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李 穆, 米 昀, 沈 世, 吴 心, 严 静, 陈 滨, 曹 蕾. [The "E-bone" - a one-stop preoperative planning system for reverse total shoulder arthroplasty]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2024; 44:967-973. [PMID: 38862455 PMCID: PMC11166726 DOI: 10.12122/j.issn.1673-4254.2024.05.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVE To develop the'E-Bone', a comprehensive one-stop preoperative planning system for reverse total shoulder arthroplasty with improved accuracy and efficiency. METHODS The nnU-net deep neural network was utilized for scapula segmentation to obtain precise scapula segmentation results. Based on the 3 key factors, namely bone density, upward and downward angle and nail length, the base was automatically positioned. The quantitative parameters required for surgical planning were calculated. A personalized guide plate was generated by combining glenoid morphology and base positioning information. The system interface was developed to modularize various functions for easy use, providing interactive operation and real-time display. RESULTS Compared with the Mimics system, the'E-bone'preoperative planning system reduced complex manual adjustments during the planning process. The average planned nail length was longer than that of the Mimics system, and the planning time was reduced by 86%. The scapula segmentation accuracy of this system reached 99.93%, better than that of Mimics to achieve a higher precision. CONCLUSION The"E-bone"system provides a one-stop, efficient, and accurate preoperative planning system for reverse shoulder replacement and potentially broader clinical applications.
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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:S1058-2746(24)00086-7. [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] [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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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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Al-Omairi S, Albadran A, Dagher D, Leroux T, Khan M. Glenoid bone loss in shoulder arthroplasty: a narrative review. ANNALS OF JOINT 2024; 9:8. [PMID: 38529296 PMCID: PMC10929280 DOI: 10.21037/aoj-23-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/04/2023] [Indexed: 03/27/2024]
Abstract
Background and Objective Crucial to the success of any total or reverse shoulder arthroplasty (RSA) is the stability of the glenoid component fixation. Instability can lead to early implant failure and unsatisfactory results. Patients often present with varying forms of glenoid bone loss (GBL) in both the primary and revision settings, which can be a challenge for the treating surgeon. Severe cases of GBL can increase the risk of potential complications and diminish implant longevity. The use of the reverse total shoulder replacement has been particularly helpful when addressing significant glenoid bony defects. Various approaches have been proposed to deal with GBL, all of which require an individualized assessment of the specifics of the defect in order to provide maximal fixation and thereby optimize the longevity of the shoulder arthroplasty. This article aims to review the recent literature on GBL in shoulder arthroplasty to provide guidance when considering treatment based on the best available evidence. Methods PubMed, MEDLINE, EMBASE, AccessMedicine, ClinicalKey, DynaMed, and Micromedex were queried for publications utilizing the following keywords: "glenoid bone loss" AND "glenoid bone deficiency" AND "shoulder arthroplasty" AND "classification". The search was restricted to research published between 2004 and 2023. There were no restrictions on study type or language. Key Content and Findings GBL should be critically evaluated prior to undertaking total shoulder arthroplasty (TSA). The treating surgeon should be aware of various methods of addressing bone defects. Conclusions The use of TSA is increasing to address various shoulder pathologies. Addressing glenoid bone defects is of critical importance to maximize the longevity and outcome of TSA.
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Affiliation(s)
- Sultan Al-Omairi
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- Orthopedic Surgery Department, Sohar hospital, Sohar, Oman
| | - Adeeba Albadran
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- Section of Orthopaedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital (KAAUH), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Danielle Dagher
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Moin Khan
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
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Patel P, Dhal K, Gupta R, Tappa K, Rybicki FJ, Ravi P. Medical 3D Printing Using Desktop Inverted Vat Photopolymerization: Background, Clinical Applications, and Challenges. Bioengineering (Basel) 2023; 10:782. [PMID: 37508810 PMCID: PMC10376892 DOI: 10.3390/bioengineering10070782] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Medical 3D printing is a complex, highly interdisciplinary, and revolutionary technology that is positively transforming the care of patients. The technology is being increasingly adopted at the Point of Care (PoC) as a consequence of the strong value offered to medical practitioners. One of the key technologies within the medical 3D printing portfolio enabling this transition is desktop inverted Vat Photopolymerization (VP) owing to its accessibility, high quality, and versatility of materials. Several reports in the peer-reviewed literature have detailed the medical impact of 3D printing technologies as a whole. This review focuses on the multitude of clinical applications of desktop inverted VP 3D printing which have grown substantially in the last decade. The principles, advantages, and challenges of this technology are reviewed from a medical standpoint. This review serves as a primer for the continually growing exciting applications of desktop-inverted VP 3D printing in healthcare.
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Affiliation(s)
- Parimal Patel
- Department of Mechanical & Aerospace Engineering, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Kashish Dhal
- Department of Mechanical & Aerospace Engineering, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Rajul Gupta
- Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Karthik Tappa
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati, Cincinnati, OH 45219, USA
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La Banca V, Giglio L, Palagi Viganó AV, Michaelis LF, Bonadiman JA, Vieira Lima GH, Ikemoto RY. Use of 3D-Printed Patient-Specific Guide for Latarjet Procedure in Patients With Anterior Shoulder Instability: Technical Note. Arthrosc Tech 2023; 12:e915-e922. [PMID: 37424644 PMCID: PMC10323828 DOI: 10.1016/j.eats.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/12/2023] [Indexed: 07/11/2023] Open
Abstract
Anterior shoulder instability can lead to anterior glenoid bone loss associated with humeral posterior deformity (bipolar bone loss). Latarjet procedure is a commonly used surgical option in such cases. However, the procedure is associated with complications in up 15% of the cases often associated with inadequate positioning of coracoid bone graft and screws. Considering that acknowledgment of patient anatomy and use of surgical planning intraoperatively can reduce such complications, we describe the use of 3D printing tools to obtain a 3D Patient-Specific Surgical Guide to aid in the Latarjet procedure. Such tools present advantages and limitations compared to other tools available, which are also discussed in this article.
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Affiliation(s)
- Vitor La Banca
- Orthopedic Surgery Department, Centro Universitário Faculdade de Medicina do ABC (FMABC), São Paulo, Brazil
- Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, Brazil
| | - Luiz Giglio
- Orthopedic Surgery Department, Centro Universitário Faculdade de Medicina do ABC (FMABC), São Paulo, Brazil
- Hospital Ipiranga, São Paulo, Brazil
| | - Ana Victória Palagi Viganó
- Orthopedic Surgery Department, Centro Universitário Faculdade de Medicina do ABC (FMABC), São Paulo, Brazil
- Hospital Ipiranga, São Paulo, Brazil
| | - Luiz Fernando Michaelis
- Orthopedic Surgery Department, Centro Universitário Faculdade de Medicina do ABC (FMABC), São Paulo, Brazil
| | | | - Guilherme Henrique Vieira Lima
- Orthopedic Surgery Department, Centro Universitário Faculdade de Medicina do ABC (FMABC), São Paulo, Brazil
- Hospital Ipiranga, São Paulo, Brazil
| | - Roberto Yukio Ikemoto
- Orthopedic Surgery Department, Centro Universitário Faculdade de Medicina do ABC (FMABC), São Paulo, Brazil
- Hospital Ipiranga, São Paulo, Brazil
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Benignus C, Buschner P, Meier MK, Wilken F, Rieger J, Beckmann J. Patient Specific Instruments and Patient Individual Implants—A Narrative Review. J Pers Med 2023; 13:jpm13030426. [PMID: 36983609 PMCID: PMC10051718 DOI: 10.3390/jpm13030426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/02/2023] Open
Abstract
Joint arthroplasties are one of the most frequently performed standard operations worldwide. Patient individual instruments and patient individual implants represent an innovation that must prove its usefulness in further studies. However, promising results are emerging. Those implants seem to be a benefit especially in revision situations. Most experience is available in the field of knee and hip arthroplasty. Patient-specific instruments for the shoulder and upper ankle are much less common. Patient individual implants combine individual cutting blocks and implants, while patient individual instruments solely use individual cutting blocks in combination with off-the-shelf implants. This review summarizes the current data regarding the implantation of individual implants and the use of individual instruments.
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Affiliation(s)
- Christian Benignus
- Department of Traumatology and Orthopedic Surgery, Hospital Ludwigsburg, Posilipostr. 4, 71640 Ludwigsburg, Germany
| | - Peter Buschner
- Department of Orthopedic Surgery and Traumatology, Hospital Barmherzige Brüder Munich, Romanstr. 93, 80639 Munich, Germany
| | - Malin Kristin Meier
- Department of Orthopedic Surgery and Traumatology, Inselspital, University Hospital Bern, University of Bern, Freiburgstr. 4, 3010 Bern, Switzerland
| | - Frauke Wilken
- Department of Orthopedic Surgery and Traumatology, Hospital Barmherzige Brüder Munich, Romanstr. 93, 80639 Munich, Germany
| | - Johannes Rieger
- Department of Orthopedic Surgery and Traumatology, Hospital Barmherzige Brüder Munich, Romanstr. 93, 80639 Munich, Germany
| | - Johannes Beckmann
- Department of Orthopedic Surgery and Traumatology, Hospital Barmherzige Brüder Munich, Romanstr. 93, 80639 Munich, Germany
- Correspondence:
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Correction of ankle varus deformity using patient-specific dome-shaped osteotomy guides designed on weight-bearing CT: a pilot study. Arch Orthop Trauma Surg 2023; 143:791-799. [PMID: 34562121 DOI: 10.1007/s00402-021-04164-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/01/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Dome-shaped supramalleolar osteotomies are a well-established treatment option for correcting ankle deformity. However, the procedure remains technically demanding and is limited by a two-dimensional (2D) radiographic planning of a three-dimensional (3D) deformity. Therefore, we implemented a weight-bearing CT (WBCT) to plan a 3D deformity correction using patient-specific guides. METHODS A 3D-guided dome-shaped supramalleolar osteotomy was performed to correct ankle varus deformity in a case series of five patients with a mean age of 53.8 years (range 47-58). WBCT images were obtained to generate 3D models, which enabled a deformity correction using patient-specific guides. These technical steps are outlined and associated with a retrospective analysis of the clinical outcome using the EFAS score, Foot and Ankle Outcome Score (FAOS) and visual analog pain scale (VAS). Radiographic assessment was performed using the tibial anterior surface angle (TAS), tibiotalar angle (TTS), talar tilt angle (TTA), hindfoot angle (HA), tibial lateral surface angle (TLS) and tibial rotation angle (TRA). RESULTS The mean follow-up was 40.8 months (range 8-65) and all patients showed improvements in the EFAS score, FAOS and VAS (p < 0.05). A 3-month postoperative WBCT confirmed healing of the osteotomy site and radiographic improvement of the TAS, TTS and HA (p < 0.05), but the TTA and TRA did not change significantly (p > 0.05). CONCLUSION Dome-shaped supramalleolar osteotomies using 3D-printed guides designed on WBCT are a valuable option in correcting ankle varus deformity and have the potential to mitigate the technical drawbacks of free-hand osteotomies. LEVEL OF EVIDENCE Level 5 case series.
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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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Kida H, Urita A, Momma D, Matsui Y, Endo T, Kawamura D, Taneichi H, Iwasaki N. Implications of navigation system use for glenoid component placement in reverse shoulder arthroplasty. Sci Rep 2022; 12:21190. [PMID: 36477208 PMCID: PMC9729232 DOI: 10.1038/s41598-022-25833-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Recently, three-dimensional (3D) planning, patient-specific instruments, and navigation system have been developed to improve the accuracy of baseplate placement in reverse shoulder arthroplasty (RSA). The purpose of this study was to evaluate baseplate placement using the navigation system. Sixty-four shoulders in 63 patients who underwent RSA for rotator cuff tear arthropathy or irreparable rotator cuff tears were enrolled. Conventional RSA was performed in 31 shoulders and navigated RSA using pre-operative planning software was performed in 33 shoulders. The use of augmented baseplates, the version and inclination of the baseplate, and screw length were compared between conventional RSA and navigated RSA. Augmented baseplates were used more frequently in navigated RSA than in conventional RSA (20 vs 9 shoulders, p = 0.014). Baseplate alignment was 1.0° (SD 5.1) of retroversion and 2.4° (SD 6.8) of superior inclination in conventional RSA and 0.2° (SD 1.9) of anteversion and 0.3° (SD 1.7) of superior inclination in navigated RSA. Compared with conventional RSA, precision of baseplate version and inclination were higher in navigated RSA (both p < 0.001). Superior, inferior, and posteroinferior screws were significantly longer in navigated RSA than in conventional RSA (p = 0.021, 0.001 and < 0.001, respectively). Precision of superior and inferior screw lengths was significantly higher in navigated RSA than in conventional RSA (both p = 0.001). Our results suggest that adoption of pre-operative planning software increased augmented baseplate use to minimize the glenoid reaming. The navigation system allows placement of the baseplate accurately, according to the pre-operative plan. Furthermore, the navigation system enables monitoring of screw length and direction in real time.
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Affiliation(s)
- Hiroaki Kida
- grid.39158.360000 0001 2173 7691Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Atsushi Urita
- grid.255137.70000 0001 0702 8004Department of Orthopaedic Surgery, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi 321-0293 Japan
| | - Daisuke Momma
- grid.412167.70000 0004 0378 6088Center of Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Yuki Matsui
- grid.39158.360000 0001 2173 7691Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takeshi Endo
- grid.39158.360000 0001 2173 7691Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Kawamura
- grid.39158.360000 0001 2173 7691Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Taneichi
- grid.255137.70000 0001 0702 8004Department of Orthopaedic Surgery, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi 321-0293 Japan
| | - Norimasa Iwasaki
- grid.39158.360000 0001 2173 7691Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Rojas JT, Jost B, Hertel R, Zipeto C, Van Rooij F, Zumstein MA. Patient-specific instrumentation reduces deviations between planned and postosteotomy humeral retrotorsion and height in shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:1929-1937. [PMID: 35346846 DOI: 10.1016/j.jse.2022.02.025] [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: 12/01/2021] [Revised: 01/23/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patient-specific instrumentation (PSI) may potentially improve humeral osteotomy in shoulder arthroplasty. The purpose of this study was to compare the deviation between planned and postosteotomy humeral inclination, retrotorsion, and height in shoulder arthroplasty, using PSI vs. standard cutting guides (SCG). METHODS Twenty fresh-frozen cadaveric specimens were allocated to undergo humeral osteotomy using either PSI or SCG, such that the 2 groups have similar age, gender, and side. Preosteotomy computed tomography (CT) scan was performed and used for the 3-dimensional (3D) planning. The osteotomy procedure was performed using a PSI designed for each specimen or an SCG depending on the group. A postosteotomy CT scan was performed. The preosteotomy and postosteotomy 3D CT scan reconstructions were superimposed to calculate the deviation between planned and postosteotomy inclination, retrotorsion, and height. Outliers were defined as cases with 1 or more of the following deviations: >5° inclination, >10° retrotorsion, and >3 mm height. The deviation and outliers in inclination, retrotorsion, and height were compared between the 2 groups. RESULTS The deviations between planned and postosteotomy parameters were similar among the PSI and SCG groups for inclination (P = .260), whereas they were significantly greater in the SCG group for retrotorsion (P < .001) and height (P = .003). There were 8 outliers in the SCG group, compared with only 1 outlier in the PSI group (P = .005). Most outliers in the SCG group were due to deviation >10° in retrotorsion. CONCLUSION After 3D planning, PSI had less deviation between planned and postosteotomy humeral retrotorsion and height, relative to SCG.
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Affiliation(s)
- J Tomás Rojas
- Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland; Department of Orthopaedics and Trauma Surgery, Hospital San José-Clínica Santa María, Santiago, Chile
| | - Bernhard Jost
- Department of Orthopaedics and Traumatology, Kantonsspital, St.Gallen, Switzerland
| | - Ralph Hertel
- Department of Orthopaedics and Trauma Surgery, Lindenhofspital, Bern, Switzerland
| | - Claudio Zipeto
- Shoulder R & D Department, Medacta International SA, Castel San Pietro, Switzerland
| | | | - Matthias A Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland; Shoulder, Elbow Unit, Sportsclinicnumber1, Bern, Switzerland; Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland; Campus Stiftung Lindenhof Bern, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland.
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12
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Elsheikh AA, Galhoum MS, Mokhtar MA, Roebuck MM, Wood A, Yin Q, Frostick SP. Patient-specific Instrumentation Versus Standard Surgical Instruments in Primary Reverse Total Shoulder Arthroplasty: A Retrospective Comparative Clinical Study. J Shoulder Elb Arthroplast 2022; 6:24715492221075449. [PMID: 35669616 PMCID: PMC9163719 DOI: 10.1177/24715492221075449] [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: 06/18/2021] [Revised: 10/09/2021] [Accepted: 01/05/2022] [Indexed: 11/15/2022] Open
Abstract
Aims Patient-specific instrumentation (PSI) in primary shoulder arthroplasty has been studied; results supported the positive impact of the PSI on the glenoid positioning. Nevertheless, no clinical outcomes have been reported. We compare the clinical outcomes of primary reverse total shoulder arthroplasty using PSI versus the standard methods. Methods Fifty-three patients with full records and a minimum of 24-months follow-up were reviewed, 35 patients received primary standard RSTA, and 18 patients received primary PSI RSTA. All patients were operated on in a single center. The median follow-up was 46 months (53 months in the standard group vs 39 months in the PSI group). Results There was an overall significant post-operative improvement in the whole cohort (P< 0.05). The standard group had more deformed glenoids (B2, B3, C&D) and significantly low preoperative constant score and forward flexion (P=0.02 & 0.034). Compared to the PSI group (all were A1, A2, B1 &one type D), there were no statistically significant differences in any clinical outcome postoperatively. PSI neither prolonged the waiting time to surgery (P=0.693) nor the intraoperative time (P=0.962). Radiologically, PSI secured a higher percentage of optimum baseplate position and screw anchorage; however, no statistical correlation was found. Conclusion In this series, both groups achieved comparable good outcomes. PSI did not achieve significantly better clinical outcomes than Standard after primary RSTA. Yet comparison has some limitations. PSI did not negatively impact the waiting time or the surgical time.
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Affiliation(s)
| | - Mohamed S Galhoum
- Menoufia University, Shebin El-Kom, Egypt
- Royal Liverpool University Hospital Trust, Liverpool, UK
| | - Mohamed A Mokhtar
- Royal Manchester Children’s Hospital, Manchester, UK
- Suez Canal University, Ismailia, Egypt
| | - Margaret M Roebuck
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Amanda Wood
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Qi Yin
- Royal Liverpool University Hospital Trust, Liverpool, UK
| | - Simon P Frostick
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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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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14
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Mohammad Sadeghi M, Kececi EF. Image processing methodology for patient‐specific instrument design. Int J Med Robot 2020; 16:1-11. [DOI: 10.1002/rcs.2159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/09/2020] [Accepted: 08/29/2020] [Indexed: 11/06/2022]
Affiliation(s)
| | - Emin Faruk Kececi
- Department of Mechanical Engineering Abdullah Gul University Kayseri Turkey
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15
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Campana V, Cardona V, Vismara V, Monteleone AS, Piazza P, Messinese P, Mocini F, Sircana G, Maccauro G, Saccomanno MF. 3D printing in shoulder surgery. Orthop Rev (Pavia) 2020; 12:8681. [PMID: 32913609 PMCID: PMC7459384 DOI: 10.4081/or.2020.8681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 10/25/2022] Open
Abstract
Three-dimensional (3D) printing is a novel modality with the potential to make a huge impact in the surgical field. The aim of this paper is to provide an overview on the current use of 3D printing in shoulder surgery. We have reviewed the use of this new method in 3 fields of shoulder surgery: shoulder arthroplasty, recurrent shoulder instability and orthopedic shoulder traumatology. In shoulder arthroplasty, several authors have shown that the use of the 3D printer improves the positioning of the glenoid component, even if longer clinical follow-up is needed to determine whether the cost of this system rationalizes the potential improved functional outcomes and decreases glenoid revision rates. In the treatment of anterior shoulder instability, the literature agrees on the fact that the use of the 3D printing can: enhance the dept and size of bony lesions, allowing a patient tailored surgical planning and potentially reducing operative times; allow the production of personalized implants to restore substantial bone loss; restore glenohumeral morphology and instability. In orthopedic trauma, the use of 3D printing can be helpful to increase the understanding of fracture patterns, facilitating a more personalized planning, and can be used for resident training and education. We can conclude the current literature regarding the use of 3D printed models in orthopedic surgery agrees finding objective improvements to preoperative planning and to the surgical procedure itself, by shortening the intraoperative time and by the possibility to develop custom-made, patient-specific surgical instruments, and it suggests that there are tangible benefits for its implementation.
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Affiliation(s)
- Vincenzo Campana
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Valentina Cardona
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Valeria Vismara
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | | | - Piero Piazza
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Piermarco Messinese
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Fabrizio Mocini
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Giuseppe Sircana
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Giulio Maccauro
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
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Rolf O, Mauch F. [Individualized shoulder arthroplasty: the current state of development]. DER ORTHOPADE 2020; 49:424-431. [PMID: 32246194 DOI: 10.1007/s00132-020-03910-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Olaf Rolf
- Klinik für Orthopädie und Unfallchirurgie, Niels-Stensen-Kliniken, Franziskus-Hospital Harderberg, Akademisches Lehrkrankenhaus der Westfälischen Wilhelms-Universität Münster, Alte Rothenfelder Straße 23, 49124, Georgsmarienhütte, Deutschland.
| | - Frieder Mauch
- Department Sportorthopädie/Sporttraumatologie Obere Extremität/Schulterendoprothetik/Kernspintomographie (MRT), Sportklinik Stuttgart GmbH, Stuttgart, Deutschland
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