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Hays C. Current Role of Reverse Total Shoulder Arthroplasty in the Management of Glenohumeral Osteoarthritis. Orthop Clin North Am 2024; 55:489-502. [PMID: 39216954 DOI: 10.1016/j.ocl.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Reverse total shoulder arthroplasty (RSA) was historically reserved for the elderly, low-demand patient with rotator cuff arthropathy (RCA) or as a salvage procedure after failed primary arthroplasty. Surgeon expertise and the advancement of implant design has allowed RSA to now become commonplace not only for RCA but also for glenohumeral osteoarthritis. RSA provides a robust glenoid baseplate fixation, which allows for easier and more reliable bone grafting or augmentation when needed. For patients with severe glenoid bone loss, RSA has been shown to have superior or equivalent patient-reported outcomes and shoulder range of motion when compared with total shoulder arthroplasty.
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Affiliation(s)
- Claire Hays
- Department of Orthopaedic Surgery, Campbell Clinic - University of Tennessee Health Science Center, Memphis, TN, USA.
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Fischer CS, Floß M, Ittermann T, Gonser CE, Giordmaina R, Bülow R, Schmidt CO, Lange J. Gender-specific factors influencing the glenoid version and reference values for it. J Orthop Traumatol 2024; 25:39. [PMID: 39152298 PMCID: PMC11329491 DOI: 10.1186/s10195-024-00778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/08/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Glenoid version is an important factor in the evaluation of shoulder stability and shoulder pathologies. However, there are neither established reference values nor known factors that influence the glenoid version, even though valid reference values are needed for diagnostic and orthopaedic surgery like corrective osteotomy and total or reverse shoulder arthroplasty (TSA/RSA). The aim of our population-based study was to identify factors influencing the glenoid version and to establish reference values from a large-scale population cohort. RESULTS Our study explored the glenoid versions in a large sample representing the general adult population. We investigated 3004 participants in the population-based Study of Health in Pomerania (SHIP). Glenoid version was measured for both shoulders via magnetic resonance imaging (MRI). Associations with the glenoid version were calculated for sex, age, body height, body weight and BMI. The reference values for glenoid version in the central European population range between -9° and 7.5°, while multiple factors are associated with the glenoid version. CONCLUSION To achieve a reliable interpretation prior to orthopaedic surgery, sex- and age-adjusted reference values are proposed.
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Affiliation(s)
- Cornelius Sebastian Fischer
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Matthias Floß
- Clinic of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, Ernst-Moritz-Arndt University of Greifswald, Greifswald, Germany
| | - Christoph Emanuel Gonser
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.
- BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany.
| | - Ryan Giordmaina
- Department of Trauma and Orthopaedics, Mater Dei Hospital, University of Malta, Msida, Malta
| | - Robin Bülow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Carsten-Oliver Schmidt
- Institute for Community Medicine, Ernst-Moritz-Arndt University of Greifswald, Greifswald, Germany
| | - Jörn Lange
- Clinic of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
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Kopriva JM, McKissack HM, Griswold BG, Hussain ZB, Cooke HL, Gottschalk MB, Wagner ER. Mixed-reality improves execution of templated glenoid component positioning in shoulder arthroplasty: a CT imaging analysis. J Shoulder Elbow Surg 2024; 33:1789-1798. [PMID: 38320671 DOI: 10.1016/j.jse.2023.12.019] [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: 09/01/2023] [Revised: 12/06/2023] [Accepted: 12/17/2023] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Glenoid placement is critical for successful outcomes in total shoulder arthroplasty (TSA). Preoperative templating with three-dimensional imaging has improved implant positioning, but deviations from the planned inclination and version still occur. Mixed-Reality (MR) is a novel technology that allows surgeons intra-operative access to three-dimensional imaging and templates, capable of overlaying the surgical field to help guide component positioning. The purpose of this study was to compare the execution of preoperative templates using MR vs.standard instruments (SIs). METHODS Retrospective review of 97 total shoulder arthroplasties (18 anatomic, 79 reverse) from a single high-volume shoulder surgeon between January 2021 and February 2023, including only primary diagnoses of osteoarthritis, rotator cuff arthropathy, or a massive irreparable rotator cuff tear. To be included, patients needed a templated preoperative plan and then a postoperative computed tomography scan. Allocation to MR vs. SI was based on availability of the MR headset, industry technical personnel, and the templated preoperative plan loaded into the software, but preoperative or intraoperative patient factors did not contribute to the allocation decision. Postoperative inclination and version were measured by two independent, blinded physicians and compared to the preoperative template. From these measurements, we calculated the mean difference, standard deviation (SD), and variance to compare MR and SI. RESULTS Comparing 25 MR to 72 SI cases, MR significantly improved both inclination (P < .001) and version (P < .001). Specifically, MR improved the mean difference from preoperative templates (by 1.9° inclination, 2.4° version), narrowed the SD (by 1.7° inclination, 1.8° version), and decreased the variance (11.7-3.0 inclination, 14.9-4.3 version). A scatterplot of the data demonstrates a concentration of MR cases within 5° of plan relative to SI cases typically within 10° of plan. There was no difference in operative time. CONCLUSION MR improved the accuracy and precision of glenoid positioning. Although it is unlikely that 2° makes a detectable clinical difference, our results demonstrate the potential ability for technology like MR to narrow the bell curve and decrease the outliers in glenoid placement. This will be particularly relevant as MR and other similar technologies continue to evolve into more effective methods in guiding surgical execution.
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Affiliation(s)
- John M Kopriva
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Haley M McKissack
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - B Gage Griswold
- Department of Orthopaedic Surgery, Denver Shoulder at Western Orthopaedics, Denver, CO, USA
| | - Zaamin B Hussain
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Hayden L Cooke
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael B Gottschalk
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric R Wagner
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
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Rocha Motta Filho GD, Amaral MV, Cohen M, Carvalho MSDS, Fonseca RSD, Oliveira ACLD. Comparison of Manual Two-dimensional and Automated Three-dimensional Methods of Assessing Shoulder Joint Morphology through Computed Tomography Images. Rev Bras Ortop 2024; 59:e590-e598. [PMID: 39239582 PMCID: PMC11374392 DOI: 10.1055/s-0044-1786821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/05/2024] [Indexed: 09/07/2024] Open
Abstract
Objective To evaluate the interobserver agreement in the measurement of anatomical parameters of the shoulder using manual methods of two-dimensional (2D) computed tomography (CT) unformatted in the plane of the scapula and to compare them with the automated measurement obtained through the Blueprint (Wright Medical, Memphis, TN, United States) software, which uses reconstructed three-dimensional (3D) images. Methods The present is a cross-sectional study in which 2D CT images of 38 patients with different diagnoses were used. The anatomical parameters were measured by the manual methods described by Friedman et al., the glenoid vault method, the Maurer et al. method, and shoulder subluxation according to Walch et al., by five independent qualified surgeons and compared with the parameters obtained through the Blueprint automated software. Results Significant differences were found between the manual measurement version obtained through the Friedman et al. method and the automated version. The mean values found for inclination did not show statistically significant differences among the methods. The mean value found for subluxation showed significant differences between the average observed in the analyses performed by the automated method and those performed by the surgeons. Conclusion The manual measurements of glenoid version and inclination performed by experienced surgeons are effective, and the vault method is superior to the Friedman et al. method in the analysis of severe glenoid deformities.
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Affiliation(s)
- Geraldo da Rocha Motta Filho
- Centro de Cirurgia de Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
- Divisão de Traumatologia e Ortopedia (DITRO), Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | - Marcus Vinícius Amaral
- Centro de Cirurgia de Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
- Divisão de Traumatologia e Ortopedia (DITRO), Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | - Márcio Cohen
- Centro de Cirurgia de Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | | | - Raphael Soares da Fonseca
- Centro de Cirurgia de Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
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Dean RE, Holte AJ, Ray GS, Bell JE. Treatment of displaced intra-articular glenoid malunion deformity with reverse total shoulder arthroplasty guided by augmented reality-assisted computer navigation. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:625-631. [PMID: 39157259 PMCID: PMC11329051 DOI: 10.1016/j.xrrt.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Affiliation(s)
- Ryan E. Dean
- Dartmouth-Hitchcock Medical Center, Department of Orthopaedic Surgery, Lebanon, NH, USA
| | - Andrew J. Holte
- Dartmouth-Hitchcock Medical Center, Department of Orthopaedic Surgery, Lebanon, NH, USA
| | - Gabrielle S. Ray
- Dartmouth-Hitchcock Medical Center, Department of Orthopaedic Surgery, Lebanon, NH, USA
| | - John-Erik Bell
- Dartmouth-Hitchcock Medical Center, Department of Orthopaedic Surgery, Lebanon, NH, USA
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Schader JF, Helfen T, Braunstein V, Ockert B, Haasters F, Hertel R, Südkamp N, Milz S, Sprecher CM. Experimental guide wire placement for total shoulder arthroplasty in glenoid models: higher precision for patient-specific aiming guides compared to standard technique without learning curve. BMC Musculoskelet Disord 2024; 25:449. [PMID: 38844899 PMCID: PMC11155061 DOI: 10.1186/s12891-024-07549-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/27/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Patient-specific aiming devices (PSAD) may improve precision and accuracy of glenoid component positioning in total shoulder arthroplasty, especially in degenerative glenoids. The aim of this study was to compare precision and accuracy of guide wire positioning into different glenoid models using a PSAD versus a standard guide. METHODS Three experienced shoulder surgeons inserted 2.5 mm K-wires into polyurethane cast glenoid models of type Walch A, B and C (in total 180 models). Every surgeon placed guide wires into 10 glenoids of each type with a standard guide by DePuy Synthes in group (I) and with a PSAD in group (II). Deviation from planned version, inclination and entry point was measured, as well as investigation of a possible learning curve. RESULTS Maximal deviation in version in B- and C-glenoids in (I) was 20.3° versus 4.8° in (II) (p < 0.001) and in inclination was 20.0° in (I) versus 3.7° in (II) (p < 0.001). For B-glenoid, more than 50% of the guide wires in (I) had a version deviation between 11.9° and 20.3° compared to ≤ 2.2° in (II) (p < 0.001). 50% of B- and C-glenoids in (I) showed a median inclination deviation of 4.6° (0.0°-20.0°; p < 0.001) versus 1.8° (0.0°-4.0°; p < 0.001) in (II). Deviation from the entry point was always less than 5.0 mm when using PSAD compared to a maximum of 7.7 mm with the standard guide and was most pronounced in type C (p < 0.001). CONCLUSION PSAD enhance precision and accuracy of guide wire placement particularly for deformed B and C type glenoids compared to a standard guide in vitro. There was no learning curve for PSAD. However, findings of this study cannot be directly translated to the clinical reality and require further corroboration.
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Affiliation(s)
- Jana F Schader
- AO Research Institute Davos, Clavadelerstrasse 8, Davos Platz, 7270, Switzerland.
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland.
| | - Tobias Helfen
- AO Research Institute Davos, Clavadelerstrasse 8, Davos Platz, 7270, Switzerland
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Volker Braunstein
- AO Research Institute Davos, Clavadelerstrasse 8, Davos Platz, 7270, Switzerland
- OrthoPlus München, Alte Börse, Lenbachplatz 2a, 80333, Munich, Germany
| | - Ben Ockert
- AO Research Institute Davos, Clavadelerstrasse 8, Davos Platz, 7270, Switzerland
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Florian Haasters
- Schön Klinik München Harlaching, Zentrum für Knie-, Hüft- und Schulterchirurgie, Harlachinger Strasse 51, 81547, Munich, Germany
| | - Ralph Hertel
- Schulter & Ellbogen Zentrum Bern, Lindenhofspital, Bremgartenstrasse 117, Bern, 3001, Switzerland
| | - Norbert Südkamp
- Medical Faculty, Albert-Ludwigs-University Freiburg, 79085, Fahnenbergplatz, Freiburg im Breisgau, Germany
| | - Stefan Milz
- Anatomische Anstalt der Ludwig-Maximilians-Universität, Pettenkoferstrasse 11, 80336, Munich, Germany
| | - Christoph M Sprecher
- AO Research Institute Davos, Clavadelerstrasse 8, Davos Platz, 7270, Switzerland
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Fleet CT, Giraudon T, Walch G, Morvan Y, Urvoy M, Walch A, Werthel JD, Athwal GS. A scapular statistical shape model can reliably predict premorbid glenoid morphology in conditions of severe glenoid bone loss. J Shoulder Elbow Surg 2024:S1058-2746(24)00359-8. [PMID: 38762148 DOI: 10.1016/j.jse.2024.03.060] [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: 10/22/2023] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Knowledge of premorbid glenoid parameters at the time of shoulder arthroplasty, such as inclination, version, joint line position, height, and width, can assist with implant selection, implant positioning, metal augment sizing, and/or bone graft dimensions. The objective of this study was to validate a scapular statistical shape model (SSM) in predicting patient-specific glenoid morphology in scapulae with clinically relevant glenoid erosion patterns. METHODS Computed tomography scans of 30 healthy scapulae were obtained and used as the control group. Each scapula was then virtually eroded to create 7 erosion patterns (Walch A1, A2, B2, B3, D, Favard E2, and E3). This resulted in 210 uniquely eroded glenoid models, forming the eroded glenoid group. A scapular SSM, created from a different database of 85 healthy scapulae, was then applied to each eroded scapula to predict the premorbid glenoid morphology. The premorbid glenoid inclination, version, height, width, radius of best-fit sphere, and glenoid joint line position were automatically calculated for each of the 210 eroded glenoids. The mean values for all outcome variables were compared across all erosion types between the healthy, eroded, and SSM-predicted groups using a 2-way repeated measures analysis of variance. RESULTS The SSM was able to predict the mean premorbid glenoid parameters of the eroded glenoids with a mean absolute difference of 3° ± 2° for inclination, 3° ± 2° for version, 2 ± 1 mm for glenoid height, 2 ± 1 mm for glenoid width, 5 ± 4 mm for radius of best-fit sphere, and 1 ± 1 mm for glenoid joint line. The mean SSM-predicted values for inclination, version, height, width, and radius were not significantly different than the control group (P > .05). DISCUSSION An SSM has been developed that can reliably predict premorbid glenoid morphology and glenoid indices in patients with common glenoid erosion patterns. This technology can serve as a useful template to visually represent the premorbid healthy glenoid in patients with severe glenoid bony erosions. Knowledge of the premorbid glenoid preoperatively can assist with implant selection, positioning, and sizing.
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Affiliation(s)
- Cole T Fleet
- Department of Mechanical and Materials Engineering, Western University, London, Canada
| | | | - Gilles Walch
- Ramsay Générale de Santé, Jean Mermoz Private Hospital, Centre Orthopédique Santy, Lyon, France
| | | | | | - Arnaud Walch
- Orthopedic Department, Hôpital Edouard Herriot, Lyon, France
| | - Jean-David Werthel
- Orthopedic Department, Hôpital Ambroise Pare, Boulogne-Billancourt, France
| | - George S Athwal
- Roth | McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Canada; Department of Surgery, Western University, London, Canada.
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Keçeci T, Uçan V, Ertogrul R, Şahin K, Bilsel K, Kapıcıoğlu M. The effect of eccentric glenoid reaming in reverse shoulder artrhoplasty for glenohumeral osteoarthritis. J Orthop 2024; 50:111-115. [PMID: 38187370 PMCID: PMC10770422 DOI: 10.1016/j.jor.2023.11.073] [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: 10/04/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Background The objective of this study was to evaluate the abilitiy of eccentric reaming in reverse total shoulder arthroplasty (RSA), in patients with glenohumeral osteoarthritis (GHOA), to correct preoperative glenoid retroversion and to compare with cuff tear arthopaty (CTA) cases. Methods Fifty-nine patients who underwent RSA with GHOA or CTA diagnosis between 2013 and 2022 and who had pre- and postoperative computed tomography scans were included in the study. Preoperative glenoid version and postoperative glenoid component versions of 17 patients with GHOA and 40 patients with CTA were measured by Friedman method. Results The median preoperative glenoid versions in GHOA and CTA groups were measured as 16° and 4° retroverted respectively (p < 0.01). The median postoperative glenoid component versions in GHOA and CTA groups were 5° and 3° retroverted respectively (p = 0.09). The version change differences between the two groups varied significantly (p < 0.01). Conclusions GHOA is related with higher preoperative glenoid retroversion compared to CTA. However; with eccentric glenoid reaming, adequate version correction and similar postoperative glenoid version can be achieved in GHOA compared to CTA when performing a RSA. Level of evidence Level III. Retrospective study. Treatment study.
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Affiliation(s)
- Tolga Keçeci
- Ordu University, Department of Orthopedics and Traumatology, Cumhuriyet mah. 1242. Sk. No: 8A/1, Altınordu, Ordu, 52200, Turkey
| | - Vahdet Uçan
- T.C. Bezmialem Foundation University, Department of Orthopedics and Traumatology, Topkapı, Adnan Menderes Blv., 34093, Fatih, Istanbul, Turkey
| | - Rodi Ertogrul
- Istanbul Şişli Hamidiye Etfal Education and Research Hospital, Department of Orthopedics and Traumatology, Halaskargazi Cd., 34371, Şişli, Istanbul, Turkey
| | - Koray Şahin
- T.C. Bezmialem Foundation University, Department of Orthopedics and Traumatology, Topkapı, Adnan Menderes Blv., 34093, Fatih, Istanbul, Turkey
| | - Kerem Bilsel
- T.C. Bezmialem Foundation University, Department of Orthopedics and Traumatology, Topkapı, Adnan Menderes Blv., 34093, Fatih, Istanbul, Turkey
- Acıbadem Fulya Hospital Dikilitaş, Yeşilçimen Sokağı No:23, 34349, Beşiktaş, İstanbul, Turkey
| | - Mehmet Kapıcıoğlu
- T.C. Bezmialem Foundation University, Department of Orthopedics and Traumatology, Topkapı, Adnan Menderes Blv., 34093, Fatih, Istanbul, Turkey
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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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Peri G, Troiano E, Colasanti GB, Mondanelli N, Giannotti S. Custom-made Glenoid Baseplate and Intra-Operative Navigation in Complex Revision Reverse Shoulder Arthroplasty: A Case Report. J Shoulder Elb Arthroplast 2024; 8:24715492231218183. [PMID: 38186674 PMCID: PMC10771046 DOI: 10.1177/24715492231218183] [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: 08/31/2023] [Revised: 10/16/2023] [Accepted: 11/10/2023] [Indexed: 01/09/2024] Open
Abstract
Prosthetic instability is one of the most challenging complications to manage when considering reverse shoulder arthroplasty (RSA). Additional tools are available to improve accuracy in planning and execution of arthroplasties, such as 3-dimensional (3D) virtual planning based on computer tomography (CT) scan and intra-operative navigation. We report a case of an 84-year-old male treated for RSA prosthetic instability combined with severe glenoid deformity and bone loss, and subclinical periprosthetic joint infection (PJI). The definitive surgery consisted in implanting a customized metaglene component realized on the basis of the bone defect detected in the 3D-CT scan and implanted with the aid of computer-assisted intra-operative navigation. The patient was periodically followed-up for a year with clinical and radiological evaluations with the absence of further prosthetic dislocations nor PJI, a good overall satisfaction, a satisfying range of motion, and acceptable functional scores (American Shoulder and Elbow Surgeons Score 62, Constant-Murley Score 36). This is the first description, to our knowledge, of a customized glenoid baseplate implanted with the aid of intraoperative navigation. The combined use of 3D-CT planning and intra-operative computer-assisted navigation allows to manage complex cases of prosthetic revision surgery even where extensive bone defects are present.
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Affiliation(s)
- Giacomo Peri
- Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Elisa Troiano
- Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Giovanni Battista Colasanti
- Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Nicola Mondanelli
- Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Stefano Giannotti
- Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
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11
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Smith AF, Frankle MA, Cronin KJ. Maximizing Implant Stability in the Face of Glenoid Bone Stock Deficiency. Orthop Clin North Am 2024; 55:101-111. [PMID: 37980095 DOI: 10.1016/j.ocl.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
As the incidence of shoulder arthroplasty continues to rise, encountering significant glenoid bone loss in the primary and revision setting is becoming a common occurrence. To effectively treat these difficult scenarios, surgeons must understand the common patterns of glenoid bone loss and be aware of the various techniques available for treatment. Understanding bone loss requires careful pre-operative evaluation with appropriate imaging and pre-operative planning software. Treatment algorithms consist of primary anatomic and reverse arthroplasty as well as the use of allograft or autograft bone grafting, augmented glenoid components, specialized surgical techniques, or custom implant designs. Ultimately, good outcomes are able to be obtained with various techniques when applied to the appropriate clinical situation.
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Affiliation(s)
- Austin F Smith
- Florida Orthopaedic Institute, 13020 North Telecom Parkway, Temple Terrace, FL 33647, USA
| | - Mark A Frankle
- Florida Orthopaedic Institute, 13020 North Telecom Parkway, Temple Terrace, FL 33647, USA; Department of Orthopaedic Surgery and Sports Medicine, University of South Florida, Florida Orthopaedic Institute, 13020 N. Telecom Parkway, Temple Terrace, FL 33647, USA
| | - Kevin J Cronin
- Florida Orthopaedic Institute, 13020 North Telecom Parkway, Temple Terrace, FL 33647, USA; Department of Orthopaedic Surgery and Sports Medicine, University of South Florida, Florida Orthopaedic Institute, 13020 N. Telecom Parkway, Temple Terrace, FL 33647, USA.
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12
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Mathon P, Chivot M, Galland A, Airaudi S, Gravier R. Pyrolytic carbon head shoulder arthroplasty: CT scan glenoid bone modeling assessment and clinical results at 3-year follow-up. JSES Int 2023; 7:2476-2485. [PMID: 37969536 PMCID: PMC10638580 DOI: 10.1016/j.jseint.2023.06.028] [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] [Indexed: 11/17/2023] Open
Abstract
Background The aim of this study is to report the radiological glenoid modifications and clinical outcomes at 3 years mean follow-up of hemi shoulder arthroplasty (HA) with pyrocarbon (PYC) humeral head. Our hypothesis was that the PYC implants would provide good outcomes without major glenoid erosion. Additionally, we hypothesized that HA-PYC allowed for remodeling of the bone. Methods Patients underwent HA with PyC humeral head for treatment of primary or secondary osteoarthritis, excluding post-traumatic cases. All patients had a Constant Score assessed preoperatively and at the last follow-up. Preoperative and postoperative computed tomography scans at the last follow-up were performed to achieve 3-dimensional reconstructions of the scapulae. Deformities of the glenoid surface were analyzed as a distance differential between postoperative and preoperative to investigate potential bone remodeling vs. glenoid erosion. The subluxation index (SLI) was measured. Results We included 41 patients implanted with a HA-PYC. Average age at the time of implant was 63.8 (40 to 79 years). All patients were followed for ≥2 years with an average follow-up of 36.3 months (24 to 60 months). Constant Scores increased from 34 at baseline to 80 at the last follow-up points on average (P < .01). Return to work rate was 100% and 96% had resumed their physical activity. Ten (77%) of the 13 patients with posterior head subluxation had normalized their SLI. Furthermore, no significant differences were detected between the individuals having corrected their posterior subluxation and the others (preoperative SLI between 0.45 and 0.55). Glenoid wear is less than 0.6 mm at 3 years mean follow-up, ie, 5 times less than metallic implants. A tendency to recenter the head in the anteroposterior plane was found in type B glenoid, without increased erosion of the glenoid, with very good clinical results. We did not find any difference according to age or glenoid type for clinical and radiological results. Conclusion HA-PYCs give, in the short term, excellent clinical results in terms of pain and function. The development of a precise and objective measurement method has made it possible to demonstrate that the glenoid surface is the site of modifications that may be part of bone remodeling or progression of the osteoarthritis disease.
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Affiliation(s)
- Pauline Mathon
- Aix-Marseille University, CNRS, ISM UMR 7287, Marseille 13288, France
| | - Matthieu Chivot
- Clinique Monticelli-Vélodrome (Groupe Ramsay Santé), Marseille, France
- Hopital Privé Clairval (Groupe Ramsay Santé), Marseille, France
- Institut de la Main et du Membre Supérieur (IMMS), Marseille, France
| | - Alexandre Galland
- Clinique Monticelli-Vélodrome (Groupe Ramsay Santé), Marseille, France
- Institut de la Main et du Membre Supérieur (IMMS), Marseille, France
| | - Stéphane Airaudi
- Clinique Monticelli-Vélodrome (Groupe Ramsay Santé), Marseille, France
- Institut de la Main et du Membre Supérieur (IMMS), Marseille, France
| | - Renaud Gravier
- Clinique Monticelli-Vélodrome (Groupe Ramsay Santé), Marseille, France
- Institut de la Main et du Membre Supérieur (IMMS), Marseille, France
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13
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Boekel P, Rikard-Bell M, Grant A, Brandon B, Doma K, O’Callaghan WB, Wilkinson M, Morse L. Image-derived instrumentation vs. conventional instrumentation with 3D planning for glenoid component placement in reverse total shoulder replacements: a randomized controlled trial. JSES Int 2023; 7:614-622. [PMID: 37426909 PMCID: PMC10328789 DOI: 10.1016/j.jseint.2023.03.004] [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] [Indexed: 07/11/2023] Open
Abstract
Hypothesis Glenoid baseplate positioning for reverse total shoulder arthroplasty (rTSA) is important for stability and longevity, with techniques such as image-derived instrumentation (IDI) developed for improving implant placement accuracy. We performed a single-blinded randomized controlled trial comparing glenoid baseplate insertion accuracy with 3D preoperative planning and IDI jigs vs. 3D preoperative planning and conventional instrumentation. Methods All patients had a preoperative 3D computed tomography to create an IDI; then underwent rTSA according to their randomized method. Repeat computed tomography scans performed at six weeks postoperatively were compared to the preoperative plan to assess for accuracy of implantation. Patient-reported outcome measures and plain radiographs were collected with 2-year follow-up. Results Forty-seven rTSA patients were included (IDI n = 24, conventional instrumentation n = 23). The IDI group was more likely to have a guidewire placement within 2mm of the preoperative plan in the superior/inferior plane (P = .01); and exhibited a smaller degree of error when the native glenoid retroversion was >10° (P = .047). There was no difference in patient-reported outcome measures or other radiographic parameters between the two groups. Conclusion IDI is an accurate method for glenoid guidewire and component placement in rTSA, particularly in the superior/inferior plane and in glenoids with native retroversion >10°, when compared to conventional instrumentation.
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Affiliation(s)
- Pamela Boekel
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
| | - Matthew Rikard-Bell
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
| | - Benjamin Brandon
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
| | - Kenji Doma
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Sports and Exercise Science, James Cook University, Townsville, Queensland, Australia
| | - William B. O’Callaghan
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Cairns Hospital, Cairns, Queensland, Australia
| | - Matthew Wilkinson
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Royal Hobart Hospital and Calvary Care, University of Tasmania, Hobart, Tasmania, Australia
| | - Levi Morse
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
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14
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Jennewine BR, Brolin TJ. Emerging Technologies in Shoulder Arthroplasty: Navigation, Mixed Reality, and Preoperative Planning. Orthop Clin North Am 2023; 54:209-225. [PMID: 36894293 DOI: 10.1016/j.ocl.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Shoulder arthroplasty is a rapidly improving and utilized management for end-stage arthritis that is associated with improved functional outcomes, pain relief, and long-term implant survival. Accurate placement of the glenoid and humeral components is critical for improved outcomes. Traditionally, preoperative planning was limited to radiographs and 2-dimensional computed tomography (CT); however, 3-dimensional CT is becoming more commonly utilized and necessary to understand complex glenoid and humeral deformities. To further increase accurate component placement, intraoperative assistive devices-patient-specific instrumentation, navigation, and mixed reality-minimize malpositioning, increase surgeon accuracy, and maximize fixation. These intraoperative technologies likely represent the future of shoulder arthroplasty.
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Affiliation(s)
- Brenton R Jennewine
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 920 Madison Avenue, Memphis, TN 38163, USA; Campbell Clinic Orthopaedics, 1211 Union Avenue #500, Memphis, TN 38104, USA
| | - Tyler J Brolin
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 920 Madison Avenue, Memphis, TN 38163, USA; Campbell Clinic Orthopaedics, 1400 South Germantown Road, Germantown, TN 38138, USA.
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15
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Galán-Olleros M, Lopiz Y, Ciller G, Alcobía-Díaz B, García-Fernández C, Marco F. Does fluoroscopy improve baseplate position compared to conventional technique in reverse shoulder arthroplasty? A preliminary study. Shoulder Elbow 2023; 15:15-26. [PMID: 36895612 PMCID: PMC9990097 DOI: 10.1177/17585732211020657] [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: 01/16/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 11/15/2022]
Abstract
Background Accurate placement of glenoid component in reverse shoulder arthroplasty remains a challenge for surgeons of all levels of expertise; however, no studies have evaluated the utility of fluoroscopy as a surgical assistance method. Methods Prospective comparative study of 33 patients undergoing primary reverse shoulder arthroplasty during a 12-month period. Fifteen patients had a baseplate placed using the conventional "free hand" technique (control group), and 18 patients using intraoperative fluoroscopy assistance group, in a case-control design. Postoperative glenoid position was evaluated on postoperative Computed Tomography (CT) scan. Results The mean deviation of version and inclination for fluoroscopy assistance vs. control group was 1.75° (0.675-3.125) vs. 4.2° (1.975-10.45) (p = .015), and 3.85° (0-7.225) vs. 10.35° (4.35-18.75) (p = .009). The distance from the central peg midpoint to the inferior glenoid rim (fluoroscopy assistance 14.61 mm/control 4.75 mm, p = .581) and the surgical time (fluoroscopy assistance 1.93 ± 0.57/control 2.18 ± 0.44 h, p = .400) showed no differences, with an average radiation dose of 0.45 mGy and fluoroscopy time of 14 s. Conclusions Accurate axial and coronal scapular plane positioning of glenoid component is improved with intraoperative fluoroscopy at the cost of a greater radiation dose and without differences in surgical time. Comparative studies are needed to determine whether their use in relation to more expensive surgical assistance systems result in similar effectiveness.L evel of evidence : Level III, therapeutic study.
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Affiliation(s)
- María Galán-Olleros
- Shoulder and Elbow Unit, Orthopaedic
Surgery and Traumatology Department, Clínico San Carlos Hospital, Madrid,
Spain
| | - Yaiza Lopiz
- Shoulder and Elbow Unit, Orthopaedic
Surgery and Traumatology Department, Clínico San Carlos Hospital, Madrid,
Spain
- Department of Surgery, Complutense
University, Madrid, Spain
| | - Gabriel Ciller
- Shoulder and Elbow Unit, Orthopaedic
Surgery and Traumatology Department, Clínico San Carlos Hospital, Madrid,
Spain
| | - Borja Alcobía-Díaz
- Shoulder and Elbow Unit, Orthopaedic
Surgery and Traumatology Department, Clínico San Carlos Hospital, Madrid,
Spain
| | - Carlos García-Fernández
- Shoulder and Elbow Unit, Orthopaedic
Surgery and Traumatology Department, Clínico San Carlos Hospital, Madrid,
Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Orthopaedic
Surgery and Traumatology Department, Clínico San Carlos Hospital, Madrid,
Spain
- Department of Surgery, Complutense
University, Madrid, Spain
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16
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Preoperative Planning for Anatomic Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2022; 30:e1207-e1216. [PMID: 36135930 DOI: 10.5435/jaaos-d-21-01119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/08/2022] [Indexed: 02/01/2023] Open
Abstract
The success of total shoulder arthroplasty is dependent on both proper patient selection and restoration of the native anatomy. After proper patient selection, preoperative planning is essential to select implants that will allow the surgeon to properly restore soft-tissue tension and correct for deformity. Although it is possible to template implants with plain radiographs, these do not allow accurate measurements of the complex three-dimensional anatomy of the glenohumeral joint. CT can be used to further examine version of the glenoid and humerus, as well as humeral head subluxation. Three-dimensional reconstructions also allow for virtual implantation, resulting in a more reliable prediction of implant appearance. Commercial software is available that calculates parameters such as version; however, these have been shown to have variability when compared with measurements obtained by surgeons. Patient-specific instrumentation can also be obtained based on preoperative measurements; however, although it allowed for improved measurements when compared with two-dimensional imaging, there has been no difference in version error, inclination error, or positional offset of the glenoid implant when comparing patient-specific instrumentation with standard instrumentation. Intraoperative navigation can also be used to give real-time feedback on implant positioning; however, additional studies are needed to fully evaluate its benefit.
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17
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Prevalence and Clinical Impact of Incidental Findings on Preoperative 3D Planning Computed Tomography for Total Shoulder Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202208000-00003. [PMID: 35944103 PMCID: PMC9359811 DOI: 10.5435/jaaosglobal-d-21-00291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 06/16/2022] [Indexed: 11/24/2022]
Abstract
Introduction: 3D planning software for shoulder arthroplasty recently emerged for aiding in intraoperative determination of native glenoid. These protocols often require increased scan resolution, however, raising the question of an increased prevalence and clinical impact of incidental findings (IFs) from preoperative imaging. Methods: A retrospective review of preoperative shoulder CT reports was conducted for 333 consecutive patients planning anatomic or reverse total shoulder arthroplasties. Patients with thin-sliced CT scans (1.25 mm) were compared with those with standard CT scans (2.5 mm). Poisson regression was performed with baseline characteristics and potentially pathologic IFs (PPIFs). Results: IFs were present in 131 of the 333 scans (39.3%), and 38 of the 333 scans (11.4%) included PPIFs. Only 8 of the 333 scans (2.4%) required workup, with 2 of the 333 (0.6%) leading to new cancer diagnoses. Thin-sliced CT scans detected a higher mean number of IFs (1.12 versus 0.22, P < 0.001) while the mean number of PPIFs remained similar (0.13 versus 0.10, P = 0.43). Conclusion: IFs are frequent; however, only 0.6% scans led to new cancer diagnoses. Comparison of thin-sliced with standard CT scans revealed a higher frequency of IFs but similar PPIFs, indicating increased burden of IFs without the benefit of identifying additional malignancies. As demand rises for shoulder arthroplasties, surgeons should consider the potential hidden costs of IFs when using 3D planning programs.
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18
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Nascimento LGP, Ikemoto RY, Wright T. Navegação em cirurgia de artroplastia de ombro. Rev Bras Ortop 2022; 57:540-545. [PMID: 35966424 PMCID: PMC9365459 DOI: 10.1055/s-0040-1712989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/10/2020] [Indexed: 11/10/2022] Open
Abstract
The indication of shoulder arthroplasties has increased progressively. Accurate positioning of the components may have significant implications for clinical results. The navigation used to aid in the performance of anatomical and reverse total arthroplasties has provided greater precision in implant placement, especially on the glenoid. The development of the technique, material, and prosthesis design have shown encouraging results and led to a trend toward its expansion. In this way, we estimate a higher survival of the arthroplasties resulting from lower rates of dislocation and early loosening. We aim to describe the current technique and to present the results of the literature with navigation. However, comparative clinical studies with long term follow-up are necessary to prove the efficacy in the final results of total shoulder arthroplasties.
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Affiliation(s)
| | - Roberto Yukio Ikemoto
- Divisão de ombro e cotovelo, Faculdade de Medicina do ABC, Santo André, SP, Brasil
- Departamento de Ortopedia, Hospital Ipiranga, São Paulo, SP, Brasil
| | - Thomas Wright
- Centro de treinamento e pesquisa musculoesquelética, University of Florida, Gainesville, Florida, United States
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19
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Mid- to long-term outcomes of augmented and nonaugmented anatomic shoulder arthroplasty in Walch B3 glenoids. J Shoulder Elbow Surg 2022; 31:S103-S109. [PMID: 35063640 DOI: 10.1016/j.jse.2021.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/06/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND In cases of severe osteoarthritis, posterior glenoid wear leads to acquired retroversion of the glenoid. Surgical treatment of glenoids with acquired retroversion and posterior humeral subluxation with anatomic total shoulder arthroplasty (aTSA) is controversial. The purpose of this study was to determine mid- to long-term outcomes and reoperation rates of augmented and nonaugmented aTSA for treatment of glenohumeral osteoarthritis with Walch B3 glenoid deformity. METHODS This observational cohort study reviewed patients with a Walch B3 glenoid undergoing aTSA at a single institution between 2007 and 2014. Patients were contacted to complete updated patient-reported outcome measures at a minimum of 6 years postoperatively. Outcome measures collected included the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score and Single Alpha Numeric Evaluation (SANE) score. Secondary outcomes included any additional surgery on the operative shoulder, patient satisfaction, and willingness to undergo aTSA again. RESULTS Thirty-nine patients met inclusion criteria, and thirty-five (89.7%) were able to be contacted for final outcomes evaluation. Mean follow-up was 8.7 years (range 6-13) after surgery. Sixteen patients were treated with an augmented glenoid component, and 19 patients were treated with a standard glenoid component. Of those with standard components, all were partially corrected with asymmetric reaming. At final follow-up, there were no statistically significant differences between those with augmented and standard glenoid components for mean ASES score (93.3 vs. 85.7, P = .217), ASES pain score (47.2 vs. 41.6, P = .161), SANE score (87.8 vs. 86.0, P = .692), and percentage patient satisfaction (95.6% vs. 96.8%, P = .735), forward elevation (148° vs. 149°, P = .852), or external rotation (36° vs. 39°, P = .202). No patient in either group had undergone revision surgery of the operative shoulder over the study period and all patients stated that they would undergo the same surgery again. DISCUSSION Both augmented and standard aTSA can provide satisfactory and sustained improvements in patient-reported outcomes in patients with acquired glenoid retroversion due to glenohumeral osteoarthritis. Despite a trend toward alternative treatment options, anatomic shoulder arthroplasty should remain a surgical consideration even in the setting of a Walch B3 glenoid deformity.
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20
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Innovations in Shoulder Arthroplasty. J Clin Med 2022; 11:jcm11102799. [PMID: 35628933 PMCID: PMC9144112 DOI: 10.3390/jcm11102799] [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: 03/05/2022] [Revised: 05/07/2022] [Accepted: 05/12/2022] [Indexed: 11/22/2022] Open
Abstract
Innovations currently available with anatomic total shoulder arthroplasty include shorter stem designs and augmented/inset/inlay glenoid components. Regarding reverse shoulder arthroplasty (RSA), metal augmentation, including custom augments, on both the glenoid and humeral side have expanded indications in cases of bone loss. In the setting of revision arthroplasty, humeral options include convertible stems and newer tools to improve humeral implant removal. New strategies for treatment and surgical techniques have been developed for recalcitrant shoulder instability, acromial fractures, and infections after RSA. Finally, computer planning, navigation, PSI, and augmented reality are imaging options now available that have redefined preoperative planning and indications as well intraoperative component placement. This review covers many of the innovations in the realm of shoulder arthroplasty.
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21
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Freehill MT, Weick JW, Ponce BA, Bedi A, Haas D, Ruffino B, Robbins C, Prete AM, Costouros JG, Warner JJP. Anatomic Total Shoulder Arthroplasty: Component Size Prediction with 3-Dimensional Pre-Operative Digital Planning. J Shoulder Elb Arthroplast 2022; 6:24715492221098818. [PMID: 35669622 PMCID: PMC9163733 DOI: 10.1177/24715492221098818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/03/2022] [Accepted: 03/12/2022] [Indexed: 11/15/2022] Open
Abstract
Background The rate, complexity, and cost of total shoulder arthroplasty (TSA) continues to grow. Technology has advanced pre-operative templating. Reducing cost of TSA has positive impact for the patient, manufacturer, and hospital. The aim of this study was to evaluate the accuracy of implant size selection based on 3-D templating. Our hypothesis was that pre-operative templating would enable accurate implant prediction within one size. Methods Multicenter retrospective study of anatomic TSAs templated utilizing 3-D virtual planning technology. This program uses computed tomography (CT) scans allowing the surgeon to predict component sizes of the glenoid and humeral head and stem. Pre-operative templated implant size were compared to actual implant size at the time of surgery. Primary data analysis utilized unweighted Cohen's Kappa test. Results 111 TSAs were analyzed from five surgeons. Pre-operative templated glenoid sizes were within one size of actual implant in 99% and exactly matched in 89%. For patients requiring a posterior glenoid augment (n = 14), 100% of implants were within one size of the template and 93% matched exactly. For stemless humeral components (n = 87) implanted, 98% matched the pre-operative template within one size with 79% exactly matched. For stemmed components (n = 24), 88% of cases were within one size of the preoperative plan and exactly matching in 83%. Humeral head diameter matched within one size of the pre-operative template in 84% of cases and exactly matched in 72%. Conclusion Pre-operative 3-D templating for TSAs can accurately predict glenoid and humeral component size. This study sets the groundwork for utilization of pre-operative 3-D templating as a potential method to reduce overall TSA costs by managing cost of implants, reducing inventory needs, and improving surgical efficiency.
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Affiliation(s)
| | - Jack W. Weick
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Brent A. Ponce
- Department of Orthopaedic Surgery, University of Alabama Birmingham, Birmingham, AL, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Bethany Ruffino
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Chris Robbins
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Alexander M. Prete
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Jon JP Warner
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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22
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Lilley BM, Lachance A, Peebles AM, Powell SN, Romeo AA, Denard PJ, Provencher CMT. What is the deviation in 3D preoperative planning software? A systematic review of concordance between plan and actual implant in reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:1073-1082. [PMID: 35017079 DOI: 10.1016/j.jse.2021.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Three-dimensional (3D) preoperative planning software for reverse total shoulder arthroplasty (rTSA) has been implemented in recent years in order to increase accuracy, improve efficiency, and add value to the outcome. A comprehensive literature review is required to determine the utility of preoperative 3D planning software in guiding orthopedic surgeons for implant placement in rTSA. We hypothesize that implementation of 3D preoperative planning software in the setting of rTSA leads to high concordance with minimal deviation from the preoperative plan. METHODS A comprehensive and iterative literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using the PubMed, Embase, OVID Medline, Scopus, Cinahl, Web of Science, and Cochrane databases for original English-language studies evaluating the impact of preoperative planning software usage on rTSA outcomes published from January 1, 2000, to present. Blinded reviewers conducted multiple screens. All included studies were graded based on level of evidence, and data concerning patient demographics and postoperative outcomes were extracted. RESULTS Nine articles met inclusion criteria (1 level II, 3 level III, and 5 level IV articles), including 415 patients and 422 shoulders. Of the patients who underwent rTSA, 235 were female and 140 were male, although 3 studies (n = 40) did not report sex breakdowns for rTSA patients. The average age was 72.7 years. Four studies (79 shoulders) reported implant final position as mean deviation from planned version and planned inclination. Six studies (n = 236) reported screw angle deviation, fixation, length, and concordance. Concordance with the preoperative plan was measured in 3 studies (n = 178), resulting in complete concordance of 90% (n = 100), arthroplasty type concordance (rTSA vs. TSA) of 100% (n = 100), and glenosphere size concordance between 93% (n = 100) and 88% (n = 76). For screw length concordance, baseplate screw matched by 81% (n = 76) and 100% (n = 2), and upper (n = 35) and lower (n = 35) screw length concordance was observed as 74% and 69%, respectively. The use of preoperative planning (n = 178) was associated with low deviation from preoperative plan, more 2-screw fixations, and longer average screw length in comparison with an unplanned cohort. CONCLUSION The use of preoperative planning software in the setting of rTSA results in minimal deviation from preoperative plan. High levels of concordance in screw angle, screw length, and glenosphere size were observed. Further prospective studies should be conducted to further substantiate these results.
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Affiliation(s)
| | | | | | - Sarah N Powell
- Georgetown University School of Medicine, Washington, DC, USA
| | - Anthony A Romeo
- Department of Orthopaedic Surgery, DuPage Medical Group, Chicago, IL, USA
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Glenoid Component Placement Assisted by Augmented Reality Through a Head-Mounted Display During Reverse Shoulder Arthroplasty. Arthrosc Tech 2022; 11:e863-e874. [PMID: 35646556 PMCID: PMC9134485 DOI: 10.1016/j.eats.2021.12.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Component positioning is a key factor for avoiding complications and improving functional outcomes in reverse shoulder arthroplasty. Preoperative planning can improve component positioning. However, translating the preoperative plan into the surgical procedure can be challenging. This is particularly the case for the glenoid component positioning in severe deformity or limited visualization of the scapula. Different computational-assisted techniques have been developed to aid implementation of the preoperative plan into the surgical procedure. Navigated augmented reality (AR) refers to the real world augmented with virtual real-time information about the position and orientation of instruments and components. This information can be presented through a head-mounted display (HMD), which enables the user to visualize the virtual information directly overlaid onto the real world. Navigated AR systems through HMD have been validated for shoulder arthroplasty using phantoms and cadavers. This article details a step-by-step guide use of a navigated AR system through HMD, in the placement of the glenoid bony-augmented component.
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Mohammad Sadeghi M, Kececi EF, Kapicioglu M, Aralasmak A, Tezgel O, Basaran MA, Yildiz F, Bilsel K. Three dimensional patient-specific guides for guide pin positioning in reverse shoulder arthroplasty: An experimental study on different glenoid types. J Orthop Surg (Hong Kong) 2022; 30:10225536221079432. [PMID: 35220811 DOI: 10.1177/10225536221079432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Incorrect positioning is one of the main factors for glenoid component loosening in reverse shoulder arthroplasty and component placement can be challenging. This study aimed to assess whether Patient-Specific Instrumentation (PSI) provides better guide pin positioning accuracy and is superior to standard guided and freehand instrumentation methods in cases of glenoid bone deformity. MATERIALS AND METHODS Based on the Walch classification, five different scapula types were acquired by computed tomography (CT). For each type, two different surgeons placed a guide pin into the scapula using three different methods: freehand method, conventional non-patient-specific guide, and PSI guide. Each method was repeated five times by both surgeons. In these experiments, a total of 150 samples of scapula models were used (5 × 2 × 3 × 5 = 150). Post-operative CT scans of the samples with the guide pin were digitally assessed and the accuracy of the pin placement was determined by comparison to the preoperative planning on a three-dimensional (3D) model. RESULTS The PSI method showed accuracies to the preoperative plan of 2.68 (SD 2.10) degrees for version angle (p < .05), 2.59 (SD 2.68) degrees for inclination angle (p < .05), and 1.55 (SD 1.26) mm for entry point offset (p < .05). The mean and standard deviation errors compared to planned values of version angle, inclination angle, and entry point offset were statistically significant for the PSI method for the type C defected glenoid and non-arthritic glenoid. CONCLUSION Using the PSI guide created by an image processing software tool for guide pin positioning showed advantages in glenoid component positioning over other methods, for defected and intact glenoid types, but correlation with clinical outcomes should be examined.
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Affiliation(s)
| | - Emin Faruk Kececi
- Department of Mechanical Engineering Kayseri, 346448Abdullah Gul University, Kayseri, Turkey
| | - Mehmet Kapicioglu
- Orthopaedics and Traumatology Department, 221265Bezmialem Vakif University, Istanbul, Turkey
| | - Ayse Aralasmak
- Radiology Department, 469683Istinye University, Istanbul, Turkey
| | - Okan Tezgel
- Radiology Department, 469683Istinye University, Istanbul, Turkey
| | - Murat Alper Basaran
- Department of Management Engineering, 450199Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Fatih Yildiz
- Orthopaedics and Traumatology Department, 221265Bezmialem Vakif University, Istanbul, Turkey
| | - Kerem Bilsel
- Orthopaedics and Traumatology Department, 221265Bezmialem Vakif University, Istanbul, Turkey
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Variability and reliability of 2-dimensional vs. 3-dimensional glenoid version measurements with 3-dimensional preoperative planning software. J Shoulder Elbow Surg 2022; 31:302-309. [PMID: 34411724 DOI: 10.1016/j.jse.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/07/2021] [Accepted: 07/11/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preoperative planning for total shoulder arthroplasty (TSA) may change according to the measured degree of glenoid version. Both 2-dimensional (2D) and 3-dimensional (3D) computed tomographic (CT) scans are used to measure glenoid version, with no consensus on which method is more accurate. However, it is generally accepted that 3D measurements are more reliable, yet most 3D reconstruction software currently in clinical use have never been directly compared to 2D. The purpose of this study is to directly compare 2D and 3D glenoid version measurements and determine the differences between the two. METHODS CT scans were performed preoperatively on 315 shoulders undergoing either anatomic or reverse TSA. 2D measurements of glenoid version were obtained manually using the Friedman method, whereas 3D measurements were obtained using the Equinoxe Planning Application (Exactech Inc.) 3D-reconstruction software. Negative version values indicate retroversion, whereas positive values indicate anteversion. Two observers collected the 2D measurements 2 separate times, and intra- and interobserver measurements were calculated. Groups were compared for variability using intraclass correlation coefficients (ICCs), and for differences in sample means using Student t tests. Additionally, samples were stratified by version value in order to better understand the potential sources of error between measurement techniques. RESULTS For the 2D measurements, intraobserver variability indicated excellent reproducibility for both observer 1 (ICC = 0.928, 95% confidence interval [CI] 0.911-0.942) and observer 2 (ICC = 0.964, 95% CI 0.955-0.971). Interobserver variability measurements also indicated excellent reproducibility (ICC = 0.915, 95% CI 0.778-0.956). The overall 2D version measurement average (-4.9° ± 10.3°) was significantly less retroverted than the 3D measurement average (-8.4° ± 9.1°) (P < .001), with 3D measurements yielding a more retroverted value 73% of the time. When stratified on the basis of version value with outliers excluded, there was no significant difference in the distribution of high-error samples within the data. DISCUSSION There was excellent reproducibility between the 2 observers in terms of both intra- and interobserver variability. The 3D measurement techniques were significantly more likely to return a more retroverted measurement, and high-error samples were evenly distributed throughout the data, indicating that there were no discernable trends in the degree of error observed. Shoulder surgeons should be aware that different glenoid version measurement strategies can yield different version measurements, as these can affect preoperative planning and surgeon decision making.
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Karelse A, Van Tongel A, Gosens T, De Boey S, De Wilde LF, Pouliart N. Limited value of current shoulder arthroplasty registries in evidence-based shoulder surgery: a review of 7 national registries. Expert Rev Med Devices 2021; 18:1189-1201. [PMID: 34903126 DOI: 10.1080/17434440.2021.2014318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
National shoulder arthroplasty registries are currently used to assess incidence, indication, type of prosthesis and revision, but they seem to lack sufficient information to lead to evidence based decision-making in shoulder surgery. There appears to be a large difference in registered parameters and outcome measurement per country. First we investigated whether existing registries have sufficient common datasets to enable pooling of data. Second, we determined whether known risk factors for prosthetic failure are being recorded. Through a non-systematic literature review studies on registries were analyzed for included parameters. Seven national registries were scrutinized for the data collected and these were classified according to categories of risk factors for failure: patient-, implant and surgeon related, and other parameters. This shows a large heterogeneity of registered parameters between countries. The majority of parameters shown to be relevant to outcome and failure of shoulder prostheses are not included in the studied registries. International agreement on parameters and outcome measurement for registries is paramount to enable pooling and comparison of data. If we intend to use the registries to provide us with evidence to improve prosthetic shoulder surgery, we need adjustment of the different parameters to be included.
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Affiliation(s)
- Anne Karelse
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.,Department of Orthopaedic Surgery and Traumatology, ZorgSaam Hospital, Terneuzen, The Netherlands
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Taco Gosens
- Department of Orthopaedic Surgery and Traumatology, Elisabeth Tweesteden Hospital, Tilburg/Waalwijk, The Netherlands
| | - Sara De Boey
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Lieven F De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Nicole Pouliart
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Jo YH, Kim DH, Lee BG. When should reverse total shoulder arthroplasty be considered in glenohumeral joint arthritis? Clin Shoulder Elb 2021; 24:272-278. [PMID: 34875733 PMCID: PMC8651594 DOI: 10.5397/cise.2021.00633] [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: 11/01/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022] Open
Abstract
Anatomical total shoulder arthroplasty (TSA) has been used widely in treatment of glenohumeral osteoarthritis and provides excellent pain relief and functional results. Reverse total shoulder arthroplasty (RSA) was created to treat the complex problem of rotator cuff tear arthropathy. RSA also has been performed for glenohumeral osteoarthritis even in cases where the rotator cuff is preserved and has shown good results comparable with TSA. The indications for RSA are expanding to include tumors of the proximal humerus, revision of hemiarthroplasty to RSA, and revision of failed TSA to RSA. The purposes of this article were to describe comprehensively the conditions under which RSA should be considered in glenohumeral osteoarthritis, to explain its theoretical background, and to review the literature.
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Affiliation(s)
- Young-Hoon Jo
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Korea
| | - Dong-Hong Kim
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Bong Gun Lee
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
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Gauci MO, Athwal GS, Sanchez-Sotelo J, Chaoui J, Urvoy M, Boileau P, Walch G. Identification of threshold pathoanatomic metrics in primary glenohumeral osteoarthritis. J Shoulder Elbow Surg 2021; 30:2270-2282. [PMID: 33813011 DOI: 10.1016/j.jse.2021.03.140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND An assessment of the pathoanatomic parameters of the arthritic glenohumeral joint (GHJ) has the potential to identify discriminating metrics to differentiate glenoid types in shoulders with primary glenohumeral osteoarthritis (PGHOA). The aim was to identify the morphometric differences and threshold values between glenoid types including normal and arthritic glenoids with the various types in the Walch classification. We hypothesized that there would be clear morphometric discriminators between the various glenoid types and that specific numeric threshold values would allow identification of each glenoid type. METHODS The computed tomography scans of 707 shoulders were analyzed: 585 obtained from shoulders with PGHOA and 122 from shoulders without glenohumeral pathology. Glenoid morphology was classified according to the Walch classification. All computed tomography scans were imported in a dedicated automatic 3D-software program that referenced measurements to the scapular body plane. Glenoid and humeral modeling was performed using the best-fit sphere method, and the root-mean-square error was calculated. The direction and orientation of the glenoid and humerus described glenohumeral relationships. RESULTS Among shoulders with PGHOA, 90% of the glenoids and 85% of the humeral heads were directed posteriorly in reference to the scapular body plane. Several discriminatory pathoanatomic parameters were identified: GHJ narrowing < 3 mm was a discriminatory metric for type A glenoids. Posterior humeral subluxation > 70% discriminated type B1 from normal GHJs. The root-mean-square error was a discriminatory metric to distinguish type B2 from type A, type B3, and normal GHJs. Type B3 glenoids differed from type A2 by greater retroversion (>13°) and subluxation (>71%). The type C glenoid retroversion inferior limit was 21°, whereas normal glenoids never presented with retroversion > 16°. CONCLUSION Pathoanatomic metrics with the identified threshold values can be used to discriminate glenoid types in shoulders with PGHOA.
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Affiliation(s)
- Marc-Olivier Gauci
- Institut Universitaire Locomoteur & Sport, Unité de Recherche Clinique Côte d'Azur (UR2CA), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France.
| | | | | | | | | | - Pascal Boileau
- Institut Universitaire Locomoteur & Sport, Unité de Recherche Clinique Côte d'Azur (UR2CA), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France
| | - Gilles Walch
- Hôpital Privé Jean Mermoz-Generale De Santé (GDS) Ramsay, Lyon, France
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Levins JG, Kukreja M, Paxton ES, Green A. Computer-Assisted Preoperative Planning and Patient-Specific Instrumentation for Glenoid Implants in Shoulder Arthroplasty. JBJS Rev 2021; 9:01874474-202109000-00006. [PMID: 35417437 DOI: 10.2106/jbjs.rvw.20.00236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Glenoid component positioning affects implant survival after total shoulder arthroplasty, and accurate glenoid-component positioning is an important technical aspect. » The use of virtual planning and patient-specific instrumentation has been shown to produce reliable implant placement in the laboratory and in some clinical studies. » Currently available preoperative planning software programs employ different techniques to generate 3-dimensional models and produce anatomic measurements potentially affecting clinical decisions. » There are no published data, to our knowledge, on the effect of preoperative computer planning and patient-specific instrumentation on long-term clinical outcomes.
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Affiliation(s)
- James G Levins
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, Brown University Warren Alpert School of Medicine, Providence, Rhode Island
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30
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Cancienne JM, Dempsey IJ, Garrigues GE, Cole BJ, Brockmeier SF, Werner BC. Trends and impact of three-dimensional preoperative imaging for anatomic total shoulder arthroplasty. Shoulder Elbow 2021; 13:380-387. [PMID: 34394735 PMCID: PMC8355644 DOI: 10.1177/1758573220908865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/29/2019] [Accepted: 01/29/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The goals of this study were to determine the incidence in the United States of preoperative three-dimensional imaging prior to anatomic total shoulder arthroplasty for osteoarthritis and to determine if preoperative imaging is associated with decreased complication rates. METHODS Using a Medicare insurance database, we identified all patients who underwent computed tomography (n = 9380) and/or magnetic resonance imaging (n = 15,653) prior to anatomic total shoulder arthroplasty for a diagnosis of osteoarthritis from 2005 to 2014. The incidence of imaging over time was analyzed and complication rates compared between patients with imaging to matched controls. RESULTS The incidence of preoperative three-dimensional imaging significantly increased over time, with computed tomography increasing more than magnetic resonance imaging. Compared to controls, patients with preoperative computed tomography imaging had significantly lower revision rates at two years (odds ratio 0.72 (0.64-0.82), p = 0.008). There were no other significant differences in the other complications studied. CONCLUSIONS The use of preoperative three-dimensional imaging for anatomic total shoulder arthroplasty for a diagnosis of osteoarthritis has increased dramatically, with the use of computed tomography increasing the most. Patients who underwent preoperative computed tomography imaging experienced lower revision rates at two years postoperatively compared to matched controls without such imaging. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
| | - Ian J Dempsey
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, USA
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, USA
| | - Stephen F Brockmeier
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, USA
- Brian C Werner, Department of Orthopaedic
Surgery, University of Virginia Health System, PO Box 800159, Charlottesville,
VA, USA.
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31
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The Evolution of the Walch Classification for Primary Glenohumeral Arthritis. J Am Acad Orthop Surg 2021; 29:e635-e645. [PMID: 33973964 DOI: 10.5435/jaaos-d-20-00880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/10/2021] [Indexed: 02/01/2023] Open
Abstract
Our understanding of the pathology of and treatment for glenohumeral arthritis (GHA) has grown dramatically in the past few decades. Original observations regarding patterns of glenoid erosion, glenoid retroversion, and posterior humeral head subluxation in patients with primary GHA were documented in the 1980s and early 1990s. In the late 1990s, Walch et al proposed what is now the most widely used classification system to describe the characteristic pathology of GHA. Improved understanding of both premorbid and pathologic anatomies, along with advancements in imaging, have steered modifications in this classification system. These changes have improved its reliability and helped to further guide management decisions. The purpose of this article is to review the evolution of the Walch classification, understand the rationale behind the modifications, and discuss potential future developments.
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Shah SS, Sahota S, Denard PJ, Provencher MT, Parsons BO, Hartzler RU, Dines JS. Variability in total shoulder arthroplasty planning software compared to a control CT-derived 3D printed scapula. Shoulder Elbow 2021; 13:268-275. [PMID: 34659466 PMCID: PMC8513001 DOI: 10.1177/1758573219888821] [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: 09/01/2019] [Revised: 10/08/2019] [Accepted: 10/21/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Two techniques exist from which all 3D preoperative planning software for total shoulder arthroplasty are based. One technique is based on measurements constructed on the mid-glenoid and scapular landmarks (Landmark). The second is an automated system using a best-fit sphere technique (Automated). The purpose was to compare glenoid measurements from the two techniques against a control computed tomography-derived 3D printed scapula. METHODS Computed tomography scans of osteoarthritic shoulders of 20 patients undergoing primary total shoulder arthroplasty were analyzed with both 3D planning software techniques. Measurements from a 3D printed scapula (Scapula) from the true 3D computed tomography scan served as controls. Glenoid version and inclination measurements from each group were blinded and reviewed. RESULTS In 65% (Automated) and 45% (Landmark) of cases, either inclination or version varied by 5° or more versus 3D printed scapula. Significant variability in version differences compared to the scapula group existed (p = 0.007). Glenoid version from the Scapula = 13.0° ± 10.6°, Automated = 15.0° ± 13.9°, and Landmark = 12.2° ± 7.8°. Inclination from Scapula = 5.4° ± 7.9°, Automated = 6.1° ± 12.6°, and Landmark = 6.2° ± 9.1°. DISCUSSION A high percentage of cases showed discrepancies in glenoid inclination and version values from both techniques. Surgeons should be aware that regardless of software technique, there is variability compared to measurements from a control 3D computed tomography printed scapula.
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Affiliation(s)
| | | | | | | | - Bradford O Parsons
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Hurst SA, Merlini L, Hansen U, Gregory J, Emery R, Gregory T. The Glenoid Vault Outer Cortex a new more accurate radiological reference for shoulder arthroplasty. SICOT J 2021; 7:32. [PMID: 34009116 PMCID: PMC8132599 DOI: 10.1051/sicotj/2021030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/13/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Correct positioning of the glenoid component is an important determinant of outcome in shoulder arthroplasty. We describe and assess a new radiological plane of reference for improving the accuracy of glenoid preparation prior to component implantation – the Glenoid Vault Outer Cortex (GvOC) plane. Methods: One hundred and five CT scans of normal scapulae were obtained. Forty six females and 59 males aged between 22 and 30 years. The accuracy of the GvOC plane was then compared against the current “gold standard” – the scapular border (SB). Measurements of glenoid inclination, version, rotation, and offset were obtained using both the GvOC and SB planes. These were then compared to actual values. Results: The mean difference between version obtained using the GvOC plane and the actual value was 1.8° (−2 to 5, SD 1.6) as compared to 6.7° (−2 to 17, SD 4.3) when the SB plane was used, (p < 0.001). The mean difference between estimates of inclination obtained using the GvOC plane and the actual were 1.9° (−4 to 6, SD 1.6) as compared to 11.2° (−4 to 25, SD 6.1) when the SB plane was used, (p < 0.001). Conclusions: The GvOC plane produced estimates of glenoid version and inclination closer to actual values with lower variance than when the SB plane was used. The GvOC may be a more accurate and reproducible radiological method for surgeons to use when defining glenoid anatomy prior to arthroplasty surgery.
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Affiliation(s)
- Simon A Hurst
- Avicenne Teaching Hospital, 125 rue Stalingrad, Bobigny, 93000 Paris, France - Université Paris Sorbonne Nord, Campus de Bobigny, 1, rue de Chablis, Bobigny, 93000 Paris, France - Imperial College, St Mary's Hospital Campus, Queen Elizabeth Queen Mother Building, Praed Street, W2 1NY London, UK
| | - Lorenzo Merlini
- Avicenne Teaching Hospital, 125 rue Stalingrad, Bobigny, 93000 Paris, France - University Sorbonne-Paris-Nord, Equip Projet MOVEO, LaMSN, 99 Avenue Jean Baptiste, Clement, 93430 Villetaneuse, France
| | - Ulrich Hansen
- Imperial College, Department of Mechanical Engineering, South Kensington Campus, SW7 2AZ London, UK
| | - Jules Gregory
- Department of Radiology, Beaujon Hospital, Paris Nord Val de Seine Hospitals, APHP, 100 Avenue du General Leclerc, 92110 Clichy, France
| | - Roger Emery
- Imperial College, St Mary's Hospital Campus, Queen Elizabeth Queen Mother Building, Praed Street, W2 1NY London, UK
| | - Thomas Gregory
- Avicenne Teaching Hospital, 125 rue Stalingrad, Bobigny, 93000 Paris, France - University Sorbonne-Paris-Nord, Equip Projet MOVEO, LaMSN, 99 Avenue Jean Baptiste, Clement, 93430 Villetaneuse, France
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Lo L, Koenig S, Leong NL, Shiu BB, Hasan SA, Gilotra MN, Wang KC. Glenoid bony morphology of osteoarthritis prior to shoulder arthroplasty: what the surgeon wants to know and why. Skeletal Radiol 2021; 50:881-894. [PMID: 33095290 DOI: 10.1007/s00256-020-03647-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 02/08/2023]
Abstract
Shoulder arthroplasty is performed with increasing frequency, and osteoarthritis is the most common indication for this procedure. However, the glenoid side of the joint is widely recognized as a limiting factor in the long-term durability of shoulder replacement, and osteoarthritis leads to characteristic bony changes at the glenoid which can exacerbate this challenge by reducing the already limited glenoid bone stock, by altering biomechanics, and by interfering with operative exposure. This article reviews the Walch classification system for glenoid morphology. Several typical findings of osteoarthritis at the glenoid are discussed including central bone loss, posterior bone loss, retroversion, biconcavity, inclination, osteophyte formation, subchondral bone quality, and bone density. The three primary types of shoulder arthroplasty are reviewed, along with several techniques for addressing glenoid deformity, including eccentric reaming, bone grafting, and the use of augmented glenoid components. Ultimately, a primary objective at shoulder arthroplasty is to correct glenoid deformity while preserving bone stock, which depends critically on characterizing the glenoid at pre-operative imaging. Understanding the surgical techniques and the implications of glenoid morphology on surgical decision-making enables the radiologist to provide the morphologic information needed by the surgeon.
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Affiliation(s)
- Lawrence Lo
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Scott Koenig
- Department of Orthopaedics, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Natalie L Leong
- Department of Orthopaedics, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA.,Department of Orthopaedics, University of Maryland, School of Medicine, 110 S. Paca Street, 6th Floor, Baltimore, MD, 21201, USA
| | - Brian B Shiu
- Department of Orthopaedics, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA.,Department of Orthopaedics, University of Maryland, School of Medicine, 2200 Kernan Drive, Suite 1154, Baltimore, MD, 21207, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA.,Department of Orthopaedics, University of Maryland, School of Medicine, 100 Penn Street, Room 540D, Baltimore, MD, 21201, USA
| | - Kenneth C Wang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA. .,Imaging Service, Baltimore VA Medical Center, 10 N. Greene St, Rm. C1-24, Baltimore, MD, 21201, USA.
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35
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Kozak T, Bauer S, Walch G, Al-Karawi S, Blakeney W. An update on reverse total shoulder arthroplasty: current indications, new designs, same old problems. EFORT Open Rev 2021; 6:189-201. [PMID: 33841918 PMCID: PMC8025709 DOI: 10.1302/2058-5241.6.200085] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Reverse total shoulder arthroplasty (RTSA) was originally developed because of unsatisfactory results with anatomic shoulder arthroplasty options for the majority of degenerative shoulder conditions and fractures. After initial concerns about RTSA longevity, indications were extended to primary osteoarthritis with glenoid deficiency, massive cuff tears in younger patients, fracture, tumour and failed anatomic total shoulder replacement. Traditional RTSA by Grammont has undergone a number of iterations such as glenoid lateralization, reduced neck-shaft angle, modular, stemless components and onlay systems. The incidence of complications such as dislocation, notching and acromial fractures has also evolved. Computer navigation, 3D planning and patient-specific implantation have been in use for several years and mixed-reality guided implantation is currently being trialled. Controversies in RTSA include lateralization, stemless humeral components, subscapularis repair and treatment of acromial fractures.
Cite this article: EFORT Open Rev 2021;6:189-201. DOI: 10.1302/2058-5241.6.200085
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Affiliation(s)
- Thomas Kozak
- Albany Health Campus, Albany, Australia.,Royal Perth Hospital, Perth, Australia
| | - Stefan Bauer
- Ensemble Hospitalier de la Côte, Morges, Switzerland
| | - Gilles Walch
- Hôpital Privé Jean-Mermoz, Centre Orthopédique Santy, Lyon, France
| | | | - William Blakeney
- Albany Health Campus, Albany, Australia.,Royal Perth Hospital, Perth, Australia
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Kurashige S, Urita A, Iwasaki N. Total shoulder arthroplasty with an anteriorly augmented glenoid component for glenohumeral osteoarthritis with anterior glenoid bone loss: a case report. JSES Int 2021; 5:365-370. [PMID: 34136841 PMCID: PMC8178596 DOI: 10.1016/j.jseint.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Shusei Kurashige
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Atsushi Urita
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Orthopaedic Surgery, Wajokai Sapporo Hospital, Sapporo, Japan
- Corresponding author: Atsushi Urita, MD, PhD, Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Ricchetti ET, Jun BJ, Jin Y, Entezari V, Patterson TE, Derwin KA, Iannotti JP. Three-dimensional computed tomography analysis of pathologic correction in total shoulder arthroplasty based on severity of preoperative pathology. J Shoulder Elbow Surg 2021; 30:237-249. [PMID: 32777478 DOI: 10.1016/j.jse.2020.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/08/2020] [Accepted: 07/19/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to quantify correction of glenoid deformity and humeral head alignment in anatomic total shoulder arthroplasty as a function of preoperative pathology (modified Walch classification) and glenoid implant type in a clinical cohort using 3-dimensional computed tomography (CT) analysis. METHODS Patients undergoing anatomic total shoulder arthroplasty with a standard glenoid (SG) (n = 110) or posteriorly stepped augmented glenoid (AG) (n = 62) component were evaluated with a preoperative CT scan and a postoperative CT scan within 3 months of surgery. Glenoid version, inclination, and medial-lateral (ML) joint line position, as well as humeral head alignment, were assessed on both CT scans, with preoperative-to-postoperative changes analyzed relative to pathology and premorbid anatomy based on the modified Walch classification and glenoid implant type. RESULTS On average, correction to the premorbid ML joint line position was significantly less in type A2 glenoids than in type A1 glenoids (-2.3 ± 2.1 mm vs. 1.1 ± 0.9 mm, P < .001). Correction to premorbid version was not different between type B2 glenoids with AG components and type A1 glenoids with SG components (-1.7° ± 6.6° vs. -1.0° ± 4.0°, P = .57), and the premorbid ML joint line position was restored on average in both groups (0.3 ± 1.6 mm vs. 1.1 ± 0.9 mm, P = .006). Correction to premorbid version was not different between type B3 glenoids with AG components and type A1 glenoids with SG components (-0.6° ± 5.1° vs. -1.0° ± 4.0°, P = .72), but correction relative to the premorbid ML joint line position was significantly less in type B3 glenoids with AG components than in type A1 glenoids with SG components (-2.2 ± 2.1 mm vs. 1.1 ± 0.9 mm, P < .001). Postoperative humeral glenoid alignment was not different in any group comparisons. DISCUSSION In cases with posterior glenoid bone loss and retroversion (type B2 or B3 glenoids), an AG component can better correct retroversion and the glenoid ML joint line position compared with an SG component, with correction to premorbid version comparable to a type A1 glenoid with an SG component. However, restoration of the premorbid ML joint line position may not always be possible with SG or AG components in cases with more advanced central glenoid bone loss (type A2 or B3 glenoids). Further follow-up is needed to determine the clinical consequences of these findings.
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Affiliation(s)
- Eric T Ricchetti
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Bong-Jae Jun
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yuxuan Jin
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Vahid Entezari
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas E Patterson
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kathleen A Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph P Iannotti
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
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Kriechling P, Roner S, Liebmann F, Casari F, Fürnstahl P, Wieser K. Augmented reality for base plate component placement in reverse total shoulder arthroplasty: a feasibility study. Arch Orthop Trauma Surg 2021; 141:1447-1453. [PMID: 32715400 PMCID: PMC8354932 DOI: 10.1007/s00402-020-03542-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 07/15/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Accurate glenoid positioning in reverse total shoulder arthroplasty (RSA) is important to achieve satisfying functional outcome and prosthesis longevity. Optimal component placement can be challenging, especially in severe glenoid deformities. The use of patient-specific instruments (PSI) and 3D computer-assisted optical tracking navigation (NAV) are already established methods to improve surgical precision. Augmented reality technology (AR) promises similar results at low cost and ease of use. With AR, the planned component placement can be superimposed to the surgical situs and shown directly in the operating field using a head mounted display. We introduce a new navigation technique using AR via head mounted display for surgical navigation in this feasibility study, aiming to improve and enhance the surgical planning. METHODS 3D surface models of ten human scapulae were printed from computed tomography (CT) data of cadaver scapulae. Guidewire positioning of the central back of the glenoid baseplate was planned with a dedicated computer software. A hologram of the planned guidewire with dynamic navigation was then projected onto the 3D-created models of the cadaver shoulders. The registration of the plan to the anatomy was realized by digitizing the glenoid surface and the base of the coracoid with optical tracking using a fiducial marker. After navigated placement of the central guidewires, another CT imaging was recorded, and the 3D model was superimposed with the preoperative planning to analyze the deviation from the planned and executed central guides trajectory and entry point. RESULTS The mean deviation of the ten placed guidewires from the planned trajectory was 2.7° ± 1.3° (95% CI 1.9°; 3.6°). The mean deviation to the planned entry point of the ten placed guidewires measured 2.3 mm ± 1.1 mm (95% CI 1.5 mm; 3.1 mm). CONCLUSION AR may be a promising new technology for highly precise surgical execution of 3D preoperative planning in RSA.
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Affiliation(s)
- Philipp Kriechling
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Simon Roner
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Florentin Liebmann
- Computer Assisted Research and Development Group, Balgrist University Hospital, Zurich, Switzerland
| | - Fabio Casari
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Philipp Fürnstahl
- Computer Assisted Research and Development Group, Balgrist University Hospital, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
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Sheth MM, Morris BJ, Laughlin MS, Cox JL, Jones S, Elkousy HA, Edwards TB. Outcomes of anatomic shoulder arthroplasty performed on B2 vs. A1 type glenoids. J Shoulder Elbow Surg 2020; 29:2571-2577. [PMID: 33190757 DOI: 10.1016/j.jse.2020.03.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid component malpositioning and glenoid component retroversion have been associated with higher rates of radiolucencies, raising concerns about its implications on glenoid loosening and ultimate failure of anatomic total shoulder arthroplasty (TSA). Although there is literature regarding the relative advantages of techniques to address posterior glenoid bone loss, we are not aware of studies comparing outcomes of TSA on these challenging Walch type B2 glenoids vs. more common A1 glenoids. The purpose of this study is to compare outcomes of TSA performed on A1 glenoids and B2 glenoids treated with asymmetric glenoid reaming. METHODS We identified 1045 shoulders that had primary TSAs performed for osteoarthritis in a prospective shoulder arthroplasty registry. Two hundred eighty-nine shoulders met inclusion criteria of a preoperative Walch type A1 (178) or B2 (111) glenoid morphology, treatment with TSA, asymmetric reaming in the B2 group, and a minimum of 2-year clinical and radiographic follow-up. Postoperative radiographs were assessed for lucencies, and patient-reported outcome measures were collected at all follow-up visits. RESULTS Follow-up averaged 40 ± 15 months for all patients, and more men presented with a B2 glenoid (80 of 111; 72%) compared with A1 (101 of 178; 57%) (P = .009). Age at surgery (P = .166), dominant-sided surgery (P = .281), body mass index (P = .501), smoking (P = .155), preoperative opioid use (P = .154), and diabetes (P = .331) were not significantly different between groups. Both groups had similar Constant Strength scores preoperatively (A1: 4.7 ± 7.1, and B2: 4.3 ± 7.3) but the B2 group improved significantly more at final follow-up (A1: 10.3 ± 6.2 vs. B2: 12.7 ± 6.7, P = .005). The Total Constant score was also significantly better at follow-up in the B2 glenoid group (P = .039). All other Constant subscales, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Single Assessment Numerical Evaluation (SANE) measures showed significant improvement preoperatively to final follow-up (all P <.001) but there were no significant differences between the A1 and B2 glenoid groups (all P > .05). A similar proportion of patients rated their satisfaction as either very satisfied or satisfied between the A1 (160; 90%) and B2 (100; 90%) (P = .613). Lazarus scores were also similar between the A1 and B2 groups (P = .952) as were the rates of humeral radiolucent lines (P = .749) and humeral osteolysis (P = .507). CONCLUSIONS Although patients with B2 glenoids may present a more technically challenging anatomic total shoulder arthroplasty, treatment with concurrent asymmetric glenoid reaming produced similar, successful clinical and radiographic early to midterm outcomes for patients undergoing TSA compared with A1 glenoids. Additional follow-up on this cohort will be important to confirm the durability of these early results.
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Affiliation(s)
- Mihir M Sheth
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Brent J Morris
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA; Fondren Orthopedic Research Institute (FORI), Houston, TX, USA; Texas Education and Research Foundation for Shoulder and Elbow Surgery, Inc. (TERFSES), Houston, TX, USA
| | - Mitzi S Laughlin
- Fondren Orthopedic Research Institute (FORI), Houston, TX, USA; Texas Education and Research Foundation for Shoulder and Elbow Surgery, Inc. (TERFSES), Houston, TX, USA.
| | - Jacob L Cox
- Texas Education and Research Foundation for Shoulder and Elbow Surgery, Inc. (TERFSES), Houston, TX, USA
| | - Stephen Jones
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA
| | - Hussein A Elkousy
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA; Fondren Orthopedic Research Institute (FORI), Houston, TX, USA; Texas Education and Research Foundation for Shoulder and Elbow Surgery, Inc. (TERFSES), Houston, TX, USA
| | - T Bradley Edwards
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA; Fondren Orthopedic Research Institute (FORI), Houston, TX, USA; Texas Education and Research Foundation for Shoulder and Elbow Surgery, Inc. (TERFSES), Houston, TX, USA
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40
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Moreschini F, Colasanti GB, Cataldi C, Mannelli L, Mondanelli N, Giannotti S. Pre-Operative CT-Based Planning Integrated With Intra-Operative Navigation in Reverse Shoulder Arthroplasty: Data Acquisition and Analysis Protocol, and Preliminary Results of Navigated Versus Conventional Surgery. Dose Response 2020; 18:1559325820970832. [PMID: 35185413 PMCID: PMC8851139 DOI: 10.1177/1559325820970832] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/24/2020] [Accepted: 10/12/2020] [Indexed: 11/17/2022]
Abstract
Reverse total shoulder arthroplasty (RSA) successfully restores shoulder function in different conditions. Glenoid baseplate fixation and positioning seem to be the most important factors influencing RSA survival. When scapular anatomy is distorted (eccentric osteoarthrirtis, rotator cuff arthropathy), optimal baseplate positioning and secure screw purchase can be challenging. The aim of this study was to evaluate whether CT-based pre-operative planning, integrated with intra-operative navigation could improve glenoid baseplate fixation and positioning by increasing screw length, reducing number of screws required to obtain fixation and increasing the use of augmented baseplate to gain the desired positioning. Twenty patients who underwent navigated RSA were compared retrospectively with 20 patients operated on with a conventional technique. All the procedures were performed by the same surgeon, using the same implant. Mean screw length was significantly longer in the navigation group (35.5 ± 4.4 mm vs 29.9 ± 3.6 mm; p = .001). Significant higher rate of optimal fixation using 2 screws only (17 vs 3 cases, p = .019) and higher rate of augmented baseplate usage (13 vs 4 cases, p = .009) was also present in the navigation group. Pre-operative CT-based planning integrated with intra-operative navigation can improve glenoid component positioning and fixation, possibly leading to an improvement of RSA survival.
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Affiliation(s)
- Fabio Moreschini
- Section of Orthopaedics, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Giovanni Battista Colasanti
- Section of Orthopaedics, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Carlo Cataldi
- Section of Orthopaedics, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Lorenzo Mannelli
- IRCCS SDN Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | - Nicola Mondanelli
- Section of Orthopaedics, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Stefano Giannotti
- Section of Orthopaedics, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
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Matsen FA, Whitson AJ, Somerson JS, Hsu JE. Anatomic Total Shoulder Arthroplasty with All-Polyethylene Glenoid Component for Primary Osteoarthritis with Glenoid Deficiencies. JB JS Open Access 2020; 5:JBJSOA-D-20-00002. [PMID: 33376930 PMCID: PMC7757838 DOI: 10.2106/jbjs.oa.20.00002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study evaluated the ability of shoulder arthroplasty using a standard glenoid component to improve patient self-assessed comfort and function and to correct preoperative humeral-head decentering on the face of the glenoid in patients with primary glenohumeral arthritis and type-B2 or B3 glenoids.
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Affiliation(s)
- Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Anastasia J Whitson
- 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
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Alashkham A, Soames R. The glenoid and humeral head in shoulder osteoarthritis: A comprehensive review. Clin Anat 2020; 34:710-720. [PMID: 33191525 DOI: 10.1002/ca.23703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/14/2020] [Accepted: 11/11/2020] [Indexed: 01/03/2023]
Abstract
The key management of glenohumeral osteoarthritis is shoulder arthroplasty which aims to reduce pain and restore full shoulder function: it has increased in recent years. A detailed understanding of the anatomy of the glenoid and humeral head, as well as morphological changes of the glenoid in osteoarthritis, are important factors to consider when deciding on replacement components. This review begins with a brief introduction of the glenohumeral joint itself, and then considers the detailed anatomy of the glenoid fossa and humeral head, both of which are reported to have variable morphology. Several studies have been undertaken to assess various parameters, especially of the glenoid fossa including its shape, height, width, and articular surface area, version and inclination, in an attempt to define a standard classification that can be applied to surgical intervention. Nevertheless, no definitive consensus concerning the classification of these morphologies has been forthcoming, hence the need for this review. Following a consideration of these morphologies, the current state of knowledge regarding glenoid deformity in osteoarthritis, as well as its surgical management, is considered.
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Affiliation(s)
- Abduelmenem Alashkham
- Anatomy, School of Biomedical Sciences, University of Edinburgh, Edinburgh, UK.,Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK.,Human Anatomy Department, Faculty of Medicine, University of Zawia, Zawia, Libya
| | - Roger Soames
- Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK
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Schoch BS, Haupt E, Leonor T, Farmer KW, Wright TW, King JJ. Computer navigation leads to more accurate glenoid targeting during total shoulder arthroplasty compared with 3-dimensional preoperative planning alone. J Shoulder Elbow Surg 2020; 29:2257-2263. [PMID: 32586595 DOI: 10.1016/j.jse.2020.03.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/15/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Commercially available preoperative planning software is now widely available for shoulder arthroplasty. However, without the use of patient-specific guides or intraoperative visual guidance, surgeons have little in vivo feedback to ensure proper execution of the preoperative plan. The purpose of this study was to assess surgeons' ability to implement a preoperative plan in vivo during shoulder arthroplasty. METHODS Fifty primary shoulder arthroplasties from a single institution were retrospectively reviewed. All surgical procedures were planned using a commercially available software package with both multiplanar 2-dimensional computed tomography and a 3-dimensional implant overlay. Following registration of intraoperative visual navigation trackers, the surgeons (1 attending and 1 fellow) were blinded to the computer navigation screen and attempted to implement the plan by simulating placement of a central-axis guide pin. Malposition was assessed (>4 mm of displacement or >10° error in version or inclination). Data were then blinded, measured, and evaluated. RESULTS Mean displacement from the planned starting point was 3.2 ± 2.0 mm. The mean error in version was 6.4° ± 5.6°, and the mean error in inclination was 6.6° ± 4.9°. Malposition was observed in 48% of cases after preoperative planning. Malposition errors were more commonly made by fellow trainees vs. attending surgeons (58% vs. 38%, P = .047). CONCLUSIONS Despite preoperative planning, surgeons of various training levels were unable to reproducibly replicate the planned component position consistently. Following completion of fellowship training, significantly less malposition resulted. Even in expert hands, the orientation of the glenoid component would have been malpositioned in 38% of cases. This study further supports the benefit of guided surgery for accurate placement of glenoid components, regardless of fellowship training.
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Affiliation(s)
- Bradley S Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Edward Haupt
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | | | - Kevin W Farmer
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
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Trivedi NN, Shimberg JL, Sivasundaram L, Mengers S, Salata MJ, Voos JE, Gillespie RJ. Advances in Glenoid Design in Anatomic Total Shoulder Arthroplasty. J Bone Joint Surg Am 2020; 102:1825-1835. [PMID: 33086353 DOI: 10.2106/jbjs.19.01294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Nikunj N Trivedi
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Olszewski A, Ramme AJ, Maerz T, Freehill MT, Warner JJP, Bedi A. Vault perforation after eccentric glenoid reaming for deformity correction in anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29:1450-1459. [PMID: 32061513 DOI: 10.1016/j.jse.2019.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/10/2019] [Accepted: 11/23/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The management of glenoid deformity during anatomic total shoulder arthroplasty remains controversial. In this study, we evaluate variable correction of glenoid deformity by eccentric reaming. We hypothesize that partial correction of modified Walch B/C-type glenoid deformities can achieve 75% bone-implant contact area (BICA) with a reduced vault perforation risk compared with complete correction. METHODS Fifty shoulder computed tomographic scans with glenohumeral osteoarthritis were retrospectively evaluated. The Tornier BluePrint v2.1.5 software simulated 3 eccentric reaming scenarios including no, partial, and complete deformity correction. Each scenario was evaluated at 4 BICAs and using 3 implant fixation types. Three-dimensional surface representations were used to evaluate medialization and vault perforation. RESULTS The patients had mean glenoid retroversion and inclination of 18.5° and 8.8°, respectively, and mean posterior humeral head subluxation of 76%. With 75% BICA, the 3 fixation types had glenoid vault perforation in 6%-26% and 26%-54% of cases for partial and complete glenoid deformity correction, respectively. The central and posterior-inferior implant components were most likely to perforate across all scenarios. DISCUSSION Eccentric reaming for glenoid deformity correction increases the risk of vault perforation. Severe glenoid deformity required increased medialization to achieve 75% BICA. Pegged implants have increased chances of perforation compared with a keeled design; the central and posterior-inferior components were most likely to perforate during deformity correction. CONCLUSION Partial deformity correction of modified Walch B/C-type glenoid deformities can achieve 75% BICA while reducing the risk of vault perforation compared with complete correction at the time of anatomic total shoulder arthroplasty.
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Affiliation(s)
- Adam Olszewski
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Austin J Ramme
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Tristan Maerz
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jon J P Warner
- Boston Shoulder Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.
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DeVito P, Agyeman KD, Judd H, Moor M, Berglund D, Malarkey A, Levy JC. Outcomes of anatomic total shoulder arthroplasty in patients with excessive glenoid retroversion: a case-control study. J Shoulder Elbow Surg 2019; 28:1948-1955. [PMID: 31227465 DOI: 10.1016/j.jse.2019.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/08/2019] [Accepted: 03/13/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ideal management of severe glenoid retroversion during anatomic total shoulder arthroplasty (TSA) remains controversial, as previous reports have suggested that severe retroversion may negatively impact clinical outcomes. The purpose of this study was to evaluate the impact of severe glenoid retroversion on clinical and radiographic TSA outcomes using a standard glenoid component, as well as to compare outcomes among patients with less severe retroversion. METHODS A case-control study was performed comparing 40 patients treated with TSA with more than 20° of glenoid retroversion preoperatively (average follow-up, 53 months) vs. a matched cohort of 80 patients with less than 20° of retroversion (average follow-up, 49 months). In all patients, the surgical technique, implant design, and postoperative rehabilitation protocol were identical. Patients were matched based on sex, age, indication, and prosthetic size. Comparisons were made regarding patient-reported outcome measures (PROMs), motion, postoperative radiographic loosening, and the presence of medial calcar resorption. RESULTS Preoperatively, both groups demonstrated similar PROMs and measured motion, except for preoperative Single Assessment Numeric Evaluation scores and American Shoulder and Elbow Surgeons total scores, which were higher for the severe retroversion group (44.4 vs. 31.3 [P = .012] and 34.9 vs. 29.4 [P = .048], respectively). Postoperative PROMs and motion were also similar between the 2 cohorts. No significant differences were observed for postoperative radiographic findings. Medial calcar resorption was identified in 74 patients (61.7%). Calcar resorption and individual resorption grades were not found to differ significantly. CONCLUSION At midterm follow-up, preoperative severe glenoid retroversion does not appear to influence clinical or radiographic outcomes of TSA using a standard glenoid component.
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Affiliation(s)
- Paul DeVito
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
| | - Kofi D Agyeman
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Hyrum Judd
- Larkin Community Hospital, Miami, FL, USA
| | - Molly Moor
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
| | | | - Andy Malarkey
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
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The Walch type B humerus: glenoid retroversion is associated with torsional differences in the humerus. J Shoulder Elbow Surg 2019; 28:1801-1808. [PMID: 31043349 DOI: 10.1016/j.jse.2019.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/01/2019] [Accepted: 02/15/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Walch type B glenoid has the hallmark features of retroversion, joint subluxation, and bony erosion. Although the type B glenoid has been well described, the morphology of the corresponding type B humerus is poorly understood. As such, the aim of this imaging-based anthropometric study was to investigate humeral torsion in Walch type B shoulders. METHODS Three-dimensional models of the full-length humerus were generated from computed tomography data for the Walch type B group (n = 59) and for a control group of normal nonarthritic shoulders (n = 59). An anatomic humeral head-neck plane was created and used to determine humeral torsion relative to the epicondylar axis. Measurements were repeated, and intraclass correlation coefficients were calculated. RESULTS The type B humeri had significantly (P < .001) less retrotorsion (14° ± 9°) than the control group (36° ± 12°) relative to the epicondylar axis. Male and female individuals within the control group showed statistically significant differences in humeral torsion (P = .043), which were not found in the type B group. Inter-rater reliability showed excellent agreement for humeral torsion (intraclass correlation coefficient, 0.962). A subgroup analysis between Walch type B2 and B3 shoulders showed no significant differences in any of the humeral or glenoid parameters. CONCLUSION The Walch type B humerus has significantly less retrotorsion than non-osteoarthritic shoulders. At present, it is unknown whether the altered humeral retrotorsion is a cause or effect of the type B glenoid. In addition, it is unknown whether surgeons should be reconstructing type B2 humeral component version to pathologic torsion or to nonpathologic population means to optimize arthroplasty survivorship.
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Smith MJ, Loftis CM, Skelley NW. Eccentric Reaming for B2 Glenoids: History, Preoperative Planning, Surgical Technique, and Outcome. J Shoulder Elb Arthroplast 2019; 3:10.1177_2471549219870348. [PMID: 34514277 PMCID: PMC8282167 DOI: 10.1177/2471549219870348] [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: 02/13/2019] [Revised: 05/17/2019] [Accepted: 07/26/2019] [Indexed: 11/16/2022] Open
Abstract
Background The biconcave (B2) glenoid is characterized by preservation of the anterior
portion of the native glenoid with asymmetric wear of the posterior glenoid.
Surgical options for glenoid correction have evolved. The goal of shoulder
arthroplasty is to place the implants in such a manner to return the humeral
head to a centered position and restore the joint line to a neutral
position. There is no current consensus on method of treatment and
correction. Methods The current and historical literature on total shoulder arthroplasty was used
to examine technique viability. Results Asymmetric remaining can be used to address up to 15° of version correction
without compromise of cortical bone. It is important to have the proper
presurgical planning, to understand the limitations of correction, and to
have other options available to treat the biconcave glenoid.
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Affiliation(s)
- Matthew J Smith
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | | | - Nathan W Skelley
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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Burns DM, Frank T, Whyne CM, Henry PDG. Glenoid component positioning and guidance techniques in anatomic and reverse total shoulder arthroplasty: A systematic review and meta-analysis. Shoulder Elbow 2019; 11:16-28. [PMID: 31447941 PMCID: PMC6688155 DOI: 10.1177/1758573218806252] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/27/2018] [Accepted: 09/17/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Positioning of the glenoid component is one of the most challenging steps in shoulder arthroplasty, and prosthesis longevity as well as functional outcomes is considered highly dependent on accurate positioning. This review considers the evidence supporting surgical navigation and patient-specific instruments for glenoid implant positioning in anatomic and reverse total shoulder arthroplasty. METHODS A systematic literature search was performed for studies assessing glenoid implant positioning accuracy as measured by cross-sectional imaging on live subjects or cadaver models. Meta-analysis of controlled studies was performed to estimate the primary effects of navigation and patient-specific instruments on glenoid implant positioning error. Meta-analysis of absolute positioning outcomes was also performed for each group incorporating data from controlled and uncontrolled studies. RESULTS Nine studies, four controlled and five uncontrolled, with 258 total subjects were included in the analysis. Meta-analysis of controlled studies supported that both navigation and patient-specific instruments had a moderate statistically significant effect on improving glenoid implant positioning outcomes. Meta-analysis of absolute positioning outcomes demonstrates glenoid implant positioning with standard instrumentation results in a high rate of malposition. DISCUSSION Navigation and patient-specific instruments improve glenoid positioning outcomes. Whether the improvement in positioning outcomes achieved translate to better clinical outcomes is unknown.
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Affiliation(s)
- David M Burns
- Division of Orthopaedic Surgery,
University of Toronto, Toronto, Canada,Sunnybrook Research Institute, Toronto,
Canada,David M Burns, Sunnybrook Health Sciences
Centre, 2075 Bayview Ave., Room S621, Toronto, ON M4N 3M5, Canada.
| | - Tym Frank
- Division of Orthopaedic Surgery,
University of Toronto, Toronto, Canada
| | | | - Patrick DG Henry
- Division of Orthopaedic Surgery,
University of Toronto, Toronto, Canada,Sunnybrook Health Sciences Centre,
Toronto, Canada
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50
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Priddy M, Zarezadeh A, Farmer KW, Struk AM, King JJ, Wright TW, Schoch BS. Early results of augmented anatomic glenoid components. J Shoulder Elbow Surg 2019; 28:S138-S145. [PMID: 31196508 DOI: 10.1016/j.jse.2019.04.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Augmented glenoid components restore the native joint line and preserve bone in shoulders with posterior glenoid bone loss. The purpose of this study was to compare the clinical and radiographic outcomes of augmented total shoulder arthroplasties (TSAs) vs. case-matched shoulders with standard implants to assess the early performance of a full-wedge augmented glenoid component. METHODS Between 2010 and 2015, all TSAs using a full-wedge posteriorly augmented glenoid component with a minimum 2-year follow-up from a single institution were retrospectively reviewed. A total of 37 augmented TSAs were matched with 37 control shoulders with unaugmented glenoid components. The primary outcomes were revision and radiographic glenoid lucencies. Secondary outcomes included range of motion (ROM) and patient-reported outcomes (PROs). RESULTS Both augmented and standard TSAs produced similar improvements in all ROM and PRO measures. Patients with augmented glenoid components were more likely to have type B2 or B3 deformities (P = .004). At final follow-up, 54% of augmented glenoids showed implant lucencies compared with 46% of control shoulders (P = .5). The mean Lazarus score remained similar between groups (1.5 vs. 1.2, P = .8). When 8° and 16° augmentations were compared, the 16° augmentation demonstrated a significantly higher mean Lazarus score (4.2 vs. 1.1, P = .03). Reoperation rates were similar between groups (5% vs. 3%, P = .6). DISCUSSION Patients with posteriorly augmented glenoid components demonstrate similar improvements in ROM and PROs to patients with standard anatomic glenoid components. Radiographic loosening and revision rates were similar. However, a higher failure rate was seen with the 16° full-wedge augmentation, which is no longer used in our practice.
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Affiliation(s)
- Michael Priddy
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Ali Zarezadeh
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Kevin W Farmer
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Aimee M Struk
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Bradley S Schoch
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA.
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