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Boekel P, Rikard-Bell M, Grant A, Brandon B, Doma K, O’Callaghan WB, Wilkinson M, Morse L. Image-derived instrumentation vs. conventional instrumentation with 3D planning for glenoid component placement in reverse total shoulder replacements: a randomized controlled trial. JSES Int 2023; 7:614-622. [PMID: 37426909 PMCID: PMC10328789 DOI: 10.1016/j.jseint.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Hypothesis Glenoid baseplate positioning for reverse total shoulder arthroplasty (rTSA) is important for stability and longevity, with techniques such as image-derived instrumentation (IDI) developed for improving implant placement accuracy. We performed a single-blinded randomized controlled trial comparing glenoid baseplate insertion accuracy with 3D preoperative planning and IDI jigs vs. 3D preoperative planning and conventional instrumentation. Methods All patients had a preoperative 3D computed tomography to create an IDI; then underwent rTSA according to their randomized method. Repeat computed tomography scans performed at six weeks postoperatively were compared to the preoperative plan to assess for accuracy of implantation. Patient-reported outcome measures and plain radiographs were collected with 2-year follow-up. Results Forty-seven rTSA patients were included (IDI n = 24, conventional instrumentation n = 23). The IDI group was more likely to have a guidewire placement within 2mm of the preoperative plan in the superior/inferior plane (P = .01); and exhibited a smaller degree of error when the native glenoid retroversion was >10° (P = .047). There was no difference in patient-reported outcome measures or other radiographic parameters between the two groups. Conclusion IDI is an accurate method for glenoid guidewire and component placement in rTSA, particularly in the superior/inferior plane and in glenoids with native retroversion >10°, when compared to conventional instrumentation.
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Affiliation(s)
- Pamela Boekel
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
| | - Matthew Rikard-Bell
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
| | - Benjamin Brandon
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
| | - Kenji Doma
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Sports and Exercise Science, James Cook University, Townsville, Queensland, Australia
| | - William B. O’Callaghan
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Cairns Hospital, Cairns, Queensland, Australia
| | - Matthew Wilkinson
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Royal Hobart Hospital and Calvary Care, University of Tasmania, Hobart, Tasmania, Australia
| | - Levi Morse
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
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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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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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Abstract
The 3D printing technology is a relatively new procedure with a high potential, especially in the field of shoulder surgery. The 3D printing procedures are increasingly being developed and also gaining new users. Principally, 3D printing procedures can be applied preoperatively in planning the surgical procedure, patient clarification and in teaching; however, the technology is increasing being used intraoperatively. In addition to intraoperative visualization of the models, 3D printing permits the use of individual and specific instruments and implants. This allows the precise transfer of the preoperative planning to the surgical procedure. Inaccuracies are mainly caused by soft tissues. The 3D printing can be beneficial in the fields of arthroplasty, shoulder instability as well as orthopedic trauma. The literature shows promising results in relation to duration of surgery, blood loss and clinical results of the procedure. On the other hand, it is still unclear which indications warrant the use of 3D printing. Other aspects that raise questions are the time of planning, the production time and the additional cost that the use of 3D printing entails. Nonetheless, 3D printing represents a meaningful enhancement of the portfolio of surgeons, which becomes highly beneficial and useful in complex situations. Furthermore, this procedure enables a certain amount of flexibility when reacting to certain circumstances.
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Elsheikh AA, Galhoum MS, Mokhtar MA, Roebuck MM, Wood A, Yin Q, Frostick SP. Patient-specific Instrumentation Versus Standard Surgical Instruments in Primary Reverse Total Shoulder Arthroplasty: A Retrospective Comparative Clinical Study. J Shoulder Elb Arthroplast 2022; 6:24715492221075449. [PMID: 35669616 PMCID: PMC9163719 DOI: 10.1177/24715492221075449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/09/2021] [Accepted: 01/05/2022] [Indexed: 11/15/2022] Open
Abstract
Aims Patient-specific instrumentation (PSI) in primary shoulder arthroplasty has been studied; results supported the positive impact of the PSI on the glenoid positioning. Nevertheless, no clinical outcomes have been reported. We compare the clinical outcomes of primary reverse total shoulder arthroplasty using PSI versus the standard methods. Methods Fifty-three patients with full records and a minimum of 24-months follow-up were reviewed, 35 patients received primary standard RSTA, and 18 patients received primary PSI RSTA. All patients were operated on in a single center. The median follow-up was 46 months (53 months in the standard group vs 39 months in the PSI group). Results There was an overall significant post-operative improvement in the whole cohort (P< 0.05). The standard group had more deformed glenoids (B2, B3, C&D) and significantly low preoperative constant score and forward flexion (P=0.02 & 0.034). Compared to the PSI group (all were A1, A2, B1 &one type D), there were no statistically significant differences in any clinical outcome postoperatively. PSI neither prolonged the waiting time to surgery (P=0.693) nor the intraoperative time (P=0.962). Radiologically, PSI secured a higher percentage of optimum baseplate position and screw anchorage; however, no statistical correlation was found. Conclusion In this series, both groups achieved comparable good outcomes. PSI did not achieve significantly better clinical outcomes than Standard after primary RSTA. Yet comparison has some limitations. PSI did not negatively impact the waiting time or the surgical time.
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Affiliation(s)
| | - Mohamed S Galhoum
- Menoufia University, Shebin El-Kom, Egypt
- Royal Liverpool University Hospital Trust, Liverpool, UK
| | - Mohamed A Mokhtar
- Royal Manchester Children’s Hospital, Manchester, UK
- Suez Canal University, Ismailia, Egypt
| | - Margaret M Roebuck
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Amanda Wood
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Qi Yin
- Royal Liverpool University Hospital Trust, Liverpool, UK
| | - Simon P Frostick
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Levins JG, Kukreja M, Paxton ES, Green A. Computer-Assisted Preoperative Planning and Patient-Specific Instrumentation for Glenoid Implants in Shoulder Arthroplasty. JBJS Rev 2021; 9:01874474-202109000-00006. [PMID: 35417437 DOI: 10.2106/jbjs.rvw.20.00236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Glenoid component positioning affects implant survival after total shoulder arthroplasty, and accurate glenoid-component positioning is an important technical aspect. » The use of virtual planning and patient-specific instrumentation has been shown to produce reliable implant placement in the laboratory and in some clinical studies. » Currently available preoperative planning software programs employ different techniques to generate 3-dimensional models and produce anatomic measurements potentially affecting clinical decisions. » There are no published data, to our knowledge, on the effect of preoperative computer planning and patient-specific instrumentation on long-term clinical outcomes.
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Affiliation(s)
- James G Levins
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, Brown University Warren Alpert School of Medicine, Providence, Rhode Island
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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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Reduction of scapulohumeral subluxation with posterior augmented glenoid implants in anatomic total shoulder arthroplasty: Short-term 3D comparison between pre- and post-operative CT. Orthop Traumatol Surg Res 2020; 106:681-686. [PMID: 32284278 DOI: 10.1016/j.otsr.2020.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 02/23/2020] [Accepted: 03/10/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Failure rates in anatomic total shoulder arthroplasty (aTSA) are higher in case of asymmetric glenoid bone loss secondary to posterior wear, and in persistent static posterior subluxation of the humeral head (PSH). HYPOTHESIS This study aimed to test the hypothesis that the combined use of posterior augmented glenoid (PAG) implants with three-dimensional (3D) surgical planning and patient-specific instrumentation (PSI) guides helps reduce short-term PSH after aTSA in patients with type B2-B3 glenoids. PATIENTS AND METHODS We included nine consecutive patients with primary glenohumeral osteoarthritis and type B2 or B3 glenoids, who underwent aTSA with cemented keeled PAG implants (posterior augments of 15, 25, or 35 degrees). All patients underwent preoperative shoulder computed tomography (CT) scans, with 3D surgical planning coupled to PSI at the time of surgery. Postoperative shoulder CT scans were performed at an average of 14 weeks (range, 10-21 weeks). Scapulohumeral subluxation and glenoid version and inclination were measured in 3D, on both pre- and post-operative CT scans, using the same reliable quantitative method. RESULTS There was a significant decrease in scapulohumeral subluxation from 49±12% preoperatively to 22±17% postoperatively (p=0.0039), with a large effect size (Cohen's d=1.89). Preoperative glenoid version was corrected from -17.3±9.4 degrees to -5.2±7.5 degrees postoperatively. The absolute difference between the postoperative and surgically planned version and inclination was 5.4±3.6 degrees and 3.3±2.0 degrees, respectively. DISCUSSION The combined use of PAG implants with 3D preoperative planning and PSI results in a significant decrease in short-term PSH and glenoid version in patients with asymmetric posterior glenoid wear. We suggest that such implants should not be limited to posterior augmentation, because glenoid deficiency can also be observed in other glenoid sectors. LEVEL OF EVIDENCE IV, Basic science study.
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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: 33] [Impact Index Per Article: 6.6] [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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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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12
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Villatte G, Muller AS, Pereira B, Mulliez A, Reilly P, Emery R. Use of Patient-Specific Instrumentation (PSI) for glenoid component positioning in shoulder arthroplasty. A systematic review and meta-analysis. PLoS One 2018; 13:e0201759. [PMID: 30133482 PMCID: PMC6104947 DOI: 10.1371/journal.pone.0201759] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/20/2018] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Total Shoulder Arthroplasty (TSA) anatomical, reverse or both is an increasingly popular procedure but the glenoid component is still a weak element, accounting for 30-50% of mechanical complications and contributing to the revision burden. Component mal-positioning is one of the main aetiological factors in glenoid failure and thus Patient-Specific Instrumentation (PSI) has been introduced in an effort to optimise implant placement. The aim of this systematic literature review and meta-analysis is to compare the success of PSI and Standard Instrumentation (STDI) methods in reproducing pre-operative surgical planning of glenoid component positioning. MATERIAL AND METHODS A search (restricted to English language) was conducted in November 2017 on MEDLINE, the Cochrane Library, EMBASE and ClinicalTrials.gov. Using the search terms "Patient-Specific Instrumentation (PSI)", "custom guide", "shoulder", "glenoid" and "arthroplasty", 42 studies were identified. The main exclusion criteria were: no CT-scan analysis results; studies done on plastic bone; and use of a reusable or generic guide. Eligible studies evaluated final deviations from the planning for version, inclination, entry point and rotation. Reviewers worked independently to extract data and assess the risk of bias on the same studies. RESULTS The final analysis included 12 studies, comprising 227 participants (seven studies on 103 humans and five studies on 124 cadaveric specimens). Heterogeneity was moderate or high for all parameters. Deviations from the pre-operative planning for version (p<0.01), inclination (p<0.01) and entry point (p = 0.02) were significantly lower with the PSI than with the STDI, but not for rotation (p = 0.49). Accuracy (deviation from planning) with PSI was about 1.88° to 4.96°, depending on the parameter. The number of component outliers (>10° of deviation or 4mm) were significantly higher with STDI than with PSI (68.6% vs 15.3% (p = 0.01)). CONCLUSION This review supports the idea that PSI enhances glenoid component positioning, especially a decrease in the number of outliers. However, the findings are not definitive and further validation is required. It should be noted that no randomised clinical studies are available to confirm long-term outcomes.
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Affiliation(s)
- Guillaume Villatte
- Service d'Orthopédie-Traumatologie, Hôpital Gabriel Montpied, Clermont Ferrand, France
- Université Clermont Auvergne, SIGMA Clermont CNRS, UMR 6296, Clermont-Ferrand, France
| | - Anne-Sophie Muller
- Service d'Orthopédie-Traumatologie, Hôpital Gabriel Montpied, Clermont Ferrand, France
| | - Bruno Pereira
- DRCI, CHU de Clermont Ferrand, Clermont Ferrand, France
| | | | - Peter Reilly
- Bioengineering Department, Imperial College, London, United Kingdom
| | - Roger Emery
- Bioengineering Department, Imperial College, London, United Kingdom
- Division of Surgery, Imperial College, London, United Kingdom
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