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Rainey J, Hameed D, Sodhi N, Malkani AL, Mont MA. Use of computed tomography for shoulder arthroplasty: A systematic review. J Orthop 2025; 59:30-35. [PMID: 39351268 PMCID: PMC11439543 DOI: 10.1016/j.jor.2024.05.007] [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: 04/30/2024] [Accepted: 05/10/2024] [Indexed: 10/04/2024] Open
Abstract
Introduction The prevalence of total shoulder arthroplasties is on the rise annually. Improvements in implant quality, construct stability, and surgical techniques have notably enhanced post-operative results, prompting an expansion of indications for shoulder arthroplasty. Despite its high success rate, opportunities for enhancement remain, especially in preoperative planning and intraoperative execution. Advanced imaging technologies offer significant potential in optimizing implant placement, thus improving the longevity of the procedure. To our knowledge, a comprehensive review examining the impact of advanced imaging on shoulder arthroplasty has yet to be conducted. This systematic review aims to investigate the benefits of advanced imaging technologies in this context, focusing on their application in preoperative planning, osteoarthritis assessment, intraoperative adjustments, patient-specific instrumentation, and navigational aids. Methods This review utilized a comprehensive search of PubMed to identify relevant studies published from 2000 to 2024, focusing on the application of various imaging techniques in shoulder arthroplasty. The search was conducted by two authors and centered on plain radiography, CT scans, and MRI. The selection criteria included availability of full-text articles, English language, direct comparison of imaging techniques, and a focus on patient outcomes, including discussions on broader applications such as intraoperative navigation and patient-specific instrumentation development. Results Enhanced imaging techniques, particularly CT scans and MRIs, have been shown to significantly improve outcomes in shoulder arthroplasty. While plain radiographs remain standard, CT scans provide superior bony detail, crucial for evaluating glenoid wear and determining augmentation needs. Preoperative CT imaging has been demonstrated to enhance implant placement accuracy. Moreover, intraoperative technologies based on CT imaging, such as patient-specific instrumentation and navigation systems, contribute to better surgical results. Conclusion The benefits of CT imaging in shoulder arthroplasty significantly outweigh the associated costs. Current literature strongly supports the adoption of CT imaging in these procedures, particularly when used alongside modern operative technologies.
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Affiliation(s)
- Joshua Rainey
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Daniel Hameed
- Department of Orthopaedic Surgery, Rubin Institute for Advanced Orthopaedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Northwell Health, Riverhead, NY, USA
| | - Arthur L Malkani
- Department of Orthopaedics, University of Louisville, Louisville, KY, USA
| | - Michael A Mont
- The Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
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2
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Boufadel P, Lopez R, Fares MY, Daher M, Dhytadak D, Gulotta LV, Abboud JA. Intraoperative Navigation in Reverse Shoulder Arthroplasty: Advantages and Future Prospects. Clin Orthop Surg 2024; 16:679-687. [PMID: 39364113 PMCID: PMC11444950 DOI: 10.4055/cios23407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/19/2024] [Accepted: 01/19/2024] [Indexed: 10/05/2024] Open
Abstract
Intraoperative navigation is a novel technology that can provide real-time feedback to the surgeon during implantation and enhance the accuracy and precision of glenoid component positioning. Applications of intraoperative navigation systems have demonstrated increased precision in baseplate version and inclination, as well as improved baseplate screw placement, with fewer screws used and greater purchase length achieved when compared to standard instrumentation. Early clinical studies have shown favorable results, with significantly improved patient-reported and clinical outcomes and decreased complications. The implementation of intraoperative navigation is associated with a short learning curve and a minimal increase in operative time. Nevertheless, further research is necessary to substantiate the clinical benefit of navigation and evaluate its economic cost-effectiveness and impact on implant survival. Augmented reality and robotic-assisted surgery are additional emerging technologies that, while novel, hold the potential to further advance the field of shoulder arthroplasty.
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Affiliation(s)
- Peter Boufadel
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Ryan Lopez
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Mohamad Y Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Mohammad Daher
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Dineysh Dhytadak
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Lawrence V Gulotta
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Joseph A Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
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Fares MY, Daher M, Mouawad J, Haikal ER, Rizk JP, Boufadel P, Abboud JA. Surgical management of biconcave glenoids: a scoping review. Clin Shoulder Elb 2024; 27:365-374. [PMID: 38303593 PMCID: PMC11393435 DOI: 10.5397/cise.2023.00689] [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: 08/04/2023] [Accepted: 10/14/2023] [Indexed: 02/03/2024] Open
Abstract
Biconcave (B2) glenoids, characterized by significant posterior glenoid bone loss and a biconcave wear pattern, are a challenging pathology in shoulder surgery. Significant bone defects present in B2 glenoids increases the risk of complications and rates of failure for operative patients with glenohumeral osteoarthritis. Diagnosing this entity is of pivotal importance, and can be accomplished with imaging and a comprehensive clinical investigation. There are no clear-cut guidelines for management, but options include hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse shoulder arthroplasty. In recent years, modern techniques such as corrective reaming, bone grafts, and the use of augmented components have improved patient outcomes. Educating prospective patients is essential for reaching a shared management decision, setting appropriate expectations, and optimizing prognostic outcomes.
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Affiliation(s)
- Mohamad Y Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Mohammad Daher
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Joseph Mouawad
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Emil R Haikal
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Jean Paul Rizk
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Peter Boufadel
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Joseph A Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
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Gauci MO, Glevarec L, Bronsard N, Cointat C, Pelletier Y, Boileau P, Gonzalez JF. Is preoperative 3D planning reliable for predicting postoperative clinical differences in range of motion between two stem designs in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2024; 33:1771-1780. [PMID: 38281677 DOI: 10.1016/j.jse.2023.11.031] [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: 08/23/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND We aim to predict a clinical difference in the postoperative range of motion (RoM) between 2 reverse shoulder arthroplasty (RSA) stem designs (Inlay-155° and Onlay-145°) using preoperative planning software. We hypothesized that preoperative 3D planning could anticipate the differences in postoperative clinical RoM between 2 humeral stem designs and by keeping the same glenoid implant. METHODS Thirty-seven patients (14 men and 23 women, 76 ± 7 years) underwent a BIO-RSA (bony increased offset-RSA) with the use of preoperative planning and an intraoperative 3-dimensional-printed patient-specific guide for glenoid component implantation between January 2014 and September 2019 with a minimum follow-up of 2 years. Two types of humeral implants were used: Inlay with a 155° inclination (Inlay-155°) and Onlay with a 145°inclination (Onlay-145°). Glenoid implants remained unchanged. The postoperative RSA angle (inclination of the area in which the glenoid component of the RSA is implanted) and the lateralization shoulder angle were measured to confirm the good positioning of the glenoid implant and the global lateralization on postoperative X-rays. A correlation between simulated and clinical RoM was studied. Simulated and last follow-up active forward flexion (AFE), abduction, and external rotation (ER) were compared between the 2 types of implants. RESULTS No significant difference in RSA and lateralization shoulder angle was found between planned and postoperative radiological implants' position. Clinical RoM at the last follow-up was always significantly different from simulated preoperative RoM. A low-to-moderate but significant correlation existed for AFE, abduction, and ER (r = 0.45, r = 0.47, and r = 0.57, respectively; P < .01). AFE and abduction were systematically underestimated (126° ± 16° and 95° ± 13° simulated vs. 150° ± 24° and 114° ± 13° postoperatively; P < .001), whereas ER was systematically overestimated (50° ± 19° simulated vs. 36° ± 19° postoperatively; P < .001). Simulated abduction and ER highlighted a significant difference between Inlay-155° and Onlay-145° (12° ± 2°, P = .01, and 23° ± 3°, P < .001), and this was also retrieved clinically at the last follow-up (23° ± 2°, P = .02, and 22° ± 2°, P < .001). CONCLUSIONS This study is the first to evaluate the clinical relevance of predicted RoM for RSA preoperative planning. Motion that involves the scapulothoracic joint (AFE and abduction) is underestimated, while ER is overestimated. However, preoperative planning provides clinically relevant RoM prediction with a significant correlation between both and brings reliable data when comparing 2 different types of humeral implants (Inlay-155° and Onlay-145°) for abduction and ER. Thus, RoM simulation is a valuable tool to optimize implant selection and choose RSA implants to reach the optimal RoM.
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Affiliation(s)
- Marc-Olivier Gauci
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France; ICARE laboratory, Inserm U1091, IBV, Université Côte d'Azur, Nice, France.
| | - Laure Glevarec
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | - Nicolas Bronsard
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France; ICARE laboratory, Inserm U1091, IBV, Université Côte d'Azur, Nice, France
| | - Caroline Cointat
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | - Yann Pelletier
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | - Pascal Boileau
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France
| | - Jean-François Gonzalez
- Institut Universitaire Locomoteur et du Sport, CHU de Nice, Hôpital Pasteur II, Nice, France; ICARE laboratory, Inserm U1091, IBV, Université Côte d'Azur, Nice, France
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5
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Boubekri A, Murphy M, Scheidt M, Shivdasani K, Anderson J, Garbis N, Salazar D. Artificial Intelligence Machine Learning Algorithms Versus Standard Linear Demographic Analysis in Predicting Implant Size of Anatomic and Reverse Total Shoulder Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202408000-00001. [PMID: 39106479 DOI: 10.5435/jaaosglobal-d-24-00182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/22/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Accurate and precise templating is paramount for anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RSA) to enhance preoperative planning, streamline surgery, and improve implant positioning. We aimed to evaluate the predictive potential of readily available patient demographic data in TSA and RSA implant sizing, independent of implant design. METHODS A total of 578 consecutive, primary, noncemented shoulder arthroplasty cases were retrospectively reviewed. Demographic variables and implant characteristics were recorded. Multivariate linear regressions were conducted to predict implant sizes using patient demographic variables. RESULTS Linear models accurately predict TSA implant sizes within 2 millimeters of humerus stem sizes 75.3% of the time, head diameter 82.1%, head height 82.1%, and RSA glenosphere diameter 77.6% of the time. Linear models predict glenoid implant sizes accurately 68.2% and polyethylene thickness 76.6% of the time and within one size 100% and 95.7% of the time, respectively. CONCLUSION Linear models accurately predict shoulder arthroplasty implant sizes from demographic data. No significant statistical differences were observed between linear models and machine learning algorithms, although the analysis was underpowered. Future sufficiently powered studies are required for more robust assessment of machine learning models in predicting primary shoulder arthroplasty implant sizes based on patient demographics.
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Affiliation(s)
- Amir Boubekri
- From the Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL (Dr. Boubekri, Dr. Murphy, Dr. Scheidt, Mr. Shivdasani, Mr. Anderson, Dr. Garbis, and Dr. Salazar), the Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL (Mr. Shivdasani)
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6
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Schader JF, Helfen T, Braunstein V, Ockert B, Haasters F, Hertel R, Südkamp N, Milz S, Sprecher CM. Experimental guide wire placement for total shoulder arthroplasty in glenoid models: higher precision for patient-specific aiming guides compared to standard technique without learning curve. BMC Musculoskelet Disord 2024; 25:449. [PMID: 38844899 PMCID: PMC11155061 DOI: 10.1186/s12891-024-07549-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/27/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Patient-specific aiming devices (PSAD) may improve precision and accuracy of glenoid component positioning in total shoulder arthroplasty, especially in degenerative glenoids. The aim of this study was to compare precision and accuracy of guide wire positioning into different glenoid models using a PSAD versus a standard guide. METHODS Three experienced shoulder surgeons inserted 2.5 mm K-wires into polyurethane cast glenoid models of type Walch A, B and C (in total 180 models). Every surgeon placed guide wires into 10 glenoids of each type with a standard guide by DePuy Synthes in group (I) and with a PSAD in group (II). Deviation from planned version, inclination and entry point was measured, as well as investigation of a possible learning curve. RESULTS Maximal deviation in version in B- and C-glenoids in (I) was 20.3° versus 4.8° in (II) (p < 0.001) and in inclination was 20.0° in (I) versus 3.7° in (II) (p < 0.001). For B-glenoid, more than 50% of the guide wires in (I) had a version deviation between 11.9° and 20.3° compared to ≤ 2.2° in (II) (p < 0.001). 50% of B- and C-glenoids in (I) showed a median inclination deviation of 4.6° (0.0°-20.0°; p < 0.001) versus 1.8° (0.0°-4.0°; p < 0.001) in (II). Deviation from the entry point was always less than 5.0 mm when using PSAD compared to a maximum of 7.7 mm with the standard guide and was most pronounced in type C (p < 0.001). CONCLUSION PSAD enhance precision and accuracy of guide wire placement particularly for deformed B and C type glenoids compared to a standard guide in vitro. There was no learning curve for PSAD. However, findings of this study cannot be directly translated to the clinical reality and require further corroboration.
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Affiliation(s)
- Jana F Schader
- AO Research Institute Davos, Clavadelerstrasse 8, Davos Platz, 7270, Switzerland.
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland.
| | - Tobias Helfen
- AO Research Institute Davos, Clavadelerstrasse 8, Davos Platz, 7270, Switzerland
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Volker Braunstein
- AO Research Institute Davos, Clavadelerstrasse 8, Davos Platz, 7270, Switzerland
- OrthoPlus München, Alte Börse, Lenbachplatz 2a, 80333, Munich, Germany
| | - Ben Ockert
- AO Research Institute Davos, Clavadelerstrasse 8, Davos Platz, 7270, Switzerland
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Florian Haasters
- Schön Klinik München Harlaching, Zentrum für Knie-, Hüft- und Schulterchirurgie, Harlachinger Strasse 51, 81547, Munich, Germany
| | - Ralph Hertel
- Schulter & Ellbogen Zentrum Bern, Lindenhofspital, Bremgartenstrasse 117, Bern, 3001, Switzerland
| | - Norbert Südkamp
- Medical Faculty, Albert-Ludwigs-University Freiburg, 79085, Fahnenbergplatz, Freiburg im Breisgau, Germany
| | - Stefan Milz
- Anatomische Anstalt der Ludwig-Maximilians-Universität, Pettenkoferstrasse 11, 80336, Munich, Germany
| | - Christoph M Sprecher
- AO Research Institute Davos, Clavadelerstrasse 8, Davos Platz, 7270, Switzerland
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7
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Yelton MJ, Da Silva AZ, Moverman MA, Joyce CD, Chalmers PN, Tashjian RZ. Comparison of 3D computer-assisted planning with and without patient-specific instrumentation for severe bone defects in reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2024:S1058-2746(24)00390-2. [PMID: 38815732 DOI: 10.1016/j.jse.2024.04.002] [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: 11/12/2023] [Revised: 03/31/2024] [Accepted: 04/08/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Preoperative planning is an integral aspect of managing complex deformity in reverse shoulder arthroplasty (RSA). The purpose of this study was to compare the success of patient-specific instrumentation (PSI) and 3D computer-assisted planning with standard instrumentation (non-PSI) in achieving planned corrections of the glenoid among patients undergoing RSA with severe bony deformity requiring glenoid bone grafts. METHODS A retrospective case-control study was performed, including all patients that underwent RSA with combined bone grafting procedures (BIO-RSA or structural bone grafting) for severe glenoid deformity by a single study between June 2016 and July 2023. Patients were required to have preoperative and postoperative CT scans as well as preoperative 3D planning performed for inclusion. Patients were divided into two groups based on the use of 3D computer-assisted planning with or without PSI (PSI vs. non-PSI). The corrected inclination and version were measured by two separate reviewers on preoperative and postoperative 2D CT scans and compared to their corresponding preoperative planning goals utilizing bivariate analyses. RESULTS We identified 45 patients that met our inclusion criteria (22 PSI and 23 non-PSI). Preoperative inclination (mean ± SD) (PSI 10.12° ± 15.86°, non-PSI 9.43° ± 10.64°; P = .864) and version (PSI -18.78° ± 18.3°, non-PSI -17.82° ± 11.49°; P = .835) measurements were similar between groups. No significant differences in the mean deviation (error) between the postoperative and planned inclination (PSI 5.49° ± 3.72; non-PSI 6.91° ± 5.05; P = .437) and version (PSI 8.37° ± 5.7; non-PSI 5.37° ± 4.43; P = .054) were found between groups. No difference in the rate of outliers (>10° error) was noted in inclination (P = .135) or version (P = .445) between groups. Greater planned version correction was correlated with greater error when PSI was utilized (PSI r = 0.519, P = .013; non-PSI r = 0.362, P = .089). CONCLUSION Both PSI and 3D computer-assisted planning without PSI (non-PSI) appear to be useful techniques to achieve version and inclination correction among patients undergoing RSA with severe glenoid deformity required glenoid bone grafting with no clear superiority of one method over the other. Surgeons should be aware that when utilizing PSI, slightly greater error in achieving version goals may occur as version correction is increased.
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Affiliation(s)
- Mitchell J Yelton
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Adrik Z Da Silva
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Michael A Moverman
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Christopher D Joyce
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT, USA.
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8
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Franceschi F, Giovannetti de Sanctis E, Cristalli E. Shaping the bone autograft for reverse total shoulder arthroplasty without the use of any specific instrumentation. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:222-227. [PMID: 38706668 PMCID: PMC11065747 DOI: 10.1016/j.xrrt.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
- Francesco Franceschi
- UniCamillus-Department of Orthopaedic and Trauma Surgery, San Pietro Fatebenefratelli Hospital, Rome, Italy
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | | | - Edoardo Cristalli
- UniCamillus-Department of Orthopaedic and Trauma Surgery, San Pietro Fatebenefratelli Hospital, Rome, Italy
- AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
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9
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Ameziane Y, Imiolczyk JP, Steinbeck J, Warnhoff M, Moroder P, Scheibel M. [Reverse Shoulder Arthroplasty - Current Concepts]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:211-228. [PMID: 38518806 DOI: 10.1055/a-2105-3147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
Due to first promising long term outcome data, reverse shoulder arthroplasty experienced an immense increase of usage during the past decade. Moreover, the initial Grammont concept has constantly been refined and adapted to current scientific findings. Therefore, clinical and radiological problems like scapular notching and postoperative instability were constantly addressed but do still remain an area of concern.This article summarises current concepts in reverse shoulder arthroplasty and gives an overview of actual indications like cuff tear arthropathy, severe osteoarthritis, proximal humerus fractures, tumours, fracture sequelae as well as revision surgery and their corresponding clinical and radiological results.
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10
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Bischofreiter M, Sacan E, Gattringer M, Gruber MS, Breulmann FL, Kindermann H, Heuberer P, Mattiassich G, Ortmaier R. The Value of Computed Tomography-Based Planning in Shoulder Arthroplasty Compared to Intra-/Interobserver Reliability of X-ray Planning. J Clin Med 2024; 13:2022. [PMID: 38610787 PMCID: PMC11012767 DOI: 10.3390/jcm13072022] [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: 03/07/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Reversed total shoulder arthroplasty (RTSA) is an established surgery for many pathologies of the shoulder and the demand continues to rise with an aging population. Preoperative planning is mandatory to support the surgeon's understanding of the patient's individual anatomy and, therefore, is crucial for the patient's outcome. Methods: In this observational study, we identified 30 patients who underwent RTSA with two- and three-dimensional preoperative planning. Each patient underwent new two-dimensional planning from a medical student and an orthopedic resident as well as through a mid-volume and high-volume shoulder surgeon, which was repeated after a minimum of 4 weeks. The intra- and interobserver reliability was then analyzed and compared to the 3D planning and the implanted prosthesis. The evaluated parameters were the size of the pegged glenoid baseplate, glenosphere, and humeral short stem. Results: The inter-rater reliability showed higher deviations in all four raters compared to the 3D planning of the base plate, glenosphere, and shaft. The intra-rater reliability showed a better correlation in more experienced raters, especially in the planning of the shaft. Conclusions: Our study shows that 3D planning is more accurate than traditional planning on plain X-rays, despite experienced shoulder surgeons showing better results in 2D planning than inexperienced ones.
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Affiliation(s)
- Martin Bischofreiter
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
| | - Edanur Sacan
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Michael Gattringer
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Michael S. Gruber
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Franziska L. Breulmann
- Department of Orthopedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Harald Kindermann
- Department of Marketing and Electronic Business, University of Applied Sciences Upper Austria, 4400 Steyr, Austria
| | | | - Georg Mattiassich
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
| | - Reinhold Ortmaier
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
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11
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Kim JS, Kim SH, Kim SC, Park JH, Kim HG, Lee SM, Yoo JC. Effect of using a small baseplate on the radiological and clinical outcomes of reverse total shoulder arthroplasty in Asian patients. Bone Joint J 2023; 105-B:1189-1195. [PMID: 37909149 DOI: 10.1302/0301-620x.105b11.bjj-2023-0450.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Aims The aim of this study was to compare the clinical and radiological outcomes of reverse shoulder arthroplasty (RSA) using small and standard baseplates in Asian patients, and to investigate the impact of a mismatch in the sizes of the glenoid and the baseplate on the outcomes. Methods This was retrospective analysis of 50 and 33 RSAs using a standard (33.8 mm, ST group) and a small (29.5 mm, SM group) baseplate of the Equinoxe reverse shoulder system, which were undertaken between January 2017 and March 2021. Radiological evaluations included the size of the glenoid, the β-angle, the inclination of the glenoid component, inferior overhang, scapular notching, the location of the central cage in the baseplate within the vault and the mismatch in size between the glenoid and baseplate. Clinical evaluations included the range of motion (ROM) and functional scores. In subgroup analysis, comparisons were performed between those in whom the vault of the glenoid was perforated (VP group) and those in whom it was not perforated (VNP group). Results Perforation of the vault of the glenoid (p = 0.018) and size mismatch in height (p < 0.001) and width (p = 0.013) were significantly more frequent in the ST group than in the SM group. There was no significant difference in the clinical scores and ROM in the two groups, two years postoperatively (all p > 0.05). In subgroup analysis, the VP group had significantly less inferior overhang (p = 0.009), more scapular notching (p = 0.018), and more size mismatch in height (p < 0.001) and width (p = 0.025) than the VNP group. Conclusion In Asian patients with a small glenoid, using a 29.5 mm small baseplate at the time of RSA was more effective in reducing size mismatch between the glenoid and the baseplate, decreasing the incidence of perforation of the glenoid vault, and achieving optimal positioning of the baseplate compared with the use of a 33.8 mm standard baseplate. However, longer follow-up is required to assess the impact of these findings on the clinical outcomes.
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Affiliation(s)
- Jae S Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Seung H Kim
- Department of Orthopaedic Surgery, Saeroun Hospital, Seoul, South Korea
| | - Su C Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Jong H Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Hyun G Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Sang M Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Jae C Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
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Rashid MS, Cunningham L, Shields DW, Walton MJ, Monga P, Bale RS, Trail IA. Clinical and radiologic outcomes of Lima ProMade custom 3D-printed glenoid components in primary and revision reverse total shoulder arthroplasty with severe glenoid bone loss: a minimum 2-year follow-up. J Shoulder Elbow Surg 2023; 32:2017-2026. [PMID: 37263477 DOI: 10.1016/j.jse.2023.04.020] [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: 01/21/2023] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND The purpose of this study is to report the clinical and radiologic outcomes of patients undergoing primary or revision reverse total shoulder arthroplasty using custom 3D-printed components to manage severe glenoid bone loss with a minimum of 2-year follow-up. METHODS Following ethical approval, patients were identified and invited to participate. Inclusion criteria were (1) severe glenoid bone loss necessitating the need for custom implants and (2) patients with definitive glenoid and humeral components implanted more than 2 years prior. Included patients underwent clinical assessment using the Oxford Shoulder Score (OSS), Constant-Murley score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and the quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH). Radiographic assessment included anteroposterior and axial projections. Patients were invited to attend a computed tomography (CT) scan to confirm osseointegration. Statistical analysis used descriptive statistics (mean and standard deviation [SD]) and paired t test for parametric data. RESULTS Eleven patients declined to participate. Five patients were deceased prior to study commencement, leaving 42 remaining patients in this analysis. Three patients had revision surgery before the 2-year follow-up; of these, 2 retained their custom glenoid components. Mean follow-up was 31.6 months from surgery (range 24-52 months). All 4 scores improved: OSS from a mean 15 (SD 8.4) to 36 (SD 12) (P < .001), Constant-Murley score from a mean 15 (SD 11.2) to 52 (SD 20.1) (P < .001), QuickDASH from a mean 70 (SD 21) to 31 (SD 24.8) (P = .004), and the ASES score from a mean 22 (SD 17.8) to 71 (SD 23.3) (P = .007). Radiologic evaluation demonstrated good osseointegration in all but 1 included patient. CONCLUSION The utility of custom 3D-printed components for managing severe glenoid bone loss in primary and revision reverse total shoulder arthroplasty yields significant clinical improvements in this complex cohort. Large complex glenoid bone defects can be managed successfully with custom 3D-printed glenoid components.
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Affiliation(s)
- Mustafa S Rashid
- Department of Orthopaedic Surgery, Wrightington Hospital, Appley Bridge, Wigan, Lancashire, UK.
| | - Lindsay Cunningham
- Department of Orthopaedic Surgery, Wrightington Hospital, Appley Bridge, Wigan, Lancashire, UK
| | - David W Shields
- Department of Orthopaedic Surgery, Wrightington Hospital, Appley Bridge, Wigan, Lancashire, UK
| | - Michael J Walton
- Department of Orthopaedic Surgery, Wrightington Hospital, Appley Bridge, Wigan, Lancashire, UK
| | - Puneet Monga
- Department of Orthopaedic Surgery, Wrightington Hospital, Appley Bridge, Wigan, Lancashire, UK
| | - Richard S Bale
- Department of Orthopaedic Surgery, Wrightington Hospital, Appley Bridge, Wigan, Lancashire, UK
| | - Ian A Trail
- Department of Orthopaedic Surgery, Wrightington Hospital, Appley Bridge, Wigan, Lancashire, UK
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13
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McDonald M, Timoteo TM, Schoch N. Contralateral preoperative templating for fracture reverse total shoulder arthroplasty: technique article and case series. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:362-369. [PMID: 37588500 PMCID: PMC10426702 DOI: 10.1016/j.xrrt.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Michael McDonald
- Grady Health System, Department of Orthopedic Surgery, Atlanta, GA, USA
| | - Taylor M. Timoteo
- Henry Ford Macomb, Department of Orthopedic Surgery, Clinton Township, MI, USA
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Velasquez Garcia A, Abdo G, Sanchez-Sotelo J, Morrey ME. The Value of Computer-Assisted Navigation for Glenoid Baseplate Implantation in Reverse Shoulder Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev 2023; 11:01874474-202308000-00008. [PMID: 37616447 DOI: 10.2106/jbjs.rvw.23.00038] [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: 08/26/2023]
Abstract
BACKGROUND Glenoid baseplate malpositioning during reverse total shoulder arthroplasty can contribute to perimeter impingement, dislocation, and loosening. Despite advances in preoperative planning, conventional instrumentation may lead to considerable inaccuracy in implant positioning unless patient-specific guides are used. Optical navigation has the potential to improve accuracy and precision when implanting a reverse shoulder arthroplasty baseplate. This systematic review aimed to analyze the most recent evidence on the accuracy and precision of glenoid baseplate positioning using intraoperative navigation and its potential impact on component selection and surgical time. METHODS We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The PubMed, Scopus, and EMBASE databases were queried in July 2022 to identify all studies that compared navigation vs. conventional instrumentation for reverse shoulder arthroplasty. Data of deviation from the planned baseplate version and inclination, the use of standard or augmented glenoid components, and surgical time were extracted. Quantitative analysis from the included publications was performed using the inverse-variance approach and Mantel-Haenszel method. RESULTS Of the 2,048 records identified in the initial query, only 10 articles met the inclusion and exclusion criteria, comprising 667 shoulders that underwent reverse total shoulder arthroplasty. The pooled mean difference (MD) of the deviation from the planned baseplate position for the clinical studies was -0.44 (95% confidence interval [CI], -3.26; p = 0.76; I2 = 36%) for version and -8.75 (95% CI, -16.83 to -0.68; p = 0.02; I2 = 83%) for inclination, both in favor of navigation. The odds ratio of selecting an augmented glenoid component after preoperative planning and navigation-assisted surgery was 8.09 (95% CI, 3.82-17.14; p < 0.00001; I2 = 60%). The average surgical time was 12 minutes longer in the navigation group (MD 12.46, 95% CI, 5.20-19.72; p = 0.0008; I2 = 71%). CONCLUSIONS Preoperative planning integrated with computer-assisted navigation surgery seems to increase the accuracy and precision of glenoid baseplate inclination compared with the preoperatively planned placement during reverse total shoulder arthroplasty. The surgical time and proportion of augmented glenoid components significantly increase when using navigation. However, the clinical impact of these findings on improving prosthesis longevity, complications, and patient functional outcomes is still unknown. LEVEL OF EVIDENCE Level III, systematic review and meta-analysis. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ausberto Velasquez Garcia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Orthopedic Surgery, Clínica Universidad de los Andes, Santiago, Chile
| | - Glen Abdo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Internal Medicine Residency Program, New York Medical College at St Mary's General Hospital, Valhalla, New York
| | | | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Berhouet J, Samargandi R, Favard L, Turbillon C, Jacquot A, Gauci MO. The Real Post-Operative Range of Motion Differs from the Virtual Pre-Operative Planned Range of Motion in Reverse Shoulder Arthroplasty. J Pers Med 2023; 13:jpm13050765. [PMID: 37240935 DOI: 10.3390/jpm13050765] [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: 03/28/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION The purpose of this study was to analyze the real range of motion (RoM) measured in patients operated on for reverse shoulder arthroplasty (RSA) and compare it to the virtual RoM provided by the preoperative planning software. HYPOTHESIS There was a difference between virtual and real RoM, which can be explained by different factors, specifically the scapula-thoracic (ST) joint. METHODS Twenty patients with RSA were assessed at a minimum follow-up of 18 months. Passive RoM in forward elevation abduction, without and with manually locking the ST joint, and in external rotation with arm at side were recorded. The humerus, scapula, and implants were manually segmented on post-operative CTs. Post-operative bony structures were registered to preoperative bony elements. From this registration, a post-operative plan corresponding to the real post-operative implant positioning was generated and the corresponding virtual RoM analysis was recorded. On the post-operative anteroposterior X-rays and 2D-CT coronal planning view, the glenoid horizontal line angle (GH), the metaphyseal horizontal line angle (MH), and the gleno-metaphyseal angle (GMA) were measured to assess the extrinsic glenoid inclination, as well as the relative position of the humeral and glenoid components. RESULTS There were some significant differences between virtual and post-operative passive abduction and forward elevation, with (55° and 50°, p < 0.0001) or without ST joint participation (15° and 27°, p < 0.002). For external rotation with arm at side, there was no significant difference between planning (24° ± 26°) and post-operative clinical observation (19° ± 12°) (p = 0.38). For the angle measurements, the GMA was significantly higher (42.8° ± 15.2° vs. 29.1°± 18.2°, p < 0.0001), and the GH angle, significantly lower on the virtual planning (85.2° ± 8.8° vs. 99.5° ± 12.5°, p < 0.0001), while the MH was not different (p = 0.33). CONCLUSIONS The virtual RoM given by the planning software used in this study differs from the real post-operative passive RoM, except for external rotation. This can be explained by the lack of ST joint and soft tissues simulation. However, in focusing on the virtual GH participation, the simulation looks informative. Some modifications between the glenoid and humerus starting positions before running the motion analysis could be provided for making it more realistic and predictive of the RSA functional results. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Julien Berhouet
- CHRU Trousseau Service d'Orthopédie Traumatologie, Faculté de Médecine de Tours, Université de Tours, 1C Avenue de la République, 37170 Tours, France
- Equipe Reconnaissance de Forme et Analyse de l'Image, Laboratoire d'Informatique Fondamentale et Appliquée de Tours EA6300, Ecole d'Ingénieurs Polytechnique Universitaire de Tours, Université de Tours, 64 Avenue Portalis, 37200 Tours, France
| | - Ramy Samargandi
- CHRU Trousseau Service d'Orthopédie Traumatologie, Faculté de Médecine de Tours, Université de Tours, 1C Avenue de la République, 37170 Tours, France
- Department of Orthopedic Surgery, Faculty of Medicine, University of Jeddah, Jeddah 23218, Saudi Arabia
| | - Luc Favard
- CHRU Trousseau Service d'Orthopédie Traumatologie, Faculté de Médecine de Tours, Université de Tours, 1C Avenue de la République, 37170 Tours, France
| | - Céline Turbillon
- CHRU Trousseau Service d'Orthopédie Traumatologie, Faculté de Médecine de Tours, Université de Tours, 1C Avenue de la République, 37170 Tours, France
| | - Adrien Jacquot
- Centre for Chirurgie des Articulations et du Sport (ARTICS), 24 rue du XXIème Régiment d'Aviation, 54000 Nancy, France
| | - Marc-Olivier Gauci
- Institut Locomoteur et du Sport, Hôpital Pasteur 2, 30 Voie Romaine, 06000 Nice, France
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Jennewine BR, Brolin TJ. Emerging Technologies in Shoulder Arthroplasty: Navigation, Mixed Reality, and Preoperative Planning. Orthop Clin North Am 2023; 54:209-225. [PMID: 36894293 DOI: 10.1016/j.ocl.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Shoulder arthroplasty is a rapidly improving and utilized management for end-stage arthritis that is associated with improved functional outcomes, pain relief, and long-term implant survival. Accurate placement of the glenoid and humeral components is critical for improved outcomes. Traditionally, preoperative planning was limited to radiographs and 2-dimensional computed tomography (CT); however, 3-dimensional CT is becoming more commonly utilized and necessary to understand complex glenoid and humeral deformities. To further increase accurate component placement, intraoperative assistive devices-patient-specific instrumentation, navigation, and mixed reality-minimize malpositioning, increase surgeon accuracy, and maximize fixation. These intraoperative technologies likely represent the future of shoulder arthroplasty.
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Affiliation(s)
- Brenton R Jennewine
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 920 Madison Avenue, Memphis, TN 38163, USA; Campbell Clinic Orthopaedics, 1211 Union Avenue #500, Memphis, TN 38104, USA
| | - Tyler J Brolin
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 920 Madison Avenue, Memphis, TN 38163, USA; Campbell Clinic Orthopaedics, 1400 South Germantown Road, Germantown, TN 38138, USA.
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17
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Accuracy of Blueprint software in predicting range of motion 1 year after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:1088-1094. [PMID: 36690174 DOI: 10.1016/j.jse.2022.12.009] [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: 09/02/2022] [Revised: 11/16/2022] [Accepted: 12/11/2022] [Indexed: 01/22/2023]
Abstract
HYPOTHESIS AND BACKGROUND Blueprint 3-dimensional computed tomography software has a functionality that predicts impingement-free range of motion (ROM) with determination of the limits of ROM at which bone and/or prosthetic impingement occurs. To our knowledge, only 1 previously published study has assessed the ability of Blueprint software to predict actual postoperative ROM after reverse total shoulder arthroplasty (RTSA). The hypotheses of this study were that (1) mean Blueprint-predicted impingement-free ROM would be statistically similar to the mean actual ROM 1 year after RTSA and (2) there would be a correlation between Blueprint-predicted impingement-free ROM and the actual ROM 1 year after RTSA. MATERIALS AND METHODS A retrospective review of patients who underwent Blueprint planning prior to undergoing RTSA from March 2017 through May 2021 was performed. At 1-year follow-up, flexion, external rotation at the side, abduction, external rotation in the abducted position, internal rotation in the abducted position, and internal rotation behind the back were measured. The preoperatively predicted flexion, extension, abduction, external rotation, and internal rotation were recorded using Blueprint software. The group 1 analysis examined the predicted vs. actual ROM of all 127 patients regardless of whether intraoperative component modifications were made. The group 2 analysis examined the predicted vs. actual ROM of only the patients who did not undergo intraoperative changes that would affect the preoperative ROM prediction (n = 97). The group 3 analysis examined the predicted vs. actual ROM of group 2 combined with the 30 patients who underwent post hoc Blueprint planning modifications to account for the changes made intraoperatively (combined sample size of 127). RESULTS Of the 141 patients, 127 (90%) were available for 1-year follow-up. When the mean values of all 3 groups were examined, the actual ROM and predicted ROM were statistically significantly different (P < .0001) for flexion, external rotation, abduction, abduction-external rotation, and abduction-internal rotation. In group 1, a very weak or poor correlation was found between predicted internal rotation and actual abducted internal rotation (r = 0.19, P = .04). For all other ROM metrics in groups 1, 2, and 3, there were no correlations between predicted and actual ROM (P ≥ .07). CONCLUSIONS In its current state, preoperative Blueprint 3-dimensional computed tomography planning software is unable to accurately predict ROM 1 year after RTSA.
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Fidvi S, Holder J, Li H, Parnes GJ, Shamir SB, Wake N. Advanced 3D Visualization and 3D Printing in Radiology. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1406:103-138. [PMID: 37016113 DOI: 10.1007/978-3-031-26462-7_6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Since the discovery of X-rays in 1895, medical imaging systems have played a crucial role in medicine by permitting the visualization of internal structures and understanding the function of organ systems. Traditional imaging modalities including Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Ultrasound (US) present fixed two-dimensional (2D) images which are difficult to conceptualize complex anatomy. Advanced volumetric medical imaging allows for three-dimensional (3D) image post-processing and image segmentation to be performed, enabling the creation of 3D volume renderings and enhanced visualization of pertinent anatomic structures in 3D. Furthermore, 3D imaging is used to generate 3D printed models and extended reality (augmented reality and virtual reality) models. A 3D image translates medical imaging information into a visual story rendering complex data and abstract ideas into an easily understood and tangible concept. Clinicians use 3D models to comprehend complex anatomical structures and to plan and guide surgical interventions more precisely. This chapter will review the volumetric radiological techniques that are commonly utilized for advanced 3D visualization. It will also provide examples of 3D printing and extended reality technology applications in radiology and describe the positive impact of advanced radiological image visualization on patient care.
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Affiliation(s)
- Shabnam Fidvi
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA.
| | - Justin Holder
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Hong Li
- Department of Radiology, Jacobi Medical Center, Bronx, NY, USA
| | | | | | - Nicole Wake
- GE Healthcare, Aurora, OH, USA
- Center for Advanced Imaging Innovation and Research, NYU Langone Health, New York, NY, USA
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Hawkes D, Brookes-Fazakerley S, Robinson S, Bhalaik V. Intraoperative and early postoperative complications of reverse shoulder arthroplasty: A current concepts review. J Orthop 2023; 35:120-125. [PMID: 36471697 PMCID: PMC9718996 DOI: 10.1016/j.jor.2022.11.012] [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: 08/03/2022] [Revised: 10/19/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022] Open
Abstract
Background Reverse shoulder arthroplasty is a common procedure performed for a variety of shoulder pathologies. Aims and objectives This current concept review evaluates the intraoperative and early postoperative complications, with a specific focus given to neurological and vascular injury, fracture, dislocation and venous thromboembolism. Conclusion A detailed knowledge of potential complications will allow surgeons to mitigate risk and maximise outcomes.
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Affiliation(s)
- David Hawkes
- Upper Limb Unit, Wirral University Teaching Hospital, Arrowe Park Rd, Upton, Birkenhead, Wirral, CH49 5PE, UK
| | - Steven Brookes-Fazakerley
- Upper Limb Unit, Wirral University Teaching Hospital, Arrowe Park Rd, Upton, Birkenhead, Wirral, CH49 5PE, UK
| | - Simon Robinson
- Upper Limb Unit, Wirral University Teaching Hospital, Arrowe Park Rd, Upton, Birkenhead, Wirral, CH49 5PE, UK
| | - Vijay Bhalaik
- Upper Limb Unit, Wirral University Teaching Hospital, Arrowe Park Rd, Upton, Birkenhead, Wirral, CH49 5PE, UK
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de Marinis R, Contreras JJ, Vidal C, Palma C, Angulo M, Valenzuela A, Jaña R, Calvo C, Liendo R, Soza F. The Reverse Shoulder Arthroplasty Angle in MRI: Impact of the Articular Cartilage in the Estimated Inclination of the Inferior Glenoid. J Shoulder Elb Arthroplast 2023; 7:24715492231167110. [PMID: 37008200 PMCID: PMC10064160 DOI: 10.1177/24715492231167110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
Purpose To describe the reverse shoulder arthroplasty angle (RSA angle) in magnetic resonance imaging (MRI) and compare the angle formed using bony landmarks (Bony RSA angle or B-RSA angle) with another angle formed using the cartilage margin as reference (Cartilage RSA angle or C-RSA angle). Methods Adult patients with a shoulder MRI obtained in our hospital between July 2020 and July 2021 were included. The C-RSA angle and B-RSA angle were measured. All images were independently assessed by 4 evaluators. Intraclass correlation coefficient (ICC) was determined for the B-RSA and C-RSA to evaluate interobserver agreement. Results A total of 61 patients were included with a median age of 59 years (17-77). C-RSA angle was significantly higher than B-RSA (25.4° ± 0.7 vs 19.5° ± 0.7, respectively) with a P-value <.001. The overall agreement was considered “good” for C-RSA (ICC = 0.74 [95% CI 0.61-0.83]) and “excellent” for B-RSA angle (ICC = 0.76 [95% CI 0.65-0.85]). Conclusions C-RSA angle is significantly higher than B-RSA angle. In cases without significant glenoid wear neglecting to account for the remaining articular cartilage at the inferior glenoid margin may result in superior inclination of standard surgical guides.
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Affiliation(s)
- Rodrigo de Marinis
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Shoulder and Elbow Unit, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
- Rodrigo de Marinis, Diagonal Paraguay 362, 3er piso, Región Metropolitana, Santiago, Chile.
| | - Julio J. Contreras
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catalina Vidal
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristóbal Palma
- Radiology Department, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Manuela Angulo
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alfonso Valenzuela
- Shoulder and Elbow Unit, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Ricardo Jaña
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudio Calvo
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Liendo
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Soza
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Muacevic A, Adler JR, Shields DW. A Systematic Review of the Utility of Intraoperative Navigation During Total Shoulder Arthroplasty. Cureus 2022; 14:e33087. [PMID: 36721577 PMCID: PMC9884066 DOI: 10.7759/cureus.33087] [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] [Accepted: 12/29/2022] [Indexed: 12/30/2022] Open
Abstract
Total shoulder arthroplasty (TSA) has been demonstrated to successfully recover function to shoulders impaired by arthrosis and rotator cuff insufficiency. Long-term survival depends on the correct positioning of glenoid components and secure bone fixation. Computed tomography (CT)-based intraoperative navigation has proven to be an effective technique for successful TSA procedures. This paper presents a review of CT-based intraoperative navigation considering its advantages and disadvantages. The crucial factors that contribute to the success of this technique are glenoid component positioning, operative duration, and screw selection, which are detailed in this review.
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22
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Hsu CP, Wu CT, Chen CY, Lin SC, Hsu KY. Difference analysis of the glenoid centerline between 3D preoperative planning and 3D printed prosthesis manipulation in total shoulder arthroplasty. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04688-8. [PMID: 36445496 DOI: 10.1007/s00402-022-04688-8] [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: 07/01/2022] [Accepted: 10/30/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Excessive version and inclination of the glenoid component during total shoulder arthroplasty can lead to glenohumeral instability, early loosening, and even failure. The orientation and position of the central pin determine the version and inclination of the glenoid component. The purpose of this study was to compare the differences in centerline position and orientation obtained using "3D preoperative planning based on the best-fit method for glenoid elements" and the surgeon's manipulation. MATERIALS AND METHODS Twenty-nine CT images of glenohumeral osteoarthritis of the shoulder were reconstructed into a 3D model, and a 3D printer was used to create an in vitro model for the surgeon to drill the center pin. The 3D shoulder model was also used for 3D preoperative planning (3DPP) using the best-fit method for glenoid elements. The in vitro model was scanned and the version, inclination and center position were measured to compare with the 3DPP results. RESULTS The respective mean inclinations (versions) of the surgeon and 3DPP were -2.63° ± 6.60 (2.87° ± 5.97) and -1.96° ± 4.24 (-3.21° ± 4.00), respectively. There was no significant difference in the inclination and version of the surgeon and 3DPP. For surgeons, the probability of the inclination and version being greater than 10° was 13.8% (4/29) and 10.3% (3/29), respectively. Compared to the 3DPP results, the surgeon's center position was shifted down an average of 1.63 mm. There was a significant difference in the center position of the surgeon and 3DPP (p < 0.05). CONCLUSION The central pin drilled by surgeons using general instruments was significantly lower than those defined using 3D preoperative planning and standard central definitions. 3D preoperative planning prevents the version and inclination of the centerline from exceeding safe values (± 10°).
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Affiliation(s)
- Chi-Pin Hsu
- High Speed 3D Printing Research Center, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Chen-Te Wu
- Department of Medical Imaging and Intervention Radiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Yu Chen
- Department of Orthopaedic Surgery Division of Sports Medicine and Musculoskeletal Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Shang-Chih Lin
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Kuo-Yao Hsu
- Department of Orthopaedic Surgery Division of Sports Medicine and Musculoskeletal Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Antonacci CL, Abdelshahed M, Omari A, Cutalo M, Fritz RC, Alberta FG. Description and Validation of the Anterior Glenoid Angle: A Novel MRI-Based Measure of Glenoid Morphologic Features and Version. Orthopedics 2022; 45:361-366. [PMID: 35858179 DOI: 10.3928/01477447-20220706-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The goal of this study was to establish a normal value for, and evaluate the reliability of, a new measurement of glenoid morphologic features using magnetic resonance imaging: the anterior glenoid angle. A total of 90 magnetic resonance imaging scans of patients without shoulder arthritis were reviewed. The anterior glenoid angle of each glenoid was measured by 4 blinded physicians. The images were randomized and measured again. Finally, the Friedman angle was measured on the same images for reference. Descriptive statistics and inter- and intraclass correlation coefficients were calculated. The mean anterior glenoid angle was 60.4°±3.6°. Of the measured values, 77% were between 56° and 64°. Intraobserver reliability was very good to excellent in single measure (range, 0.763-0.901) and mean measure (range, 0.865-0.948) comparisons. Interobserver reliability was very good to excellent in both single measure (0.769) and mean measure (0.964) comparisons. The mean Friedman angle was 10.2°. Correlation between the anterior glenoid angle and Friedman angle ranged from a moderate negative (-0.496) to a strong negative correlation (-0.711) among the observers. The mean anterior glenoid angle measured via magnetic resonance imaging scan was 60.4° in normal shoulders, and more than 75% of the values were within 4° of the mean. The anterior glenoid angle has excellent inter- and intrarater reliability without using computed tomography scan or including the entire scapula in the field of view. The anterior glenoid angle has a good to very good negative correlation with the Friedman angle because decreasing anterior glenoid angles indicate increasing retroversion. [Orthopedics. 2022;45(6):361-366.].
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Nascimento LGP, Ikemoto RY, Wright T. Navegação em cirurgia de artroplastia de ombro. Rev Bras Ortop 2022; 57:540-545. [PMID: 35966424 PMCID: PMC9365459 DOI: 10.1055/s-0040-1712989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/10/2020] [Indexed: 11/10/2022] Open
Abstract
The indication of shoulder arthroplasties has increased progressively. Accurate positioning of the components may have significant implications for clinical results. The navigation used to aid in the performance of anatomical and reverse total arthroplasties has provided greater precision in implant placement, especially on the glenoid. The development of the technique, material, and prosthesis design have shown encouraging results and led to a trend toward its expansion. In this way, we estimate a higher survival of the arthroplasties resulting from lower rates of dislocation and early loosening. We aim to describe the current technique and to present the results of the literature with navigation. However, comparative clinical studies with long term follow-up are necessary to prove the efficacy in the final results of total shoulder arthroplasties.
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Affiliation(s)
| | - Roberto Yukio Ikemoto
- Divisão de ombro e cotovelo, Faculdade de Medicina do ABC, Santo André, SP, Brasil
- Departamento de Ortopedia, Hospital Ipiranga, São Paulo, SP, Brasil
| | - Thomas Wright
- Centro de treinamento e pesquisa musculoesquelética, University of Florida, Gainesville, Florida, United States
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Berhouet J, Jacquot A, Walch G, Deransart P, Favard L, Gauci MO. Preoperative planning of baseplate position in reverse shoulder arthroplasty: Still no consensus on lateralization, version and inclination. Orthop Traumatol Surg Res 2022; 108:103115. [PMID: 34653644 DOI: 10.1016/j.otsr.2021.103115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/07/2021] [Accepted: 05/10/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In the context of reverse shoulder arthroplasty, some parameters of glenoid baseplate placement follow established golden rules, while other parameters still have no consensus. The assessment of glenoid wear in the future location of the glenoid baseplate varies among surgeons. The objective of this study was to analyze the inter-observer reproducibility of glenoid baseplate 3D positioning during virtual pre-operative planning. METHOD Four shoulder surgeons planned the glenoid baseplate position of a reverse arthroplasty in the CT scans of 30 degenerative shoulders. The position of the glenoid guide pin entry point and the glenoid baseplate center was compared between surgeons. The baseplate's version and inclination were also analyzed. RESULTS The 3D positioning of the pin entry point was achieved within ± 4 mm for nearly 100% of the shoulders. The superoinferior, anteroposterior and mediolateral positions of the baseplate center were achieved within ± 2 mm for 77.2%, 67.8% and 39.4% of the plans, respectively. The 3D orientation of the glenoid baseplate within ± 10° was inconsistent between the four surgeons (weak agreement, K=0.31, p=0.17). DISCUSSION The placement of the glenoid guide pin was very consistent between surgeons. Conversely, there was little agreement on the lateralization, version and inclination criteria for positioning the glenoid baseplate between surgeons. These parameters need to be studied further in clinical practice to establish golden rules. Three-dimensional information from pre-operative planning is beneficial for assessing the glenoid deformity and for limiting its impact on the baseplate position achieved by different surgeons. LEVEL OF EVIDENCE III. Case control study.
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Affiliation(s)
- Julien Berhouet
- Université de Tours-Faculté de Médecine de Tours - CHRU Trousseau Service d'Orthopédie Traumatologie 1C, Avenue de la République, 37170 Chambray-les-Tours, France; Université de Tours-Ecole d'Ingénieurs Polytechnique Universitaire de Tours-Laboratoire d'Informatique Fondamentale et Appliquée de Tours EA6300, Equipe Reconnaissance de Forme et Analyse de l'Image, 64 Avenue Portalis, 37200 Tours, France.
| | - Adrien Jacquot
- Chirurgie des Articulations et du Sport, Centre ARTICS, 24 rue du XXIème Régiment d'Aviation, 54000 Nancy, France
| | - Gilles Walch
- Centre Orthopédique Santy, Unité Epaule, 24 Avenue Paul Santy, 69008 Lyon, France
| | | | - Luc Favard
- Université de Tours-Faculté de Médecine de Tours - CHRU Trousseau Service d'Orthopédie Traumatologie 1C, Avenue de la République, 37170 Chambray-les-Tours, France
| | - Marc-Olivier Gauci
- Institut Locomoteur et du Sport, Hôpital Pasteur 2, 30 Voie Romaine, 06000 Nice, France
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Mohammad Sadeghi M, Kececi EF, Kapicioglu M, Aralasmak A, Tezgel O, Basaran MA, Yildiz F, Bilsel K. Three dimensional patient-specific guides for guide pin positioning in reverse shoulder arthroplasty: An experimental study on different glenoid types. J Orthop Surg (Hong Kong) 2022; 30:10225536221079432. [PMID: 35220811 DOI: 10.1177/10225536221079432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Incorrect positioning is one of the main factors for glenoid component loosening in reverse shoulder arthroplasty and component placement can be challenging. This study aimed to assess whether Patient-Specific Instrumentation (PSI) provides better guide pin positioning accuracy and is superior to standard guided and freehand instrumentation methods in cases of glenoid bone deformity. MATERIALS AND METHODS Based on the Walch classification, five different scapula types were acquired by computed tomography (CT). For each type, two different surgeons placed a guide pin into the scapula using three different methods: freehand method, conventional non-patient-specific guide, and PSI guide. Each method was repeated five times by both surgeons. In these experiments, a total of 150 samples of scapula models were used (5 × 2 × 3 × 5 = 150). Post-operative CT scans of the samples with the guide pin were digitally assessed and the accuracy of the pin placement was determined by comparison to the preoperative planning on a three-dimensional (3D) model. RESULTS The PSI method showed accuracies to the preoperative plan of 2.68 (SD 2.10) degrees for version angle (p < .05), 2.59 (SD 2.68) degrees for inclination angle (p < .05), and 1.55 (SD 1.26) mm for entry point offset (p < .05). The mean and standard deviation errors compared to planned values of version angle, inclination angle, and entry point offset were statistically significant for the PSI method for the type C defected glenoid and non-arthritic glenoid. CONCLUSION Using the PSI guide created by an image processing software tool for guide pin positioning showed advantages in glenoid component positioning over other methods, for defected and intact glenoid types, but correlation with clinical outcomes should be examined.
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Affiliation(s)
| | - Emin Faruk Kececi
- Department of Mechanical Engineering Kayseri, 346448Abdullah Gul University, Kayseri, Turkey
| | - Mehmet Kapicioglu
- Orthopaedics and Traumatology Department, 221265Bezmialem Vakif University, Istanbul, Turkey
| | - Ayse Aralasmak
- Radiology Department, 469683Istinye University, Istanbul, Turkey
| | - Okan Tezgel
- Radiology Department, 469683Istinye University, Istanbul, Turkey
| | - Murat Alper Basaran
- Department of Management Engineering, 450199Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Fatih Yildiz
- Orthopaedics and Traumatology Department, 221265Bezmialem Vakif University, Istanbul, Turkey
| | - Kerem Bilsel
- Orthopaedics and Traumatology Department, 221265Bezmialem Vakif University, Istanbul, Turkey
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An overview of 3D printing and the orthopaedic application of patient-specific models in malunion surgery. Injury 2022; 53:977-983. [PMID: 34838259 DOI: 10.1016/j.injury.2021.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/12/2021] [Accepted: 11/09/2021] [Indexed: 02/02/2023]
Abstract
As the emerging technology of three-dimensional (3D) printing impacts several facets of medicine, innovative techniques and applications are increasingly being incorporated into clinical workflows. Specifically, 3D printing technology has allowed for the individualization of patient care through the creation of printed surgical guides, patient-specific anatomical models, and simulation practice models. In this paper, we review the broad applications of 3D printing in orthopaedic surgery. The purpose of this paper is to help orthopaedic trauma surgeons understand 3D printing's emerging influence on the delivery of care as well as how to directly apply this technology to their practice. We aim to illustrate these principles through a specific example of a patient who presented for malunion surgery. A 3D printed model of a very complex traumatic scapula malunion was used to not only pre-surgically plan the reconstruction, but to also facilitate provider and patient education. This paper highlights the benefits of 3D printing and how trauma surgeons are uniquely positioned to apply this technology to improve patient care.
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Variability and reliability of 2-dimensional vs. 3-dimensional glenoid version measurements with 3-dimensional preoperative planning software. J Shoulder Elbow Surg 2022; 31:302-309. [PMID: 34411724 DOI: 10.1016/j.jse.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/07/2021] [Accepted: 07/11/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preoperative planning for total shoulder arthroplasty (TSA) may change according to the measured degree of glenoid version. Both 2-dimensional (2D) and 3-dimensional (3D) computed tomographic (CT) scans are used to measure glenoid version, with no consensus on which method is more accurate. However, it is generally accepted that 3D measurements are more reliable, yet most 3D reconstruction software currently in clinical use have never been directly compared to 2D. The purpose of this study is to directly compare 2D and 3D glenoid version measurements and determine the differences between the two. METHODS CT scans were performed preoperatively on 315 shoulders undergoing either anatomic or reverse TSA. 2D measurements of glenoid version were obtained manually using the Friedman method, whereas 3D measurements were obtained using the Equinoxe Planning Application (Exactech Inc.) 3D-reconstruction software. Negative version values indicate retroversion, whereas positive values indicate anteversion. Two observers collected the 2D measurements 2 separate times, and intra- and interobserver measurements were calculated. Groups were compared for variability using intraclass correlation coefficients (ICCs), and for differences in sample means using Student t tests. Additionally, samples were stratified by version value in order to better understand the potential sources of error between measurement techniques. RESULTS For the 2D measurements, intraobserver variability indicated excellent reproducibility for both observer 1 (ICC = 0.928, 95% confidence interval [CI] 0.911-0.942) and observer 2 (ICC = 0.964, 95% CI 0.955-0.971). Interobserver variability measurements also indicated excellent reproducibility (ICC = 0.915, 95% CI 0.778-0.956). The overall 2D version measurement average (-4.9° ± 10.3°) was significantly less retroverted than the 3D measurement average (-8.4° ± 9.1°) (P < .001), with 3D measurements yielding a more retroverted value 73% of the time. When stratified on the basis of version value with outliers excluded, there was no significant difference in the distribution of high-error samples within the data. DISCUSSION There was excellent reproducibility between the 2 observers in terms of both intra- and interobserver variability. The 3D measurement techniques were significantly more likely to return a more retroverted measurement, and high-error samples were evenly distributed throughout the data, indicating that there were no discernable trends in the degree of error observed. Shoulder surgeons should be aware that different glenoid version measurement strategies can yield different version measurements, as these can affect preoperative planning and surgeon decision making.
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Gauci MO. Patient-specific guides in orthopedic surgery. Orthop Traumatol Surg Res 2022; 108:103154. [PMID: 34838754 DOI: 10.1016/j.otsr.2021.103154] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/10/2021] [Accepted: 04/29/2021] [Indexed: 02/03/2023]
Abstract
The interest of patient-specific guides (PSGs) lies in reliable intraoperative achievement of preoperative planning goals. They are a form of instrumentation optimizing intraoperative precision and thus improving the safety and reproducibility of surgical procedures. Clinical superiority, however, has not been demonstrated. The various steps from design to implementation leave room for error, which needs to be known and controlled by the surgeon who is responsible for final outcome. Instituting large-scale patient-specific surgery requires management systems for guides and innovative implants which cannot be a simple extension of current practices. We shall approach the present state of knowledge regarding PSGs via 5 questions: (1) What is a PSG? Single-use instrumentation produced after preoperative planning, aiming exclusively to optimize procedural exactness. (2) How to use and assess PSGs in orthopedic surgery? Strict rules of use must be adhered to. Any deviation from the predefined objective is, necessarily, an error that must be identified as such. (3) Do PSGs provide greater surgical exactness? The contribution of PSGs varies greatly between procedures. Exactness is enhanced in the spine, in osteotomies around the knee and in bone-tumor surgery. In the shoulder, their contribution is seen only in complex cases. Data are sparse for hip replacement, and controversial for knee replacement. (4) What are the expected benefits of PSGs? As well as improving exactness, PSGs allow a lower radiation dose and shorter operating time. They also enable junior surgeons to train in techniques otherwise reserved to hyperspecialists. (5) How to include PSGs in everyday practice? As well as their potential clinical interest, PSGs involve deep changes in organization, equipment provision and economic model. LEVEL OF EVIDENCE: V; expert opinion.
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Affiliation(s)
- Marc-Olivier Gauci
- Institut Universitaire Locomoteur et du Sport (IULS), CHU de Nice, Unité de Recherche Clinique Côte d'Azur (UCA), Hôpital Pasteur II, 30, voie Romaine, 06000 Nice, France.
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30
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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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31
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Bohonos CJ, Russell SP, Morrissey DI. CT versus MRI planning for reverse geometry total shoulder arthroplasty. J Orthop 2021; 28:21-25. [PMID: 34744377 DOI: 10.1016/j.jor.2021.10.003] [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: 06/11/2021] [Revised: 08/04/2021] [Accepted: 10/10/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Preoperative planning for Reverse Total Shoulder Arthroplasty (RTSA) using CT or MRI is well described.1, 2, 3, 4, 5, 6, 7 We aimed to compare pre-operative CT versus MRI measurement accuracy for predicting intra-operative glenoid implant sizing. Methods All patients with a preoperative CT or MRI undergoing RTSA at our tertiary referral center from October 2017 to February 2020 were included. Data was collected from theatre and implant registers. Glenosphere Width (GW) and Baseplate Central Screw Length (BCSL) were independently predicted from pre-operative CT or MRI imaging by 2 blinded senior authors. A sub-group analysis was also performed between trauma and non-trauma CT cases. SPSS v26 was used for statistical comparison between predicted and actual implants. Results 71 data sets from 69 patients were included for analysis: 31 CT predictions and 40 MRI predictions. 61.3% of CT measured GW predictions were accurate compared to 82.5% of MRI predictions (p = 0.045). BCSL predictions were 77.4% and 70% accurate for CT and MRI respectively, without significant difference. There was no significant difference in sub-group analysis for trauma vs elective CT accuracy of BCSL or GW measurements. Conclusion MRI imaging may be superior to CT for predicting GW and no less accurate than CT for predicting BCSL in the elective setting. No difference in CT measurement accuracy was seen between trauma and elective settings. While simultaneously clearly defining shoulder soft tissue anatomy, MRI may also be the preferred modality for bony measurements during pre-operative planning for elective RTSA.
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Affiliation(s)
- Colton J Bohonos
- University College Cork, Cork, Ireland.,Department of Trauma and Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.,Cork University Hospital, Cork, Ireland
| | - Shane P Russell
- University College Cork, Cork, Ireland.,Department of Trauma and Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.,Royal College of Surgeons, Dublin, Ireland
| | - David I Morrissey
- University College Cork, Cork, Ireland.,Department of Trauma and Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.,Cork University Hospital, Cork, Ireland.,Royal College of Surgeons, Dublin, Ireland
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Schmalzl J, Gerhardt C, Lehmann LJ. Dreidimensionale Planung und Verwendung patientenspezifischer Instrumentierung (PSI) in der Schultertotalendoprothetik. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00482-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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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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Hurst SA, Merlini L, Hansen U, Gregory J, Emery R, Gregory T. The Glenoid Vault Outer Cortex a new more accurate radiological reference for shoulder arthroplasty. SICOT J 2021; 7:32. [PMID: 34009116 PMCID: PMC8132599 DOI: 10.1051/sicotj/2021030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/13/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Correct positioning of the glenoid component is an important determinant of outcome in shoulder arthroplasty. We describe and assess a new radiological plane of reference for improving the accuracy of glenoid preparation prior to component implantation – the Glenoid Vault Outer Cortex (GvOC) plane. Methods: One hundred and five CT scans of normal scapulae were obtained. Forty six females and 59 males aged between 22 and 30 years. The accuracy of the GvOC plane was then compared against the current “gold standard” – the scapular border (SB). Measurements of glenoid inclination, version, rotation, and offset were obtained using both the GvOC and SB planes. These were then compared to actual values. Results: The mean difference between version obtained using the GvOC plane and the actual value was 1.8° (−2 to 5, SD 1.6) as compared to 6.7° (−2 to 17, SD 4.3) when the SB plane was used, (p < 0.001). The mean difference between estimates of inclination obtained using the GvOC plane and the actual were 1.9° (−4 to 6, SD 1.6) as compared to 11.2° (−4 to 25, SD 6.1) when the SB plane was used, (p < 0.001). Conclusions: The GvOC plane produced estimates of glenoid version and inclination closer to actual values with lower variance than when the SB plane was used. The GvOC may be a more accurate and reproducible radiological method for surgeons to use when defining glenoid anatomy prior to arthroplasty surgery.
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Affiliation(s)
- Simon A Hurst
- Avicenne Teaching Hospital, 125 rue Stalingrad, Bobigny, 93000 Paris, France - Université Paris Sorbonne Nord, Campus de Bobigny, 1, rue de Chablis, Bobigny, 93000 Paris, France - Imperial College, St Mary's Hospital Campus, Queen Elizabeth Queen Mother Building, Praed Street, W2 1NY London, UK
| | - Lorenzo Merlini
- Avicenne Teaching Hospital, 125 rue Stalingrad, Bobigny, 93000 Paris, France - University Sorbonne-Paris-Nord, Equip Projet MOVEO, LaMSN, 99 Avenue Jean Baptiste, Clement, 93430 Villetaneuse, France
| | - Ulrich Hansen
- Imperial College, Department of Mechanical Engineering, South Kensington Campus, SW7 2AZ London, UK
| | - Jules Gregory
- Department of Radiology, Beaujon Hospital, Paris Nord Val de Seine Hospitals, APHP, 100 Avenue du General Leclerc, 92110 Clichy, France
| | - Roger Emery
- Imperial College, St Mary's Hospital Campus, Queen Elizabeth Queen Mother Building, Praed Street, W2 1NY London, UK
| | - Thomas Gregory
- Avicenne Teaching Hospital, 125 rue Stalingrad, Bobigny, 93000 Paris, France - University Sorbonne-Paris-Nord, Equip Projet MOVEO, LaMSN, 99 Avenue Jean Baptiste, Clement, 93430 Villetaneuse, France
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Erickson BJ, Chalmers PN, Denard P, Lederman E, Horneff G, Werner BC, Provencher MT, Romeo AA. Does commercially available shoulder arthroplasty preoperative planning software agree with surgeon measurements of version, inclination, and subluxation? J Shoulder Elbow Surg 2021; 30:413-420. [PMID: 32544424 DOI: 10.1016/j.jse.2020.05.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preoperative planning with commercially available imaging software in shoulder arthroplasty may allow for improved decision-making and more accurate placement of the glenoid component. METHODS A total of 81 consecutive shoulder computed tomography scans obtained for preoperative planning purposes for shoulder arthroplasty were analyzed by commercially available software from 4 companies (Blueprint: Wright Medical, Memphis, TN, USA; GPS: Exactech, Gainesville, FL, USA; Materialise: DJO, Vista, CA, USA; and VIP: Arthrex, Naples, FL, USA) and by 5 fellowship-trained sports medicine/shoulder surgeons. Inclination, version, and subluxation of the humerus were measured in a blinded fashion on axial and coronal sequences at the mid-glenoid. Surgeon measurements were analyzed for agreement and were compared with the 4 commercial programs. RESULTS Surgeon reliability was acceptable for version (intraclass correlation coefficient [ICC]: 0.876), inclination (ICC: 0.84), and subluxation (ICC: 0.523). Significant differences were found between surgeon and commercial software measurements in version (P = .03), inclination (P = .023), and subluxation (P < .001). Software measurements tended to be more superiorly inclined (average -2° to 2° greater), more retroverted (average 2°-5° greater), and more posteriorly subluxed (average 7°-10° greater) than surgeon measurements. In comparing imaging software measurements, only Blueprint was found to produce significantly different version measurements than surgeon measurements (P = .02). CONCLUSION Preoperative planning software for shoulder arthroplasty has limited agreement in measures of version, inclination, and subluxation measurements, whereas surgeons have high inter-reliability. Surgeons should be cautious when using commercial software planning systems and when comparing publications that use different planning systems to determine preoperative glenoid deformity measurements.
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Affiliation(s)
- Brandon J Erickson
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, New York, NY, USA.
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Patrick Denard
- Department of Orthopaedic Surgery, Southern Oregon Orthopaedics, Medford, OR, USA
| | - Evan Lederman
- Department of Orthopaedic Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Gabriel Horneff
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Chalfont, PA, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | | | - Anthony A Romeo
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, New York, NY, USA
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Impact of preoperative 3-dimensional planning and intraoperative navigation of shoulder arthroplasty on implant selection and operative time: a single surgeon's experience. J Shoulder Elbow Surg 2020; 29:2564-2570. [PMID: 33190756 DOI: 10.1016/j.jse.2020.03.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preoperative 3D planning and intraoperative navigation for shoulder arthroplasty has recently gained interest because of the potential to enhance the surgeon's understanding of glenoid anatomy and improve the accuracy of glenoid component positioning. The purpose of our study was to assess the impact of preoperative 3D planning on the surgeon's selection of the glenoid component (standard vs. augmented) and compare duration of surgery with and without intraoperative navigation. METHODS We retrospectively analyzed 200 consecutive patients who underwent shoulder arthroplasty. The first group of 100 patients underwent shoulder arthroplasty using standard 2D preoperative planning based on standard radiographs and computed tomographic scans. The second group of 100 patients underwent shoulder arthroplasty using 3D preoperative planning and intraoperative navigation. Type of glenoid component and operative time were recorded in each case. RESULTS For the group of patients with standard preoperative planning, only 15 augmented glenoid components were used, whereas in the group of patients with 3D preoperative planning and navigation, 54 augments were used (P < .001). The operative time was 11 minutes longer for the procedures that used intraoperative navigation, compared with those that did not (P < .001). This difference diminished as the surgeon became more proficient with the navigation technique. CONCLUSION Use of preoperative 3D planning changes the surgeon's understanding of the patient's glenoid anatomy. In our study, using 3D planning increased the likelihood that the surgeon selected an augmented glenoid component compared with 2D planning. Intraoperative navigation slightly lengthened the duration of surgery, but this became insignificant as part of a learning curve within 6 months.
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Intersurgeon and intrasurgeon variability in preoperative planning of anatomic total shoulder arthroplasty: a quantitative comparison of 49 cases planned by 9 surgeons. J Shoulder Elbow Surg 2020; 29:2610-2618. [PMID: 33190760 DOI: 10.1016/j.jse.2020.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/28/2020] [Accepted: 04/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preoperative planning software is widely available for most anatomic total shoulder arthroplasty (ATSA) systems. It can be most useful in determining implant selection and placement with advanced glenoid wear. The purpose of this study was to quantify inter- and intrasurgeon variability in preoperative planning of a series of ATSA cases. METHODS Forty-nine computed tomography scans were planned for ATSA by 9 fellowship-trained shoulder surgeons using the ExactechGPS platform (Exactech Inc., Gainesville, FL, USA). Each case was planned a second time between 4 and 12 weeks later. Variability within and between surgeons was measured for implant type, size, version and inclination correction, and implant face position. Interclass correlation coefficients, Pearson, and Light's kappa coefficients were used for statistical analysis. RESULTS There was considerable variation in the frequency of augment use between surgeons and between rounds for the same surgeon. Thresholds for augment use also varied between surgeons. Interclass correlation coefficients for intersurgeon variability were 0.37 for version, 0.80 for inclination, 0.36 for implant type, and 0.36 for implant size. Pearson coefficients for intrasurgeon variability were 0.17 for version and 0.53 for inclination. Light's kappa coefficient for implant type was 0.64. CONCLUSIONS This study demonstrates substantial inter- and intrasurgeon variability in preoperative planning of ATSA. Although the magnitude of differences in correction was small, surgeons differed significantly in the use of augments to achieve the resultant plan. Surgeons differed from each other on thresholds for augment use and maximum allowable residual retroversion. This suggests that there may a range of acceptable corrections for each shoulder rather than a single optimal plan.
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Sprowls GR, Wilson CD, Stewart W, Hammonds KA, Baruch NH, Ward RA, Robin BN. Intraoperative navigation and preoperative templating software are associated with increased glenoid baseplate screw length and use of augmented baseplates in reverse total shoulder arthroplasty. JSES Int 2020; 5:102-108. [PMID: 33554174 PMCID: PMC7846692 DOI: 10.1016/j.jseint.2020.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Preoperative templating software and intraoperative navigation have the potential to impact baseplate augmentation utilization and increase screw length for baseplate fixation in reverse total shoulder arthroplasty (rTSA). We aimed to assess their impact on the (1) baseplate screw length, (2) number of screws used, and (3) frequency of augmented baseplate use in navigated rTSA. Methods We compared 51 patients who underwent navigated rTSA with 63 controls who underwent conventional rTSA at a single institution. Primary outcomes included the screw length, composite screw length, number of screws used, percentage of patients in whom 2 screws in total were used, and use of augmented baseplates. Results Navigation resulted in the use of significantly longer individual screws (36.7 mm vs. 30 mm, P < .0001), greater composite screw length (84 mm vs. 76 mm, P = .048), and fewer screws (2.5 ± 0.7 vs. 2.8 ± 1, P = .047), as well as an increased frequency of using 2 screws in total (35 of 51 patients [68.6%] vs. 32 of 63 controls [50.8%], P = .047). Preoperative templating resulted in more frequent augmented baseplate utilization (76.5% vs. 19.1%, P < .0001). Conclusion The difference in the screw length, number of screws used, and augmented baseplate use demonstrates the evolving role that computer navigation and preoperative templating play in surgical planning and the intraoperative technique for rTSA.
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Affiliation(s)
- Gregory R. Sprowls
- Department of Orthopaedic Surgery, Baylor Scott & White Health, Temple, TX, USA
- College of Medicine, Texas A&M University, Temple, TX, USA
- Corresponding author: Gregory R. Sprowls, MD, 3108 Mea Ct, Temple, TX 76502, USA.
| | - Charlie D. Wilson
- Department of Orthopaedic Surgery, Baylor Scott & White Health, Temple, TX, USA
- College of Medicine, Texas A&M University, Temple, TX, USA
| | - Wells Stewart
- Department of Orthopaedic Surgery, Baylor Scott & White Health, Temple, TX, USA
- College of Medicine, Texas A&M University, Temple, TX, USA
| | | | | | - Russell A. Ward
- Department of Orthopaedic Surgery, Baylor Scott & White Health, Temple, TX, USA
- College of Medicine, Texas A&M University, Temple, TX, USA
| | - Brett N. Robin
- Department of Orthopaedic Surgery, Baylor Scott & White Health, Temple, TX, USA
- College of Medicine, Texas A&M University, Temple, TX, USA
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Mananagement von Glenoiddefekten in der Schulterprothetik. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Meshram P, Pawaskar A, Kekatpure A. 3D CT scan-based study of glenoid morphology in Indian population: Clinical relevance in design of reverse total shoulder arthroplasty. J Clin Orthop Trauma 2020; 11:S604-S609. [PMID: 32774036 PMCID: PMC7394810 DOI: 10.1016/j.jcot.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/02/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The knowledge of normal anatomy of glenoid in a population has relevance in terms of comparison with other regional and national population. Furthermore, it could enable clinicians to judge whether the available sizes of reverse total shoulder arthroplasty (RTSA) prosthesis could provide optimal fit for the glenoid in Indian patients. METHODS We evaluated consecutive 200 3-dimensional chest CT scans of 50 male and 50 female patients which included both shoulder joints and done for non-orthopaedic diseases at a tertiary care institute. The glenoid height, width, and version were measured using commercially available computer program. RESULTS Mean age of the patents was 38.6 ± 13.8 years (range, 19-59 years). The mean glenoid height was 33.9 ± 3.1 mm and maximum glenoid width was 24.2 ± 2.1 mm. Mean glenoid version in the study population was a retroversion of 3.47 ± 4.7°. The maximum glenoid width of 45% female and 15% male patients was less than 25 mm which is the diameter of smallest available glenoid baseplate among the commonly used RTSA systems. CONCLUSIONS The normal glenoid size of a large cohort of Indian population studied was smaller than that reported in cohorts from western countries. The glenoid width of substantial proportion of patients, especially female patients, was less than the diameter of smallest available glenoid baseplate. Clinical studies are needed in future in Indian patients undergoing RTSA to evaluate the glenoid bone-baseplate mismatch and ascertain the necessity of development of smaller size glenoid baseplate for optimal prosthesis fit in Indian patients.
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Affiliation(s)
- Prashant Meshram
- Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India
| | - Aditya Pawaskar
- Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India
| | - Aashay Kekatpure
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, Wardha, India
- Corresponding author. Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, Wardha, India, Maharashtra, 442004, India.
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Olszewski A, Ramme AJ, Maerz T, Freehill MT, Warner JJP, Bedi A. Vault perforation after eccentric glenoid reaming for deformity correction in anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29:1450-1459. [PMID: 32061513 DOI: 10.1016/j.jse.2019.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/10/2019] [Accepted: 11/23/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The management of glenoid deformity during anatomic total shoulder arthroplasty remains controversial. In this study, we evaluate variable correction of glenoid deformity by eccentric reaming. We hypothesize that partial correction of modified Walch B/C-type glenoid deformities can achieve 75% bone-implant contact area (BICA) with a reduced vault perforation risk compared with complete correction. METHODS Fifty shoulder computed tomographic scans with glenohumeral osteoarthritis were retrospectively evaluated. The Tornier BluePrint v2.1.5 software simulated 3 eccentric reaming scenarios including no, partial, and complete deformity correction. Each scenario was evaluated at 4 BICAs and using 3 implant fixation types. Three-dimensional surface representations were used to evaluate medialization and vault perforation. RESULTS The patients had mean glenoid retroversion and inclination of 18.5° and 8.8°, respectively, and mean posterior humeral head subluxation of 76%. With 75% BICA, the 3 fixation types had glenoid vault perforation in 6%-26% and 26%-54% of cases for partial and complete glenoid deformity correction, respectively. The central and posterior-inferior implant components were most likely to perforate across all scenarios. DISCUSSION Eccentric reaming for glenoid deformity correction increases the risk of vault perforation. Severe glenoid deformity required increased medialization to achieve 75% BICA. Pegged implants have increased chances of perforation compared with a keeled design; the central and posterior-inferior components were most likely to perforate during deformity correction. CONCLUSION Partial deformity correction of modified Walch B/C-type glenoid deformities can achieve 75% BICA while reducing the risk of vault perforation compared with complete correction at the time of anatomic total shoulder arthroplasty.
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Affiliation(s)
- Adam Olszewski
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Austin J Ramme
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Tristan Maerz
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jon J P Warner
- Boston Shoulder Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.
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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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Abstract
PURPOSE OF REVIEW The goal of this review is to introduce surgical decision-making pearls for reverse shoulder arthroplasty and describe optimization of surgical exposure for reverse shoulder arthroplasty. RECENT FINDINGS While the technology of reverse shoulder replacement and the associated prosthetic options have expanded, the principles involved in successfully exposing the humerus and glenoid in arthroplasty remain the same. Reverse shoulder replacement should be considered in arthroplasty situations with rotator cuff disease, deformity, bone loss, and instability as part of the diagnosis. Optimal exposure in reverse shoulder arthroplasty can be obtained by (1) releasing deltoid adhesions, (2) removal of humeral osteophytes, (3) generous humeral head cuts, (4) thorough humeral and glenoid capsular release and (5) optimal glenoid retractor placement. Neuromuscular paralysis can also aid glenoid exposure.
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Holt AM, Throckmorton TW. Reverse Shoulder Arthroplasty for B2 Glenoid Deformity. J Shoulder Elb Arthroplast 2019; 3:2471549219897661. [PMID: 34497958 PMCID: PMC8282141 DOI: 10.1177/2471549219897661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/27/2019] [Accepted: 12/08/2019] [Indexed: 11/23/2022] Open
Abstract
In shoulder osteoarthritis, the B2 glenoid presents challenges in treatment
because of the excessive retroversion and posterior deficiency of the glenoid.
Correction of retroversion and maintenance of a stable joint line with
well-fixed implants are essential for the successful treatment of this deformity
with arthroplasty. Reverse shoulder arthroplasty offers several key advantages
in achieving this goal, including favorable biomechanics, a well-fixed
baseplate, and proven success in other applications. Techniques such as
eccentric reaming, bone grafting, and baseplate augmentation allow surgeons to
tailor treatment to the patient’s altered anatomy. Eccentric reaming is favored
for correction of small defects or mild version anomalies. Current trends favor
bone grafting for larger corrections, though augmented components have shown
early promise with the potential for expanded use. With overall promising
results reported in the literature, reverse shoulder arthroplasty is a useful
tool for treating older patients with B2 glenoid deformities.
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Affiliation(s)
- Andrew M Holt
- Campbell Clinic, Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee, Memphis, Tennesse
| | - Thomas W Throckmorton
- Campbell Clinic, Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee, Memphis, Tennesse
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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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Accuracy of patient-specific instrumentation in shoulder arthroplasty: a systematic review and meta-analysis. JSES OPEN ACCESS 2019; 3:117-129. [PMID: 31709351 PMCID: PMC6834995 DOI: 10.1016/j.jses.2019.07.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background There has been significant recent emphasis on the use of patient-specific instrumentation (PSI) in shoulder arthroplasty. However, clinical data are lacking to support the increased time and expense associated with PSI. Our purposes were to determine whether PSI significantly improves implantation accuracy during total shoulder arthroplasty (TSA) and to analyze available techniques and correlation with clinical outcomes. We hypothesized that PSI may improve glenoid component position radiographically but without correlation with clinical outcomes. Methods The MEDLINE, Scopus, Embase, and Cochrane Library databases were queried. Included articles reported use of any preoperative or intraoperative PSI techniques, models, or guides to assist with TSA prosthesis implantation. The primary outcomes were mean deviation from the preoperative plan in version (in degrees), inclination (in degrees), and entry-point offset on the glenoid (in millimeters). Results Among the included articles, 518 TSA procedures (352 anatomic and 166 reverse) were performed. The mean postoperative errors in both version and inclination angles were 5° or less in 20 articles (90.9%) using PSI. Meta-analysis revealed no statistically significant differences in version error (P > .999, I 2 = 64.6%), inclination error (P = .702, I 2 = 82.2%), or positional offset (P = .777, I 2 = 85.7%) between PSI and standard instrumentation. No data regarding patient-reported outcome measures, range of motion, strength, or glenoid component loosening and longevity were reported. Conclusions Meta-analysis revealed no significant differences in accuracy between PSI and standard instrumentation. Although PSI may possess the potential to improve TSA techniques, further investigations regarding long-term clinical outcomes, impact on operating room time, and cost-effectiveness are warranted before PSI can be routinely recommended over conventional instrumentation.
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Novel 3-dimensionally printed patient-specific guide improves accuracy compared with standard total shoulder arthroplasty guide: a cadaveric study. JSES OPEN ACCESS 2019; 3:83-92. [PMID: 31334434 PMCID: PMC6620202 DOI: 10.1016/j.jses.2019.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Patient-specific instrumentation (PSI) systems for total shoulder arthroplasty (TSA) can improve glenoid component placement, but may involve considerable expense and production delays. The purpose of this study was to evaluate a novel technique for in-house production of 3-dimensionally printed, patient-specific glenoid guides. We hypothesized that our PSI guide would improve the accuracy of glenoid guide pin placement compared with a standard TSA guide. Methods We randomized 20 cadaveric shoulders to receive pin placement via the PSI guide (n = 10, study group) or standard TSA guide (n = 10, control group). PSI guides were designed to fit each glenoid based on 3-dimensional scapular models constructed from computed tomography scans. A presurgical plan was created for the guide pin trajectory in neutral version and inclination based on individual scapular anatomy. After pin placement, 3-dimensional models from repeated computed tomography scans were superimposed to calculate deviation from the presurgical plan for each specimen. Results Inclination deviation was significantly lower in the PSI group than in the standard guide group (1.5° ± 1.6° vs. 6.4° ± 5.0°, P = .009). The glenoid entry site exhibited significantly less deviation in the PSI group (0.8 ± 0.6 mm vs. 2.1 ± 1.2 mm, P = .008). The average production cost and time for the PSI guides were $29.95 and 4 hours 40 minutes per guide, respectively. Conclusions The PSI guide significantly improved the accuracy of glenoid pin placement compared with the standard TSA guide. Our PSI guides can be produced in-house, inexpensively, and with substantially reduced time compared with commercially available guides.
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Matsuki K, Sugaya H, Hoshika S, Ueda Y, Takahashi N, Tokai M, Banks SA. Three-dimensional measurement of glenoid dimensions and orientations. J Orthop Sci 2019; 24:624-630. [PMID: 30579647 DOI: 10.1016/j.jos.2018.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/12/2018] [Accepted: 11/29/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Asians generally have smaller stature than Europeans and Americans, and currently available implants used in reverse shoulder arthroplasty might not fit smaller bony anatomies. However, few articles have reported glenoid geometry in the Asian population. The purpose of this study was to measure the dimensions and orientations of the glenoid from three-dimensional computed tomography reconstructions of elderly Japanese subjects. METHODS This study included 100 shoulders (50 males and 50 females with >50 years of age). The mean age was 67 ± 7 years for both sexes, and the mean height was 167 ± 7 cm for males and 154 ± 6 cm for females. Three-dimensional scapular models were created from computed tomographic images, and the glenoid height, glenoid width, glenoid version, glenoid inclination, vault depth, and vault width were measured. RESULTS The mean glenoid height and width were 38.6 and 29.4 mm for males and 33.1 and 24.4 mm for females, respectively. Both retroversion and superior inclination were approximately 3° in both sexes. The glenoid vault was deeper in the posterior region with the maximum depth of 26.1 and 23.6 mm in males and females. The vault width was narrower in the anterior region with the anterior width of 2.5 mm at 15 mm medial from the glenoid face in females. CONCLUSION Glenoids of Japanese females are small compared to currently available baseplates for reverse shoulder arthroplasty. These results may be helpful to aid design in smaller baseplates that better fit the anatomic geometry of the Asian glenoid.
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Affiliation(s)
- Keisuke Matsuki
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan; Department of Mechanical and Aerospace Engineering, University of Florida, 330 MAE-A P.O. Box 116250, Gainesville, FL 32611-6250, USA.
| | - Hiroyuki Sugaya
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan
| | - Shota Hoshika
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan
| | - Yusuke Ueda
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan
| | - Norimasa Takahashi
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan
| | - Morihito Tokai
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba 2740822, Japan
| | - Scott A Banks
- Department of Mechanical and Aerospace Engineering, University of Florida, 330 MAE-A P.O. Box 116250, Gainesville, FL 32611-6250, USA
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Berhouet J, Favard L, Boas D, Voisin T, Slimane M. Thoughts on a new surgical assistance method for implanting the glenoid component during total shoulder arthroplasty. Part 1: Statistical modeling of the native premorbid glenoid. Orthop Traumatol Surg Res 2019; 105:203-209. [PMID: 30765310 DOI: 10.1016/j.otsr.2018.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/12/2018] [Accepted: 10/25/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to identify points on the scapula that can be used to predict the anatomy of the native premorbid glenoid. MATERIAL AND METHODS Forty-three normal scapulas reconstructed in 3D and positioned in a common coordinate system were used. Twenty points distributed over the blade of the scapula (portion considered normal and used as a reference) and the glenoid (portion considered pathological and needing to be reconstructed) were captured manually. Thirteen distances (X) between two points not on the glenoid and 31 distances (Y) between two points of which at least one was on the glenoid were then calculated automatically. A multiple linear regression model was applied to calculate the Y distances from the X distances. The best four equations were retained based on their coefficient of determination (R2) to explain a point on the glenoid being reconstructed (p<0.05). In the first scenario, the glenoid was modeled assuming it was completely destroyed. In the second scenario, only the inferior portion of the glenoid was worn. RESULTS For a completely destroyed glenoid, the mean error for a chosen distance for a given point on the glenoid was 2.4 mm (4.e-3mm; 12.5mm). For a partially damaged glenoid, the mean error was 1.7mm (4.e-3mm; 6.5mm) for the same distance evaluated for a given point on the glenoid. DISCUSSION/CONCLUSION The proposed statistical model was used to predict the premorbid anatomy of the glenoid with an acceptable level of accuracy. A surgeon could use this information during the preoperative planning stage and during the actual surgery by using a new surgical assistance method.
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Affiliation(s)
- Julien Berhouet
- Équipe reconnaissance de forme et analyse de l'image, université François Rabelais de Tours, école d'ingénieurs polytechnique universitaire de Tours, laboratoire d'informatique EA6300, 64, avenue Portalis, 37200 Tours, France; Western France Orthopedics Society (SOO)/HUGORTHO, 18, rue de Bellinière, 49800 Trélazé, France.
| | - Luc Favard
- Service d'orthopédie traumatologie, faculté de médecine de Tours, université François Rabelais de Tours, CHRU Trousseau, 1C, avenue de la République, 37170 Chambray-les-Tours, France; Western France Orthopedics Society (SOO)/HUGORTHO, 18, rue de Bellinière, 49800 Trélazé, France
| | - David Boas
- Équipe reconnaissance de forme et analyse de l'image, université François Rabelais de Tours, école d'ingénieurs polytechnique universitaire de Tours, laboratoire d'informatique EA6300, 64, avenue Portalis, 37200 Tours, France
| | - Théo Voisin
- Équipe reconnaissance de forme et analyse de l'image, université François Rabelais de Tours, école d'ingénieurs polytechnique universitaire de Tours, laboratoire d'informatique EA6300, 64, avenue Portalis, 37200 Tours, France
| | - Mohamed Slimane
- Équipe reconnaissance de forme et analyse de l'image, université François Rabelais de Tours, école d'ingénieurs polytechnique universitaire de Tours, laboratoire d'informatique EA6300, 64, avenue Portalis, 37200 Tours, France
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50
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Flurin PH, Sirveaux F. Is CT indispensable in shoulder arthroplasty in 2019? Orthop Traumatol Surg Res 2019; 105:199-201. [PMID: 30799175 DOI: 10.1016/j.otsr.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Pierre-Henri Flurin
- Clinique du sport Bordeaux-Mérignac, 4, rue Georges-Negrevergne, 33700 Mérignac, France.
| | - François Sirveaux
- Centre chirurgical Emile-Gallé, CHRU de Nancy, 49, rue Hermite, 54000 Nancy, France
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