoulder arthroplasty functions to modify the center of joint rotation, allowing the deltoid and intact components of the cuff to carry out shoulder function more effectively. Our preferred technique uses a standard open deltopectoral shoulder approach with a 3-dimensional glenoid baseplate model and a 135° prosthesis in an onlay configuration to reduce the risk of scapular notching and increase lateralization of the humerus.
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Affiliation(s)
- Fletcher R. Preuss
- University of California Los Angeles Medical Center, Los Angeles, California, U.S.A
| | - Hannah K. Day
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | | | - Matthew T. Provencher
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A,The Steadman Clinic, Vail, Colorado, U.S.A,Address correspondence to CAPT Matthew T. Provencher, M.D., M.B.A., M.C., U.S.N.R. (ret.), The Steadman Clinic, 181 W Meadow Dr, Ste 400, Vail, CO 81657, U.S.A.
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Hao KA, Sutton CD, Wright TW, Schoch BS, Wright JO, Struk AM, Haupt ET, Leonor T, King JJ. Influence of glenoid wear pattern on glenoid component placement accuracy in shoulder arthroplasty. JSES Int 2022; 6:200-208. [PMID: 35252914 PMCID: PMC8888204 DOI: 10.1016/j.jseint.2021.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Accurate glenoid component placement in shoulder arthroplasty is often difficult even with the use of preoperative planning. Computer navigation and patient-specific guides increase component placement accuracy, but which patients benefit most is unknown. Our purpose was to assess surgeons' accuracy in placing a glenoid component in vivo using 3-dimensional preoperative planning and standard instruments among various glenoid wear patterns. Methods We conducted a retrospective review of 170 primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) performed at a single institution. Commercially available preoperative planning software was used in all arthroplasties with multiplanar 2-dimensional computed tomography and a 3-dimensional implant overlay. After registration of intraoperative bony landmarks to the navigation system, participating surgeons with knowledge of the preoperative plan were blinded to the computer screen and attempted to implement their preoperative plan by simulating placement of a central-axis glenoid guide pin. Two hundred thirty-three screenshots of surgeon's simulated guide pin placement were included. Glenoid displacement, error in version and inclination, and overall malposition from the preoperatively planned target point were stratified by posterior wear status (with [Walch B2 or B3] or without [A1, A2, or B1]) and Walch classification (A1, A2, B1, B2, or B3). The glenoid component was considered malpositioned when version or inclination errors exceeded 10° or the starting point displacement exceeded 4 mm. Results For rTSA, errors in version were greater for glenoids with posterior wear compared with those without (8.1° ± 5.6° vs. 4.7° ± 4.0°; P < .001). On post hoc analysis, B2 glenoids had greater version error than A1, A2, and B1 glenoids. A greater proportion of glenoids undergoing rTSA that possessed posterior wear had an error in version >10° compared with those without (31% vs. 8%; P < .001). Consequently, glenoids undergoing rTSA with posterior wear were malpositioned at a greater rate compared with those without (73% vs. 53%). In contrast, glenoids undergoing aTSA with and without posterior wear did not differ based on displacement error, version error, inclination error, or malposition occurrence. Conclusions Posterior glenoid bone loss more commonly resulted in glenoid version errors exceeding 10 degrees and component malposition in rTSA, but not for aTSA. Malposition was still relatively high in patients without significant posterior wear for both aTSA (36%) and rTSA (53%). Surgeons should consider alternate techniques beyond preoperative planning and standard instrumentation when performing shoulder arthroplasty in patients with posteriorly worn glenoids.
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Tashjian RZ, Beck L, Stertz I, Chalmers PN. Preoperative three-dimensional computer planning for reverse total shoulder arthroplasty and bone grafting for severe glenoid deformity. Shoulder Elbow 2021; 13:492-501. [PMID: 34659482 PMCID: PMC8512969 DOI: 10.1177/1758573220908903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/25/2020] [Accepted: 01/27/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Computer assisted planning without patient specific instrumentation may be utilized to guide reverse total shoulder arthroplasty baseplate placement. The purpose of this study was to determine the difference between planned and achieved inclination and retroversion correction with three-dimensional preoperative computer assisted planning in reverse total shoulder arthroplasty without patient specific instrumentation with bone grafting for severe glenoid erosion. METHODS Preoperative three-dimensional computer assisted planning without patient specific instrumentation was performed on 15 patients undergoing primary reverse total shoulder arthroplasty with glenoid bone grafting for severe glenoid erosion. On preoperative and immediate postoperative computed tomography slices, two-dimensional retroversion and inclination were measured. Preoperative three-dimensional baseline retroversion and inclination and planned postoperative three-dimensional retroversion and inclination were measured. Planned and achieved version and inclination changes were compared. RESULTS The planned and achieved retroversion corrections were 18° and 12°, respectively (p < 0.001). The planned and achieved inclination corrections were 11° and 11°, respectively (p = 0.803). CONCLUSIONS Three-dimensional computer assisted planning without patient specific instrumentation in the setting of reverse total shoulder arthroplasty with severe glenoid erosion requiring bone grafting can accurately guide baseplate placement. All cases in which failure to correct retroversion or inclination within 10° of planning occurred in patients with severe erosion (B3 or E3 glenoids), therefore patient specific guides may be warranted in these cases to improve accuracy of implantation. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Robert Z Tashjian
- Robert Z Tashjian, University of Utah
Orthopaedic Center, 590 Wakara Way, Salt Lake City, UT 84108, USA.
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Schiffman CJ, Prabhakar P, Hsu JE, Shaffer ML, Miljacic L, Matsen FA. Assessing the Value to the Patient of New Technologies in Anatomic Total Shoulder Arthroplasty. J Bone Joint Surg Am 2021; 103:761-770. [PMID: 33587515 DOI: 10.2106/jbjs.20.01853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Publications regarding anatomic total shoulder arthroplasty (TSA) have consistently reported that they provide significant improvement for patients with glenohumeral arthritis. New TSA technologies that have been introduced with the goal of further improving these outcomes include preoperative computed tomography (CT) scans, 3-dimensional preoperative planning, patient-specific instrumentation, stemless and short-stemmed humeral components, as well as metal-backed, hybrid, and augmented glenoid components. The benefit of these new technologies in terms of patient-reported outcomes is unknown. METHODS We reviewed 114 articles presenting preoperative and postoperative values for commonly used patient-reported metrics. The results were analyzed to determine whether patient outcomes have improved over the 20 years during which new technologies became available. RESULTS The analysis did not identify evidence that the results of TSA were statistically or clinically improved over the 2 decades of study or that any of the individual technologies were associated with significant improvement in patient outcomes. CONCLUSIONS Additional research is required to document the clinical value of these new technologies to patients with glenohumeral arthritis. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Corey J Schiffman
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Pooja Prabhakar
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | | | - Ljubomir Miljacic
- The Mountain-Whisper-Light Statistical Consulting, Seattle, Washington
| | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
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Computer-Assisted Surgery in Reverse Shoulder Arthroplasty: Early Experience. Indian J Orthop 2021; 55:1003-1008. [PMID: 34194658 PMCID: PMC8192603 DOI: 10.1007/s43465-020-00344-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/30/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND In the last decade, new technologies have been applied to shoulder arthroplasty. The aim of this work was to show that navigated RSA allows the surgeon to reach the planned version/inclination in all cases. In this article are shown preliminary data, advantages, disadvantages and limits of the technique. METHODS Eighteen computer-assisted reverse shoulder arthroplasty were performed. Preoperative glenoid version and inclination were evaluated with preoperative CT scan using Orthoblue® (Exactech, Gainesville, FL,USA) software, as well as baseplate type, planned glenoid component seating, planned postoperative version, planned postoperative inclination, intraoperative glenoid version/inclination, screw length and surgical time. A senior shoulder surgeon has analyzed the advantages, disadvantages and limitation of this kind of surgery. RESULTS Mean surgical time of the primary implants was 92 ± 12 min (min 75-max 110). Mean preoperative inclination was + 2.6° ± 6.4, mean preoperative version was - 7.6° ± 8.4. Mean planned postoperative inclination was - 2.7° ± 2.3, mean planned postoperative version was - 1.6° ± 2.9 and mean planned glenoid seating was 89% ± 8%. Planned settings were reached in all cases during surgery. Baseplate implanted were in nine cases 8° posterior augmented, in six cases standard and in three cases 10° superior augmented. Mean screw length was 33.5 mm ± 4.2 mm. No GPS system failure has been recorded. One coracoid fracture occurred during the first case. DISCUSSION Intraoperative navigation system is a reliable and user-friendly technology that allows the surgeon to reach planned glenoid positioning during surgery. Furthermore, this technology will allow the surgeon to compare clinical outcomes to component positioning data. The lack of humeral implant navigation is the main limit of this technique.
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Abstract
Preoperative assessment of the glenoid in the setting of shoulder arthroplasty is critical to account for variations in glenoid morphology, wear, version, inclination, and glenohumeral subluxation. Three-dimensional computed tomography (3D CT) scan assessment of the morphology of glenoid erosion allows for a more accurate surgical decision-making process to correct deformity and restore the joint line. Newer technology has brought forth computer-assisted software for glenoid planning in shoulder arthroplasty and patient-specific instrumentation. There have been promising early findings, although further evaluation is needed to determine how this technology impacts implant survivorship, function, and patient-reported outcomes.
Cite this article: EFORT Open Rev 2020;5:126-137. DOI: 10.1302/2058-5241.5.190011
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Affiliation(s)
- Stephen Gates
- Department of Orthopaedic Surgery, Shoulder Service, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brain Sager
- Department of Orthopaedic Surgery, Shoulder Service, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Khazzam
- Department of Orthopaedic Surgery, Shoulder Service, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Whitham RDJ, Clifford ZJ, Tasker AJB, Woods DA. Rib fracture as a complication of erroneous baseplate and inferior screw placement in reverse total shoulder replacement: a case report. J Shoulder Elbow Surg 2020; 29:e87-e92. [PMID: 32067713 DOI: 10.1016/j.jse.2019.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 11/07/2019] [Accepted: 11/16/2019] [Indexed: 02/01/2023]
Affiliation(s)
- Robert D J Whitham
- Department of Trauma and Orthopaedics, Great Western Hospital, Swindon, UK.
| | - Zoë J Clifford
- Department of Trauma and Orthopaedics, Great Western Hospital, Swindon, UK
| | - Andrew J B Tasker
- Department of Trauma and Orthopaedics, Great Western Hospital, Swindon, UK
| | - David A Woods
- Department of Trauma and Orthopaedics, Great Western Hospital, Swindon, UK
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Berhouet J, Favard L, Boas D, Voisin T, Slimane M. Thoughts on a new surgical assistance method for implanting the glenoid component during total shoulder arthroplasty. Part 1: Statistical modeling of the native premorbid glenoid. Orthop Traumatol Surg Res 2019; 105:203-209. [PMID: 30765310 DOI: 10.1016/j.otsr.2018.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/12/2018] [Accepted: 10/25/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to identify points on the scapula that can be used to predict the anatomy of the native premorbid glenoid. MATERIAL AND METHODS Forty-three normal scapulas reconstructed in 3D and positioned in a common coordinate system were used. Twenty points distributed over the blade of the scapula (portion considered normal and used as a reference) and the glenoid (portion considered pathological and needing to be reconstructed) were captured manually. Thirteen distances (X) between two points not on the glenoid and 31 distances (Y) between two points of which at least one was on the glenoid were then calculated automatically. A multiple linear regression model was applied to calculate the Y distances from the X distances. The best four equations were retained based on their coefficient of determination (R2) to explain a point on the glenoid being reconstructed (p<0.05). In the first scenario, the glenoid was modeled assuming it was completely destroyed. In the second scenario, only the inferior portion of the glenoid was worn. RESULTS For a completely destroyed glenoid, the mean error for a chosen distance for a given point on the glenoid was 2.4 mm (4.e-3mm; 12.5mm). For a partially damaged glenoid, the mean error was 1.7mm (4.e-3mm; 6.5mm) for the same distance evaluated for a given point on the glenoid. DISCUSSION/CONCLUSION The proposed statistical model was used to predict the premorbid anatomy of the glenoid with an acceptable level of accuracy. A surgeon could use this information during the preoperative planning stage and during the actual surgery by using a new surgical assistance method.
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Affiliation(s)
- Julien Berhouet
- Équipe reconnaissance de forme et analyse de l'image, université François Rabelais de Tours, école d'ingénieurs polytechnique universitaire de Tours, laboratoire d'informatique EA6300, 64, avenue Portalis, 37200 Tours, France; Western France Orthopedics Society (SOO)/HUGORTHO, 18, rue de Bellinière, 49800 Trélazé, France.
| | - Luc Favard
- Service d'orthopédie traumatologie, faculté de médecine de Tours, université François Rabelais de Tours, CHRU Trousseau, 1C, avenue de la République, 37170 Chambray-les-Tours, France; Western France Orthopedics Society (SOO)/HUGORTHO, 18, rue de Bellinière, 49800 Trélazé, France
| | - David Boas
- Équipe reconnaissance de forme et analyse de l'image, université François Rabelais de Tours, école d'ingénieurs polytechnique universitaire de Tours, laboratoire d'informatique EA6300, 64, avenue Portalis, 37200 Tours, France
| | - Théo Voisin
- Équipe reconnaissance de forme et analyse de l'image, université François Rabelais de Tours, école d'ingénieurs polytechnique universitaire de Tours, laboratoire d'informatique EA6300, 64, avenue Portalis, 37200 Tours, France
| | - Mohamed Slimane
- Équipe reconnaissance de forme et analyse de l'image, université François Rabelais de Tours, école d'ingénieurs polytechnique universitaire de Tours, laboratoire d'informatique EA6300, 64, avenue Portalis, 37200 Tours, France
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Berhouet J, Slimane M, Facomprez M, Jiang M, Favard L. Views on a new surgical assistance method for implanting the glenoid component during total shoulder arthroplasty. Part 2: From three-dimensional reconstruction to augmented reality: Feasibility study. Orthop Traumatol Surg Res 2019; 105:211-218. [PMID: 30522851 DOI: 10.1016/j.otsr.2018.08.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/13/2018] [Accepted: 08/21/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The main goal of this study was to propose a new method of surgical assistance for the implantation of a total shoulder prosthesis, with the use of augmented reality (AR). The advantage of this approach is that it supplements information, on the one hand pre-existing or disappeared due to a pathological process, such as the premorbid glenoid, and on the other hand already existing but not accessible to the surgeon during the procedure, such as the so-called "hidden" face of the scapula. MATERIAL AND METHODS Several information preparation steps were needed. The first consisted in the three-dimensional (3D) rendering of the pathological glenoid, from a point cloud corresponding to the premorbid glenoid based on previously developed regression equations. A library of "healthy" generic glenoids was then created by hierarchical bottom-up analysis. From this database, a so-called adequate normal generic glenoid was fused and matched to the pathological glenoid reconstructed using a morphing technique. An experimental AR application was constructed. Smart glasses were used to display the prepared 3D information. RESULTS A pathological 3D glenoid was reconstructed and used for the AR application. A complete display of the scene, reconstructed glenoid and full scapula was obtained. However, an offset from reality was observed. The main limitations were technical, related to the connected tool itself and the operating software. DISCUSSION/CONCLUSION This was a feasibility study of the different steps required to apply AR, from information preparation to its visualization. A new parameter crossing experiment is needed to optimize each step of this process. LEVEL OF EVIDENCE IV, Basic science study.
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Affiliation(s)
- Julien Berhouet
- Service d'orthopédie traumatologie 1C, faculté de médecine de Tours, université François-Rabelais de Tours, CHRU Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France; Équipe reconnaissance de forme et analyse de l'image, laboratoire d'informatique fondamentale et appliquée de Tours EA6300, école d'ingénieurs polytechnique universitaire de Tours, université François-Rabelais de Tours, 64, avenue Portalis, 37200 Tours, France; Société d'orthopédie de L'Ouest (SOO)/HUGORTHO, 18, rue de Bellinière, Trélazé, France.
| | - Mohamed Slimane
- Équipe reconnaissance de forme et analyse de l'image, laboratoire d'informatique fondamentale et appliquée de Tours EA6300, école d'ingénieurs polytechnique universitaire de Tours, université François-Rabelais de Tours, 64, avenue Portalis, 37200 Tours, France
| | - Maxime Facomprez
- Équipe reconnaissance de forme et analyse de l'image, laboratoire d'informatique fondamentale et appliquée de Tours EA6300, école d'ingénieurs polytechnique universitaire de Tours, université François-Rabelais de Tours, 64, avenue Portalis, 37200 Tours, France
| | - Min Jiang
- Équipe reconnaissance de forme et analyse de l'image, laboratoire d'informatique fondamentale et appliquée de Tours EA6300, école d'ingénieurs polytechnique universitaire de Tours, université François-Rabelais de Tours, 64, avenue Portalis, 37200 Tours, France
| | - Luc Favard
- Service d'orthopédie traumatologie 1C, faculté de médecine de Tours, université François-Rabelais de Tours, CHRU Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France; Société d'orthopédie de L'Ouest (SOO)/HUGORTHO, 18, rue de Bellinière, Trélazé, France
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Jun BJ, Vasanji A, Ricchetti ET, Rodriguez E, Subhas N, Li ZM, Iannotti JP. Quantification of regional variations in glenoid trabecular bone architecture and mineralization using clinical computed tomography images. J Orthop Res 2018; 36:85-96. [PMID: 28561262 DOI: 10.1002/jor.23620] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/19/2017] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to demonstrate feasibility of a clinical CT imaging and analysis technique to quantify regional variations in trabecular bone architecture and mineralization of glenoid bones. Specifically, our objective was to determine to what extent clinical CT imaging of intact upper extremities can describe variations of trabecular bone architectures at anatomic and peri-implant regions by comparing trabecular bone architectures as measured by high-resolution, micro CT imaging of same excised glenoid bones. Bone volume fraction (BVF), trabecular bone thickness (TbTh), number of trabecular bone (TbN), spacing (TbS), pattern factor (TbPf), bone surface area (BSA), and skeletal connectivity (Conn.), in addition to bone mineral content (BMC) and bone mineral density (BMD), were quantified from both clinical and micro CT images using whole bone, anatomic, and peri-implant bone masks. Strong correlations of BVF, TbTh, TbSp, BMC, and BMD were found between clinical CT and micro CT imaging methods. The variations in BVF, TbTh, TbSp, TbN, BMC, and BMD at anatomical and peri-implant regions were larger than those at whole bone regions. In this study, we have demonstrated that this clinical CT imaging methodology can be used to quantify variations of a patient's glenoid bone at anatomic and peri-implant levels. Statement of Clinical Significance. An in vivo quantitative assessment of glenoid trabecular bone architecture in the anatomic and peri-implant regions may improve our understanding on the role of bone quality on glenoid component loosening following total shoulder arthroplasty. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:85-96, 2018.
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Affiliation(s)
- Bong-Jae Jun
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland 44195, Ohio.,Department of Biomedical Engineering, Cleveland Clinic, Cleveland 44195, Ohio
| | | | - Eric T Ricchetti
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland 44195, Ohio
| | - Eric Rodriguez
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland 44195, Ohio
| | - Naveen Subhas
- Department of Radiology, Cleveland Clinic, Cleveland 44195, Ohio
| | - Zong-Ming Li
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland 44195, Ohio.,Department of Biomedical Engineering, Cleveland Clinic, Cleveland 44195, Ohio
| | - Joseph P Iannotti
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland 44195, Ohio
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Affiliation(s)
- Kamal I Bohsali
- 1Jacksonville Orthopaedic Institute, Jacksonville Beach, Florida 2Section of Orthopaedic Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada 3Department of Orthopaedics, University of Texas HSC-San Antonio, San Antonio, Texas
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