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Narang A, Dupley L, Davies R, Phillips N, Peach C. Suprascapular nerve irritation as an important cause of pain following reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2024; 33:e291-e295. [PMID: 38461937 DOI: 10.1016/j.jse.2024.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 01/30/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Ashish Narang
- Shoulder and Elbow Unit, Manchester University Hospitals, Manchester, UK.
| | - Leanne Dupley
- Shoulder and Elbow Unit, Manchester University Hospitals, Manchester, UK
| | - Ronnie Davies
- Shoulder and Elbow Unit, Manchester University Hospitals, Manchester, UK
| | - Nicholas Phillips
- Shoulder and Elbow Unit, Manchester University Hospitals, Manchester, UK
| | - Christopher Peach
- Shoulder and Elbow Unit, Manchester University Hospitals, Manchester, UK
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Longo UG, Lalli A, Gobbato B, Nazarian A. Metaverse, virtual reality and augmented reality in total shoulder arthroplasty: a systematic review. BMC Musculoskelet Disord 2024; 25:396. [PMID: 38773483 PMCID: PMC11106997 DOI: 10.1186/s12891-024-07436-8] [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: 09/27/2023] [Accepted: 04/11/2024] [Indexed: 05/23/2024] Open
Abstract
PURPOSE This systematic review aims to provide an overview of the current knowledge on the role of the metaverse, augmented reality, and virtual reality in reverse shoulder arthroplasty. METHODS A systematic review was performed using the PRISMA guidelines. A comprehensive review of the applications of the metaverse, augmented reality, and virtual reality in in-vivo intraoperative navigation, in the training of orthopedic residents, and in the latest innovations proposed in ex-vivo studies was conducted. RESULTS A total of 22 articles were included in the review. Data on navigated shoulder arthroplasty was extracted from 14 articles: seven hundred ninety-three patients treated with intraoperative navigated rTSA or aTSA were included. Also, three randomized control trials (RCTs) reported outcomes on a total of fifty-three orthopedics surgical residents and doctors receiving VR-based training for rTSA, which were also included in the review. Three studies reporting the latest VR and AR-based rTSA applications and two proof of concept studies were also included in the review. CONCLUSIONS The metaverse, augmented reality, and virtual reality present immense potential for the future of orthopedic surgery. As these technologies advance, it is crucial to conduct additional research, foster development, and seamlessly integrate them into surgical education to fully harness their capabilities and transform the field. This evolution promises enhanced accuracy, expanded training opportunities, and improved surgical planning capabilities.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128, Italy.
| | - Alberto Lalli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128, Italy
| | - Bruno Gobbato
- Department of Orthopaedic Surgery, Hospital Sao Jose Jaraguá do Sul, Jaraguá, SC, 89251-830, Brazil
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Spek RW, Hoogervorst LA, Brink RC, Schoones JW, van Deurzen DF, van den Bekerom MP. Ten technical aspects of baseplate fixation in reverse total shoulder arthroplasty for patients without glenoid bone loss: a systematic review. Clin Shoulder Elb 2024; 27:88-107. [PMID: 38147872 PMCID: PMC10938023 DOI: 10.5397/cise.2023.00493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 12/28/2023] Open
Abstract
The aim of this systematic review was to collect evidence on the following 10 technical aspects of glenoid baseplate fixation in reverse total shoulder arthroplasty (rTSA): screw insertion angles; screw orientation; screw quantity; screw length; screw type; baseplate tilt; baseplate position; baseplate version and rotation; baseplate design; and anatomical safe zones. Five literature libraries were searched for eligible clinical, cadaver, biomechanical, virtual planning, and finite element analysis studies. Studies including patients >16 years old in which at least one of the ten abovementioned technical aspects was assessed were suitable for analysis. We excluded studies of patients with: glenoid bone loss; bony increased offset-reversed shoulder arthroplasty; rTSA with bone grafts; and augmented baseplates. Quality assessment was performed for each included study. Sixty-two studies were included, of which 41 were experimental studies (13 cadaver, 10 virtual planning, 11 biomechanical, and 7 finite element studies) and 21 were clinical studies (12 retrospective cohorts and 9 case-control studies). Overall, the quality of included studies was moderate or high. The majority of studies agreed upon the use of a divergent screw fixation pattern, fixation with four screws (to reduce micromotions), and inferior positioning in neutral or anteversion. A general consensus was not reached on the other technical aspects. Most surgical aspects of baseplate fixation can be decided without affecting fixation strength. There is not a single strategy that provides the best outcome. Therefore, guidelines should cover multiple surgical options that can achieve adequate baseplate fixation.
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Affiliation(s)
- Reinier W.A. Spek
- Department of Orthopaedic Surgery, Flinders University and Flinders Medical Center, Adelaide, Australia
- Department of Orthopaedic Surgery, OLVG Amsterdam, Amsterdam, the Netherlands
- Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lotje A. Hoogervorst
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
- Department of Biomedical Data Sciences and Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob C. Brink
- Department of Orthopaedic Surgery, OLVG Amsterdam, Amsterdam, the Netherlands
| | - Jan W. Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Michel P.J. van den Bekerom
- Department of Orthopaedic Surgery, OLVG Amsterdam, Amsterdam, the Netherlands
- Shoulder and Elbow Expertise Center, Amsterdam, the Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Diaz MA, Hutchinson AJ, Ricchetti ET, Hsu JE, Garrigues GE, Gutiérrez S, Frankle MA. How to avoid baseplate failure: the effect of compression and reverse shoulder arthroplasty baseplate design on implant stability. J Shoulder Elbow Surg 2024; 33:389-398. [PMID: 37689101 DOI: 10.1016/j.jse.2023.07.043] [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: 05/01/2023] [Revised: 07/10/2023] [Accepted: 07/29/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Failure to achieve fixation of the glenoid baseplate will lead to clinical failure. The fixation of the baseplate to the scapula must be able to withstand sufficient shear forces to allow bony ingrowth. The importance of compression to neutralize the forces at the baseplate-bone interface has been assumed to be critical in limiting excessive micromotion. The purpose of this study is to determine the effect of compression on implant stability with different baseplate designs. METHODS Various baseplate designs (1-piece monolithic central screw [1P], 2-piece locking central screw [2PL], and 2-piece nonlocking center screw [2PNL]) were investigated at 3 different compressive forces (high [810 N], medium [640 N], and low [530 N]). Synthetic bone cylinders were instrumented, and peripheral screws were used in all models. The combination of 1 locking and 3 nonlocking peripheral screw fixation was selected as worst-case scenario. Dynamic testing protocol followed the ASTM F2028-17 standard. The baseplate micromotion at high compression was compared to low compression. Additionally, the baseplate micromotion for each design was compared at baseline (first 50 cycles) and at 10,000 cycles for the 3 different compressive forces where motion above 150 μm was defined as failure. RESULTS Baseplate micromotion was found to negatively correlate with compression (rpb = -0.83, P < .0001). At baseline, all baseplate designs were considered stable, regardless of compression. With high compression, average micromotion at the glenoid baseplate-bone interface remained below the 150-μm threshold for all baseplate designs at 10,000 cycles (1P: 50 ± 10 μm; 2PL: 78 ± 32 μm; 2PNL: 79 ± 8 μm; P = .060). With medium compression, average micromotion at 10,000 cycles for all 3 designs remained below the 150-μm threshold (1P: 88 ± 22 μm; 2PL: 132 ± 26 μm; 2PNL: 107 ± 39 μm). The 2PL design had the highest amount of micromotion (P = .013). With low compression, both 2-piece designs had an average micromotion above the 150-μm threshold whereas the 1-piece design did not (1P: 133 ± 35 μm; 2PL: 183 ± 21 μm; 2PNL: 166 ± 39 μm). The 2PL design had significantly higher micromotion when compared to 1P design (P = .041). DISCUSSION The stability of a central screw baseplate correlates with the amount of compression obtained and is affected by implant design. For the same amount of compression, more micromotion is observed in a 2-piece design than a 1-piece design.
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Affiliation(s)
- Miguel A Diaz
- Foundation for Orthopaedic Research & Education, Tampa, FL, USA
| | | | - Eric T Ricchetti
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | | | - Mark A Frankle
- Department of Orthopaedics & Sports Medicine, University of South Florida, Tampa, FL, USA; Florida Orthopaedic Institute, Tampa, FL, USA.
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Velasquez Garcia A, Abdo G. Does computer-assisted navigation improve baseplate screw configuration in reverse shoulder arthroplasty? A systematic review and meta-analysis of comparative studies. J Orthop 2023; 36:29-35. [PMID: 36582549 PMCID: PMC9793209 DOI: 10.1016/j.jor.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/18/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Navigation technologies have improved accuracy and precision in positioning glenoid components during shoulder arthroplasty. The influence of navigation on baseplate screw placement has not been independently investigated. This study aimed to evaluate and synthesize the best scientific evidence on the influence of intraoperative navigation on the length and number of screws for primary baseplate fixation in reverse total shoulder arthroplasty procedures. Methods In August 2022, PubMed, Scopus, and Embase databases were accessed. We analyzed the screw purchase length, the number of screws required for the fixation of the baseplate, and the proportion of cases fixed with two screws in all clinical trials, comparing navigation to standard instrumentation for reverse shoulder arthroplasty. Following an evaluation of the heterogeneity of the studies, DerSimonian-Laird random-effects models were utilized to merge data from separate studies. Results The systematic search revealed a total of 2034 articles. After excluding duplicates and irrelevant studies, 633 shoulder arthroplasties from 6 trials were included in the analysis. The pooled mean difference in screw purchase length was 5.839 mm (95 %CI 4.496 to 7. 182) in favor of navigation (P < .001). In addition, significant differences were also found in the number of screws per case (- 0.547, 95 %CI -0.890 to -0.203, P = .002) and in the proportion of cases fixed with two screws (Odds Ratio 3.182 95 %CI 1.057 to 9.579, P = .040) in favor of the navigation group. Conclusions Intraoperative navigation improves the baseplate screw placement, allowing for a greater screw purchase length and fewer screws to achieve primary fixation of the glenoid component during reverse shoulder arthroplasty. It is unclear whether these improvements will increase the longevity of the prosthesis or the clinical outcomes of the patients.
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Affiliation(s)
- Ausberto Velasquez Garcia
- Department of Orthopedic Surgery, Clinica Universidad de Los Andes, Santiago, Chile
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Glen Abdo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- St Mary's General Hospital, Department of Graduate Medical Education, Internal Medicine Residence Program, Passaic, NJ, USA
- Department of Basic Sciences, Touro College of Osteopathic Medicine, New York, NY, USA
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Torkan L, Bryant JT, Bicknell RT, Ploeg HL. Accuracy of an Apparatus for Measuring Glenoid Baseplate Micromotion in Reverse Shoulder Arthroplasty. J Med Device 2022. [DOI: 10.1115/1.4055063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Reverse shoulder arthroplasty (RSA) is used to treat patients with cuff tear arthropathy. Loosening remains one of the principal modes of implant failure and the main complication leading to revision. Excess micromotion contributes to glenoid loosening. This study assessed the predictive accuracy of an experimental system designed to assess factors contributing to RSA glenoid baseplate micromotion. A half-fractional factorial experiment was designed to assess 4 factors: central element type (screw vs. peg), central element length (13.5 vs. 23.5 mm), anterior posterior peripheral screw type (locking vs. nonlocking) and cancellous bone density (10 vs. 25 pounds per cubic foot [pcf]). Four linear variable differential transducers (LVDTs) recorded micromotion from a stainless-steel disc surrounding a modified glenosphere. The displacements were used to interpolate micromotion at each of the respective peripheral screw positions. The mean absolute percentage error (MAPE) was used to determine the predictive accuracy and error range of the system. The MAPE for each condition ranged from 6.8% to 12.9% for an overall MAPE of (9.5&#177;0.9)%. The system had an error range of 2.7 &#181;m to 20.1 &#181;m, which was lower than those reported by prior studies using optical systems. One of the eight conditions had micromotion that exceeded 150 &#181;m. These findings support the use of displacement transducers, specifically LVDTs, as an accurate system for determining RSA baseplate micromotion in rigid polyurethane foam bone surrogates.
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Affiliation(s)
- Lawrence Torkan
- Human Mobility Research Centre, Queen's University, Kingston, ON, Canada; Department of Mechanical and Materials Engineering , Queen's University, Kingston, ON, Canada
| | - John T Bryant
- Human Mobility Research Centre, Queen's University, Kingston, ON, Canada; Department of Mechanical and Materials Engineering , Queen's University, Kingston, ON, Canada
| | - Ryan T Bicknell
- Human Mobility Research Centre, Queen's University, Kingston, ON, Canada; Department of Surgery, Queen's University , Kingston, ON, Canada
| | - Heidi-Lynn Ploeg
- Human Mobility Research Centre, Queen's University, Kingston, ON, Canada; Department of Mechanical and Materials Engineering , Queen's University, Kingston, ON, Canada
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7
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Central fixation element type and length affect glenoid baseplate micromotion in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:1385-1392. [PMID: 35172207 DOI: 10.1016/j.jse.2022.01.120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/03/2022] [Accepted: 01/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) is commonly used to treat patients with rotator cuff tear arthropathy. Loosening of the glenoid component remains one of the principal modes of failure and represents a significant complication that requires revision surgery. This study assessed the effects of various factors on glenoid baseplate micromotion for primary fixation of RSA. MATERIALS AND METHODS A half-fractional factorial design of experiment was used to assess 4 factors: central element type (central peg or screw), central cortical engagement according to length (13.5 or 23.5 mm), anterior-posterior peripheral screw type (nonlocking or locking), and cancellous bone surrogate density (160 or 400 kg/m3, 10 or 25 PCF). Glenoid baseplates were implanted into high- or low-density Sawbones rigid polyurethane foam blocks and cyclically loaded at 60° for 1000 cycles (500-N compressive force range) using a custom-designed loading apparatus. Micromotion at the 4 peripheral screw positions was recorded using linear variable differential transformers. RESULTS Central peg fixation generated 358% greater micromotion at all peripheral screw positions compared with central screw fixation (P < .001). Baseplates with short central elements that lacked cortical bone engagement generated 328% greater micromotion than those with long central elements (P = .001). No significant effects were observed when varying anterior-posterior peripheral screw type or bone surrogate density. There were significant interactions between central element type and length (P < .001). DISCUSSION A central screw and a long central element that engaged cortical bone reduced RSA baseplate micromotion. These findings serve to inform surgical decision making regarding baseplate fixation elements to minimize the risk of glenoid loosening and, thus, the need for revision surgery.
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Eyberg BA, Wilder LB, Simon P, Gutierrez S, Ayala G, Iannotti JP, Mighell MA, Frankle MA. Identifying areas of screw fixation in glenoids with severe bone loss in shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:S136-S142. [PMID: 35182767 DOI: 10.1016/j.jse.2022.01.131] [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: 11/15/2021] [Revised: 01/11/2022] [Accepted: 01/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Severe glenoid bone loss (SGBL) poses significant technical challenges. Adequate fixation of glenoid implants may require the use of alternative screw placement. Although bone volumes for the spine and lateral pillars have previously been defined, insufficient evidence exists regarding the distribution of screw placement for fixation in such regions for cases with SGBL. The purpose of this study is to evaluate the variability of screw placement. We hypothesize that determining this variability and establishing common patterns of glenoid bone loss will allow for recommendations for preoperative planning, and implant design and selection. METHODS An internal registry of 2 high-volume shoulder and elbow surgeons was queried, and 65 three-dimensional scapulae models exhibiting SGBL were identified. A fellowship-trained shoulder and elbow surgeon simulated the placement of two 3.5 mm × 30 mm screws, one in the scapular spine (CS) bone volume and one in the inferior column (IS) bone volume. Three orthogonal reference planes were created using anatomic reference points: the scapula trigonum, estimated glenoid center, and inferior pole. Screw positions were mapped, and deviations from the reference planes were calculated. Mutual positions of the IS to CS were also computed. Intraobserver reliability was assessed using 10 randomly selected samples. Median and 25th and 75th percentiles were reported for screw orientation distributions. Means and standard deviations were reported for screw head positions. RESULTS We demonstrated excellent intraobserver reliability (intraclass correlation coefficients, 0.90-0.98). Fifty percent of CS were oriented 10° ± 5° of retroversion from the scapula plane, with 5° ± 5° of inclination. For IS, 50% were positioned 0° ± 4° from the scapula plane, with -33° ± 7° of inclination. The relationship of the IS with the CS was medial and posterior in 49% of cases, lateral and posterior in 45%, and lateral and anterior in 6% of cases. On average, the distance between the CS and IS heads was 25 mm ± 4 mm. DISCUSSION For SGBL, adequate fixation of glenoid implants can be achieved by placing screws in the spine and lateral columns, with excellent reproducibility. Future implant designs should accommodate CS positioned -16° to -5° from the scapula plane, with 0° to 12° of inclination, and IS positioned -6° to 4° from the scapula plane, with -40° to -25° of inclination. Moreover, mutual screw positions suggested bone loss distributions anteriorly and inferiorly. Future implant designs should consider the potential benefits of augmentation to accommodate interscrew distances of 21-29 mm and anatomic locations of the IS relative to the CS.
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Affiliation(s)
- Blake A Eyberg
- Shoulder Service, Florida Orthopaedic Institute, Tampa, FL, USA
| | - Lauren B Wilder
- Department of Translational Research, Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Peter Simon
- Department of Translational Research, Foundation for Orthopaedic Research and Education, Tampa, FL, USA; Department of Medical Engineering, University of South Florida, Tampa, FL, USA
| | - Sergio Gutierrez
- Department of Translational Research, Foundation for Orthopaedic Research and Education, Tampa, FL, USA; Department of Medical Engineering, University of South Florida, Tampa, FL, USA
| | - Giovanni Ayala
- Department of Translational Research, Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Joseph P Iannotti
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mark A Mighell
- Shoulder Service, Florida Orthopaedic Institute, Tampa, FL, USA
| | - Mark A Frankle
- Shoulder Service, Florida Orthopaedic Institute, Tampa, FL, USA.
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Miyatake K, Fukuta S, Tonogai I, Wada K, Higashino K, Mikami H, Yonezu H, Sairyo K, Tsuruo Y. Influence of the glenoid baseplate position on the direction and length of the superior and inferior locking screws. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:185-190. [DOI: 10.2152/jmi.69.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Katsutoshi Miyatake
- Department of Orthopaedic Surgery, Yoshinogawa Medical Center, Tokushima, Japan
| | - Shoji Fukuta
- Department of Orthopaedic Surgery, Kochi National Hospital, Kochi, Japan
| | - Ichiro Tonogai
- Department of Orthopaedic Surgery, Tokushima University, Tokushima, Japan
| | - Keizo Wada
- Department of Orthopaedic Surgery, Tokushima University, Tokushima, Japan
| | - Kosaku Higashino
- Department of Orthopaedic Surgery, Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | - Hiroshi Mikami
- Department of Orthopaedic Surgery, Yoshinogawa Medical Center, Tokushima, Japan
| | - Hiroshi Yonezu
- Department of Orthopaedic Surgery, Yoshinogawa Medical Center, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopaedic Surgery, Tokushima University, Tokushima, Japan
| | - Yoshihiro Tsuruo
- Department of Anatomy and Cell biology, Tokushima University, Tokushima, Japan
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Ehrlich JH, Vendries V, Bryant TJ, Rainbow MJ, Ploeg HL, Bicknell RT. Trabecular bone density distribution in the scapula of patients undergoing reverse shoulder arthroplasty. JSES Int 2021; 6:32-39. [PMID: 35141673 PMCID: PMC8811382 DOI: 10.1016/j.jseint.2021.09.004] [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] [Indexed: 11/22/2022] Open
Abstract
Background To improve implant survival after reverse shoulder arthroplasty (RSA), surgeons need to maximize screw fixation. However, bone density variation and distribution within the scapula are not well understood as they relate to RSA. The three columns of bone in the scapula surrounding the glenoid fossa are the lateral border, the base of the coracoid process, and the spine of the scapula. In our previous study by Daalder et al on cadaveric specimens, the coracoid column was significantly less dense than the lateral border and spine. This study’s objective was to verify whether these results are consistent with computer tomography (CT) scan information from patients undergoing RSA. Methods Two-dimensional axial CT images from twelve patients were segmented, and a three-dimensional digital model of the scapula was subsequently created using Mimics 17.0 Materialise Software (Leuven, Belgium). Hounsfield unit (HU) values representing cortical bone were filtered out to determine the distributions of trabecular bone density. An analysis of variance with post hoc Bonferroni tests determined the differences in bone density between the columns of bone in the scapula. Results The coracoid superolateral (270 ± 45.6 HU) to the suprascapular notch was significantly less dense than the inferior (356 ± 63.6 HU, P = .03, ds = 1.54) and anterosuperior portion of the lateral border (353 ± 68.9 HU, P = .04, ds = 1.42) and the posterior (368 ± 70 HU, P = .007, ds = 1.65) and anterior spine (370 ± 78.9 HU, P = .006, ds = 1.54). Discussion/Conclusion The higher-density bone in the spine and lateral border compared with the coracoid region may provide better bone purchase for screws when fixing the glenoid baseplate in RSA. This is in agreement with our previous study and indicates that the previous cadaveric results are applicable to clinical CT scan data. When these studies are taken together, they provide robust evidence for clinical applications, including having surgeons aim screws for higher-density regions to increase screw fixation, which may decrease micromotion and improve implant longevity.
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11
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Almeida A, Agostini DC, Nesello PF, de Almeida NC, Mioso R, Agostini AP. Tomographic Analysis of Positioning of Reverse Baseplates Positioning. J Shoulder Elb Arthroplast 2021; 5:2471549220987714. [PMID: 34497966 PMCID: PMC8282139 DOI: 10.1177/2471549220987714] [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: 08/28/2020] [Revised: 10/15/2020] [Accepted: 12/22/2020] [Indexed: 11/17/2022] Open
Abstract
Objective To verify whether reverse baseplate positioning without the support of intraoperative three-dimensional technology is within the acceptable parameters in the literature and whether glenoid bone deformity (GBD) compromises this positioning. Methods Sixty-nine reverse shoulder arthroplasties were evaluated with volumetric computed tomography (CT). Two radiologists performed blinded CT scan analysis and evaluated baseplate position within 2mm of the inferior glenoid; the inclination and version of the baseplate in relation to the Friedman line; and upper and lower screw and baseplate metallic peg end point positionings. The patients were divided according to the presence of GBD for statistical analyses. Results The two radiologists concurred reasonably in their interpretations of the following analyzed parameters: baseplate position within 2mm of the inferior glenoid rim (97.1% and 95.7%), baseplate inclination (82.6% and 81.2%), baseplate version (69.6% and 56.5%), the upper screw reaching the base of the coracoid process (71% and 79.7%), the inferior screw remaining inside the scapula (88.4% and 84.1%), and the metallic peg of the baseplate considered intraosseous (88.4% and 72.5%). Conclusion Reverse baseplate positioning without intraoperative three-dimensional technology is within the acceptable parameters of the literature, except for baseplate version and upper screw position. GBD did not interfere with baseplate positioning in reverse shoulder arthroplasty.
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Affiliation(s)
| | | | | | | | - Rafael Mioso
- Radiologist Physician, General Hospital, Caxias do Sul, Brazil
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12
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Li J, Zhou J, Wang D, Li D, Zhang W. Applied anatomical study on suprascapular nerve protection in reverse total shoulder arthroplasty. J Orthop Surg Res 2020; 15:524. [PMID: 33176828 PMCID: PMC7661197 DOI: 10.1186/s13018-020-02061-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to investigate the three-dimensional (3D) anatomical relationship between the suprascapular nerve and scapula, and the method of protecting the suprascapular nerve in reverse total shoulder arthroplasty (RTSA) METHODS: In the present study, 12 fresh adult cadaver shoulder specimens were dissected. X-ray and computed tomography (CT) were used to investigate the 3D scapular and suprascapular nerve images. RESULTS The results revealed that the best fitting baseplate diameter was 24.73 ± 1.56 mm. Furthermore, the baseplate diameter correlated with the glenoid cavity width. After the osteotomy, a simulated screw placement on the baseplate was performed. The dangerous area for the posterior screw placement was at the angle between the upper edge and transverse axis exceeding 38° and between the lower edge and transverse axis exceeding 76°. The distance between the nearest point of the nerve and osteotomy plane was 15.38 ± 2.02 mm, and the angle between the projection point of the nearest point and transverse axis was 27.33 ± 7.96°, which was the dangerous area for retractor placement. The suitable angle between the superior screw and longitudinal axis was 21.67 ± 13.27°, and the suitable superior screw length was 34.66 ± 2.41 mm. CONCLUSION In RTSA, the baseplate size correlates with the glenoid cavity width. The relationship between the screw and suprascapular nerve and retractor placement position should be carefully considered to avoid damaging the suprascapular nerve.
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Affiliation(s)
- Jianfeng Li
- Department of Orthopaedics, Beijing Chaoyang Hospital of Capital Medical University, No. 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, PR China
| | - Junlin Zhou
- Department of Orthopaedics, Beijing Chaoyang Hospital of Capital Medical University, No. 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, PR China.
| | - Dong Wang
- Department of Orthopaedics, Beijing Chaoyang Hospital of Capital Medical University, No. 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, PR China
| | - Dacun Li
- Department of Upper Limb Surgery, Beijing Shunyi District Hospital, No. 3 of Guangming Nanjie, Shunyi District, Beijing, 101300, PR China
| | - Wentong Zhang
- Department of Upper Limb Surgery, Beijing Shunyi District Hospital, No. 3 of Guangming Nanjie, Shunyi District, Beijing, 101300, PR China
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13
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Venne G, Pickell M, Ellis RE, Bicknell RT. Reliability of a novel 3-dimensional computed tomography method for reverse shoulder arthroplasty postoperative evaluation. JSES OPEN ACCESS 2019; 3:168-173. [PMID: 31709357 PMCID: PMC6835033 DOI: 10.1016/j.jses.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Long-term function and survival of reverse shoulder arthroplasties (RSAs) are reliant on component positioning and fixation. Conventional postoperative analysis is performed using plain radiographs or 2-dimensional (2D) computed tomography (CT) images. Although 3-dimensional (3D) CT would be preferred, its use is limited by metal artifacts. This study proposes a new 3D CT method for postoperative RSA evaluation and compares its interobserver reliability with conventional methods. Materials and methods Preoperative and postoperative CT scans, as well as postoperative radiographs, were obtained from 18 patients who underwent RSA implantation; the scapula, implant, and screws were reconstructed as 3D CT models. The postoperative 3D scapula and implant were imported into preoperative coordinates and matched to the preoperative scapula. Standardized scapula coordinates were defined, in which the glenoid baseplate version and inclination angle were measured. The percentage of screw volume in bone was measured from a Boolean intersection operation between the preoperative scapula and screw models. Four independent reviewers performed the measurements using 3D CT and conventional 2D methods. Intraclass correlation coefficients (ICCs) were used to compare the reliability of the methods. Results The 3D CT method showed excellent reliability (ICC > 0.75) in baseplate inclination (ICC = 0.92), version (ICC = 0.97), and screw volume in bone (ICC = 0.99). Conventional 2D methods demonstrated poor reliability (ICC < 0.4). For radiographs, inclination showed poor reliability (ICC = 0.09) and the screw percentage in bone showed fair reliability (ICC = 0.54). Version was not measured with plain radiographs. For 2D CT slice measurements, inclination showed poor reliability (ICC = 0.02), version showed excellent reliability (ICC = 0.81), and the screw percentage in bone showed poor reliability (ICC = 0.28). Conclusion The new 3D CT-based method for evaluating RSA glenoid implant positioning and screw volume in bone showed excellent reliability and overcame the metal-artifact limitation of postoperative CT and 3D CT reconstruction.
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Affiliation(s)
- Gabriel Venne
- Department of Anatomy and Cell Biology, McGill University, Montréal, QC, Canada
- Corresponding author: Gabriel Venne, DO, PhD, Department of Anatomy and Cell Biology, McGill University, 3640 Rue University, Montréal, QC H3A 0C7, Canada. gabriel.venne.@mcgill.ca
| | - Michael Pickell
- Department of Surgery, Queen’s University, Kingston, ON, Canada
- Kinston General Hospital, Kingston, ON, Canada
| | - Randy E. Ellis
- Department of Surgery, Queen’s University, Kingston, ON, Canada
- Kinston General Hospital, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
- Department of Mechanical and Materials Engineering, Queen’s University, Kingston, ON, Canada
- School of Computing, Queen’s University, Kingston, ON, Canada
| | - Ryan T. Bicknell
- Department of Surgery, Queen’s University, Kingston, ON, Canada
- Kinston General Hospital, Kingston, ON, Canada
- Department of Mechanical and Materials Engineering, Queen’s University, Kingston, ON, Canada
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14
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Nashikkar PS, Scholes CJ, Haber MD. Role of intraoperative navigation in the fixation of the glenoid component in reverse total shoulder arthroplasty: a clinical case-control study. J Shoulder Elbow Surg 2019; 28:1685-1691. [PMID: 31262637 DOI: 10.1016/j.jse.2019.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/28/2019] [Accepted: 03/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fixation of the glenoid baseplate in reverse total shoulder arthroplasty (rTSA) is an important factor in the success of the procedure. There is limited information available regarding the effect of navigation on fixation characteristics. Therefore, the aims of this study were to determine whether computed tomography-based computer navigation improved the glenoid base plate fixation by (1) increasing the length of screw purchase, (2) altering screw angulation, and (3) decreasing central cage perforation in patients undergoing rTSA. METHODS Patients undergoing rTSAs using navigation (NAV, N = 27) and manual technique (MAN, N = 23) from January 2014 to July 2017 were analyzed in a case-control design. Screw purchase length and central cage perforation were assessed using multiplanar computed tomography. RESULTS Median screw purchase length was significantly longer in the NAV group for both anterior (20 mm vs. 15 mm, P < .01) and posterior screws (20 mm vs. 13 mm, P < .01). In addition, the NAV group displayed significantly lower incidences of inadequate screw purchase (<22 mm) for the anterior (64.7% vs. 95.2%, P = .03) and posterior (70.6% vs. 100%, P = .01) screws. Significant differences in axial and coronal screw angulation were observed between groups. Similarly, the NAV group displayed significantly reduced incidence of central cage perforation (17.7% vs. 52.4%, P = .04). CONCLUSION The use of computer-assisted navigated rTSA contributes to significant alterations in screw purchase length, screw angulation, and central cage perforation of the glenoid baseplate compared with non-navigated methods.
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Affiliation(s)
| | | | - Mark D Haber
- Southern Orthopaedics, Wollongong, NSW, Australia.
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15
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Central screw use delays implant dislodgement in osteopenic bone but not synthetic surrogates: A comparison of reverse total shoulder models. J Biomech 2019; 93:11-17. [DOI: 10.1016/j.jbiomech.2019.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/21/2019] [Accepted: 06/03/2019] [Indexed: 11/18/2022]
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16
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Jeong YS, Yum JK, Lee JS. Another Glenoid Measurements for Shoulder Surgery. Clin Shoulder Elb 2018; 21:179-185. [PMID: 33330174 PMCID: PMC7726404 DOI: 10.5397/cise.2018.21.4.179] [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: 06/01/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 11/25/2022] Open
Abstract
Background We analyzed the angle between the glenoid anterior surface and glenoid axis, the range of the glenoid apex and the location of the glenoid apex for assistance during shoulder surgery. Methods Sixty-two patients underwent a computed tomography of the shoulder with a proximal humerus fracture. In the range of the glenoid apex, the ratios of the distribution of triangles with a Constant anterior and posterior area of the glenoid were measured. The location of glenoid apex was confirmed as the percentage of the position with respect to the upper part of the glenoid with the center of the part, analyzed the angle between the glenoid anterior surface and glenoid axis was measured. Results The angle between the glenoid anterior surface and glenoid axis was 19.80° ± 3.88°. The location of the glenoid apex is 60.36% ± 9.31%, with the upper end of the glenoid as the reference. The range of the glenoid apex was 21.16% ± 4.98%. When the height of the glenoid becomes smaller, the range of the glenoid apex tends to become larger (p=0.001) and the range of the glenoid apex becomes wider (p=0.001) as the glenoid width narrows. Conclusions We believe the anatomical measurements of the glenoid will be helpful for a more accurate insertion in glenoid component. It is thought that more accurate insertion is possible if we can set other anatomical measurements using computed tomography imaging of the glenoid which can develop into the study of other anatomical measurements.
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Affiliation(s)
- Yeon-Seok Jeong
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Jae-Kwang Yum
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Jun-Seok Lee
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
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Trabecular bone density distribution in the scapula relevant to reverse shoulder arthroplasty. JSES OPEN ACCESS 2018; 2:174-181. [PMID: 30675591 PMCID: PMC6334872 DOI: 10.1016/j.jses.2018.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background How trabecular bone density varies within the scapula and how this may lead to more optimal reverse shoulder arthroplasty (RSA) screw placement has not been addressed in the scientific literature. The 3 columns of trabecular bone within the scapula adjacent to the glenoid fossa, one extending through the lateral border, a second into the base of the coracoid process, and a third extending into the spine of the scapula, were hypothesized to be of relatively similar density. Methods Two-dimensional axial computed tomography (CT) images of 19 fresh frozen cadaver specimens were obtained. Digital Imaging and Communications in Medicine (DICOM; National Electrical Manufacturers Association, Rosslyn, VA, USA) image files of the CT scanned scapulae were imported into Mimics 17.0 Materialise Software (Leuven, Belgium) for segmentation and 3-dimensional digital model generation. To determine the distribution of trabecular bone density, Hounsfield unit (HU) values in the scapulae gray value files obtained from Mimics were filtered to remove any cortical bone. HU values of 650 define the corticocancellous interface in CT image data and were considered to be cortical bone. Analyses of variance with post hoc Bonferroni tests were used to determine statistical differences between the intra- and inter-regions of bone density comparisons. Results The base of the coracoid process was statistically significantly less dense than the spine and the lateral border of the scapulae examined (P < .05). Discussion/Conclusion The higher-quality bone in the spine and lateral border, compared with the coracoid regions, may provide better bone purchase for screws when fixing the glenoid baseplate in RSA.
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18
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Glenoid morphology and the safe zone for protecting the suprascapular nerve during baseplate fixation in reverse shoulder arthroplasty. INTERNATIONAL ORTHOPAEDICS 2017; 42:587-593. [PMID: 28956117 DOI: 10.1007/s00264-017-3646-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to investigate glenoid morphology and define the safe zone for protecting the suprascapular nerve baseplate screw during baseplate fixation in reverse shoulder arthroplasty (RSA) in a Chinese population. METHODS Shoulder computed tomography (CT) scans from 56 subjects were retrospectively reviewed. Three-dimensional (3D) reconstruction was performed using Mimics software, and corresponding bony references were used to evaluate glenoid morphology. To standardize evaluation, the coronal scapular plane was defined. Safe fixation distances and screw placements were investigated by constructing a simulated cutting plane of the baseplate during RSA. RESULTS Mean glenoid height was 35.83 ± 2.95 mm, and width was 27.32 ± 2.78 mm, with significant sexual dimorphism (p < 0.01). According to the cutting plane morphology, the average baseplate radius was 13.84 ± 1.34 mm. The distances from the suprascapular notch and from two bony reference points at the base of the scapular spine to the cutting plane were 30.27 ± 2.77 mm, 18.39 ± 1.67 mm and 16.52 ± 1.52 mm, respectively, with a gender-related difference. Based on the clock face indication system, the danger zone caused by the suprascapular nerve projection was oriented between the two o'clock and eight o'clock positions in reference to the right shoulder. CONCLUSIONS Glenoid size and the safe zone for screw fixation during RSA were characterized in a Chinese population. Careful consideration of baseplate fixation and avoidance of suprascapular nerve injury are important for improved clinical outcome.
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Mathews S, Burkhard M, Serrano N, Link K, Häusler M, Frater N, Franke I, Bischofberger H, Buck FM, Gascho D, Thali M, Serowy S, Müller-Gerbl M, Harper G, Qureshi F, Böni T, Bloch HR, Ullrich O, Rühli FJ, Eppler E. Glenoid morphology in light of anatomical and reverse total shoulder arthroplasty: a dissection- and 3D-CT-based study in male and female body donors. BMC Musculoskelet Disord 2017; 18:9. [PMID: 28068966 PMCID: PMC5223371 DOI: 10.1186/s12891-016-1373-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 12/19/2016] [Indexed: 11/19/2022] Open
Abstract
Background Placement of the glenoid baseplate is of paramount importance for the outcome of anatomical and reverse total shoulder arthroplasty. However, the database around glenoid size is poor, particularly regarding small scapulae, for example, in women and smaller individuals, and is derived from different methodological approaches. In this multimodality cadaver study, we systematically examined the glenoid using morphological and 3D-CT measurements. Methods Measurements of the glenoid and drill hole tunnel length for superior baseplate screw placement were recorded to define size of the glenoid and the distance to the scapular notch on cadaveric specimens. Glenoid angles were determined on both, 3D-CT-scans of the thoraxes using the Friedman method and on subsequently isolated scapulae from 18 male and female donors (average 84 years, range 60–98 years). Results Mean glenoid height was 36.6 mm ± 3.6, and width 27.8 mm ± 3.1 with a significant sex dimorphism (p ≤ 0.001): in males, glenoid height 39.5 mm ± 3.5, and width 30.3 mm ± 3.3, and in females, glenoid height 34.8 mm ± 2.2, and width 26.2 mm ± 1.6. The average distance from the superior screw entry to its exit in the scapular notch measured by calliper was 27.2 mm ± 6.0 with a sex difference: in males, 29.4 mm ± 5.7, and in females, 25.8 mm ± 5.9 mm with a minimum recorded distance of 15 mm. Measured by CT, the mean inclination angle for male and female donors combined was 13.0° ± 7.0, and the ante-/retroversion angle −1.0° ± 4.0°. Conclusion This study is one of the first to combine dissection, including drill holes, with anatomical measurements and radiological data. In some women and smaller individuals, smaller baseplates should be selected. The published safe zone of 20 mm is generally feasible for superior screw placement, however, in small patients this distance may be substantially shorter than expected and start as of 13 and 15 mm, respectively. No correlation between glenoid height or width with the length of our drilling canal towards the scapular notch was found. Preoperative CT-based treatment planning to determine version and inclination angles is recommended.
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Affiliation(s)
- Sandra Mathews
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.
| | - Marco Burkhard
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Nabil Serrano
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.,Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Karl Link
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.,Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Martin Häusler
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.,Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Nakita Frater
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland
| | - Ingeborg Franke
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Helena Bischofberger
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Florian M Buck
- Medical Radiology Institute, Schulthess Clinic, Zurich, Switzerland.,Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Dominic Gascho
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Michael Thali
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Steffen Serowy
- Institute of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Magdalena Müller-Gerbl
- Musculoskeletal Research Unit, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Gareth Harper
- Shoulder Unit, Queen Alexandra Hospital, Portsmouth, UK
| | - Ford Qureshi
- Shoulder Unit, Doncaster Royal Infirmary, Doncaster, UK
| | - Thomas Böni
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.,Technical Orthopedics Unit, University Hospital Balgrist, Zurich, Switzerland
| | | | - Oliver Ullrich
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Frank-Jakobus Rühli
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland
| | - Elisabeth Eppler
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland.,Institute of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany.,Musculoskeletal Research Unit, Department of Biomedicine, University of Basel, Basel, Switzerland
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20
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Kim YK, Won JS, Park CK, Kim JG. Evaluating Scapular Notching after Reverse Total Shoulder Arthroplasty. Clin Shoulder Elb 2015. [DOI: 10.5397/cise.2015.18.4.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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