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Wright MA, O'Leary M, Johnston P, Murthi AM. Advances in Anatomic Total Shoulder Arthroplasty Glenoid Implant Design. J Am Acad Orthop Surg 2024:00124635-990000000-01065. [PMID: 39151177 DOI: 10.5435/jaaos-d-23-00257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/12/2024] [Indexed: 08/18/2024] Open
Abstract
Since the advent of Neer's total shoulder arthroplasty in 1974, glenoid implant design has evolved to optimize patient function and increase implant longevity. Glenoid loosening continues to be a major cause of total shoulder arthroplasty failure due to both patient and implant factors. The more recent development of posterior augmented glenoids, peg fixation with ingrowth potential, inlay implants, zoned conformity implants, and convertible glenoids have all shown promising results in improving glenoid fixation and survival in different clinical circumstances. The increased utilization of 3D CT scans, preoperative planning, and patient-specific instrumentation has paralleled innovation in glenoid implants with the aim of improving the accuracy of glenoid implant placement to further optimize patient function and implant longevity. Specific indications for the variety of glenoid implants available today are still being studied. The shoulder arthroplasty surgeon should consider patient and implant factors and patient goals when determining the appropriate implant for each individual.
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Affiliation(s)
- Melissa A Wright
- From the Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, ML (Wright and Murthi), Department of Orthopedic Surgery, Georgetown University School of Medicine, Washington, DC (Wright, Johnston, and Murthi), Excelsior Orthopaedics, Amherst, NY (O'Leary), and the Centers for Advanced Orthopedics, Southern Maryland Orthopaedics and Sports Medicine, Leonardtown, ML (Johnston)
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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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Kopriva JM, McKissack HM, Griswold BG, Hussain ZB, Cooke HL, Gottschalk MB, Wagner ER. Mixed-reality improves execution of templated glenoid component positioning in shoulder arthroplasty: a CT imaging analysis. J Shoulder Elbow Surg 2024; 33:1789-1798. [PMID: 38320671 DOI: 10.1016/j.jse.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/06/2023] [Accepted: 12/17/2023] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Glenoid placement is critical for successful outcomes in total shoulder arthroplasty (TSA). Preoperative templating with three-dimensional imaging has improved implant positioning, but deviations from the planned inclination and version still occur. Mixed-Reality (MR) is a novel technology that allows surgeons intra-operative access to three-dimensional imaging and templates, capable of overlaying the surgical field to help guide component positioning. The purpose of this study was to compare the execution of preoperative templates using MR vs.standard instruments (SIs). METHODS Retrospective review of 97 total shoulder arthroplasties (18 anatomic, 79 reverse) from a single high-volume shoulder surgeon between January 2021 and February 2023, including only primary diagnoses of osteoarthritis, rotator cuff arthropathy, or a massive irreparable rotator cuff tear. To be included, patients needed a templated preoperative plan and then a postoperative computed tomography scan. Allocation to MR vs. SI was based on availability of the MR headset, industry technical personnel, and the templated preoperative plan loaded into the software, but preoperative or intraoperative patient factors did not contribute to the allocation decision. Postoperative inclination and version were measured by two independent, blinded physicians and compared to the preoperative template. From these measurements, we calculated the mean difference, standard deviation (SD), and variance to compare MR and SI. RESULTS Comparing 25 MR to 72 SI cases, MR significantly improved both inclination (P < .001) and version (P < .001). Specifically, MR improved the mean difference from preoperative templates (by 1.9° inclination, 2.4° version), narrowed the SD (by 1.7° inclination, 1.8° version), and decreased the variance (11.7-3.0 inclination, 14.9-4.3 version). A scatterplot of the data demonstrates a concentration of MR cases within 5° of plan relative to SI cases typically within 10° of plan. There was no difference in operative time. CONCLUSION MR improved the accuracy and precision of glenoid positioning. Although it is unlikely that 2° makes a detectable clinical difference, our results demonstrate the potential ability for technology like MR to narrow the bell curve and decrease the outliers in glenoid placement. This will be particularly relevant as MR and other similar technologies continue to evolve into more effective methods in guiding surgical execution.
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Affiliation(s)
- John M Kopriva
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Haley M McKissack
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - B Gage Griswold
- Department of Orthopaedic Surgery, Denver Shoulder at Western Orthopaedics, Denver, CO, USA
| | - Zaamin B Hussain
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Hayden L Cooke
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael B Gottschalk
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric R Wagner
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
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Dean RE, Holte AJ, Ray GS, Bell JE. Treatment of displaced intra-articular glenoid malunion deformity with reverse total shoulder arthroplasty guided by augmented reality-assisted computer navigation. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:625-631. [PMID: 39157259 PMCID: PMC11329051 DOI: 10.1016/j.xrrt.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Affiliation(s)
- Ryan E. Dean
- Dartmouth-Hitchcock Medical Center, Department of Orthopaedic Surgery, Lebanon, NH, USA
| | - Andrew J. Holte
- Dartmouth-Hitchcock Medical Center, Department of Orthopaedic Surgery, Lebanon, NH, USA
| | - Gabrielle S. Ray
- Dartmouth-Hitchcock Medical Center, Department of Orthopaedic Surgery, Lebanon, NH, USA
| | - John-Erik Bell
- Dartmouth-Hitchcock Medical Center, Department of Orthopaedic Surgery, Lebanon, NH, USA
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Werthel JD, Dufrenot M, Schoch BS, Walch A, Morvan Y, Urvoy M, Walch G, Gauci MO. Are glenoid retroversion, humeral subluxation, and Walch classification associated with a muscle imbalance? J Shoulder Elbow Surg 2024; 33:1493-1502. [PMID: 38242526 DOI: 10.1016/j.jse.2023.11.027] [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: 08/31/2023] [Revised: 11/07/2023] [Accepted: 11/27/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND The etiology of humeral posterior subluxation remains unknown, and it has been hypothesized that horizontal muscle imbalance could cause this condition. The objective of this study was to compare the ratio of anterior-to-posterior rotator cuff and deltoid muscle volume as a function of humeral subluxation and glenoid morphology when analyzed as a continuous variable in arthritic shoulders. METHODS In total, 333 computed tomography scans of shoulders (273 arthritic shoulders and 60 healthy controls) were included in this study and were segmented automatically. For each muscle, the volume of muscle fibers without intramuscular fat was measured. The ratio between the volume of the subscapularis and the volume of the infraspinatus plus teres minor (AP ratio) and the ratio between the anterior and posterior deltoids (APdeltoid) were calculated. Statistical analyses were performed to determine whether a correlation could be found between these ratios and glenoid version, humeral subluxation, and/or glenoid type per the Walch classification. RESULTS Within the arthritic cohort, no statistically significant difference in the AP ratio was found between type A glenoids (1.09 ± 0.22) and type B glenoids (1.03 ± 0.16, P = .09), type D glenoids (1.12 ± 0.27, P = .77), or type C glenoids (1.10 ± 0.19, P > .999). No correlation was found between the AP ratio and glenoid version (ρ = -0.0360, P = .55) or humeral subluxation (ρ = 0.076, P = .21). The APdeltoid ratio of type A glenoids (0.48 ± 0.15) was significantly greater than that of type B glenoids (0.35 ± 0.16, P < .01) and type C glenoids (0.21 ± 0.10, P < .01) but was not significantly different from that of type D glenoids (0.64 ± 0.34, P > .999). When evaluating both healthy control and arthritic shoulders, moderate correlations were found between the APdeltoid ratio and both glenoid version (ρ = 0.55, P < .01) and humeral subluxation (ρ = -0.61, P < .01). CONCLUSION This in vitro study supports the use of software for fully automated 3-dimensional reconstruction of the 4 rotator cuff muscles and the deltoid. Compared with previous 2-dimensional computed tomography scan studies, our study did not find any correlation between the anteroposterior muscle volume ratio and glenoid parameters in arthritic shoulders. However, once deformity occurred, the observed APdeltoid ratio was lower with type B and C glenoids. These findings suggest that rotator cuff muscle imbalance may not be the precipitating etiology for the posterior humeral subluxation and secondary posterior glenoid erosion characteristic of Walch type B glenoids.
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Affiliation(s)
| | | | | | | | | | | | - Gilles Walch
- Ramsay Générale de Santé, Centre Orthopédique Santy, Jean Mermoz Private Hospital, Lyon, France
| | - Marc-Olivier Gauci
- Institut Universitaire Locomoteur et du Sport - Centre Hospitalier Universitaire (IULS-CHU) de Nice, Nice, France
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Hess S, Husarek J, Müller M, Eberlein SC, Klenke FM, Hecker A. Applications and accuracy of 3D-printed surgical guides in traumatology and orthopaedic surgery: A systematic review and meta-analysis. J Exp Orthop 2024; 11:e12096. [PMID: 39135870 PMCID: PMC11317891 DOI: 10.1002/jeo2.12096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 08/15/2024] Open
Abstract
Background Patient-Specific Surgical Guides (PSSGs) are advocated for reducing radiation exposure, operation time and enhancing precision in surgery. However, existing accuracy assessments are limited to specific surgeries, leaving uncertainties about variations in accuracy across different anatomical sites, three-dimensional (3D) printing technologies and manufacturers (traditional vs. printed at the point of care). This study aimed to evaluate PSSGs accuracy in traumatology and orthopaedic surgery, considering anatomical regions, printing methods and manufacturers. Methods A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies were eligible if they (1) assessed the accuracy of PSSGs by comparing preoperative planning and postoperative results in at least two different planes (2) used either computer tomography or magnetic resonance imaging (3) covered the field of orthopaedic surgery or traumatology and (4) were available in English or German language. The 'Quality Assessment Tool for Quantitative Studies' was used for methodological quality assessment. Descriptive statistics, including mean, standard deviation, and ranges, are presented. A random effects meta-analysis was performed to determine the pooled mean absolute deviation between preoperative plan and postoperative result for each anatomic region (shoulder, hip, spine, and knee). Results Of 4212 initially eligible studies, 33 were included in the final analysis (8 for shoulder, 5 for hip, 5 for spine, 14 for knee and 1 for trauma). Pooled mean deviation (95% confidence interval) for total knee arthroplasty (TKA), total shoulder arthroplasty (TSA), total hip arthroplasty (THA) and spine surgery (pedicle screw placement during spondylodesis) were 1.82° (1.48, 2.15), 2.52° (1.9, 3.13), 3.49° (3.04, 3.93) and 2.67° (1.64, 3.69), respectively. Accuracy varied between TKA and THA and between TKA and TSA. Conclusion Accuracy of PSSGs depends on the type of surgery but averages around 2-3° deviation from the plan. The use of PSSGs might be considered for selected complex cases. Level of Evidence Level 3 (meta-analysis including Level 3 studies).
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Affiliation(s)
- Silvan Hess
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Julius Husarek
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
- Faculty of MedicineUniversity of BernBernSwitzerland
- Faculty of MedicineMedical University of SofiaSofiaBulgaria
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Sophie C. Eberlein
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Frank M. Klenke
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Andreas Hecker
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
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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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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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Kahsai EA, O'Connor B, Khoo KJ, Ogunleye TD, Telfer S, Hagen MS. Improving Patient Understanding of Femoroacetabular Impingement Syndrome With Three-Dimensional Models. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202405000-00006. [PMID: 38722846 PMCID: PMC11081616 DOI: 10.5435/jaaosglobal-d-24-00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Three-dimensional (3D) printed models may help patients understand complex anatomic pathologies such as femoroacetabular impingement syndrome (FAIS). We aimed to assess patient understanding and satisfaction when using 3D printed models compared with standard imaging modalities for discussion of FAIS diagnosis and surgical plan. METHODS A consecutive series of 76 new patients with FAIS (37 patients in the 3D model cohort and 39 in the control cohort) from a single surgeon's clinic were educated using imaging and representative 3D printed models of FAI or imaging without models (control). Patients received a voluntary post-visit questionnaire that evaluated their understanding of the diagnosis, surgical plan, and visit satisfaction. RESULTS Patients in the 3D model cohort reported a significantly higher mean understanding of FAIS (90.0 ± 11.5 versus 79.8 ± 14.9 out of 100; P = 0.001) and surgery (89.5 ± 11.6 versus 81.0 ± 14.5; P = 0.01) compared with the control cohort. Both groups reported high levels of satisfaction with the visit. CONCLUSION In this study, the use of 3D printed models in clinic visits with patients with FAIS improved patients' perceived understanding of diagnosis and surgical treatment.
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Affiliation(s)
- Ermyas A. Kahsai
- From the Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA
| | - Bailey O'Connor
- From the Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA
| | - Kevin J. Khoo
- From the Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA
| | - Temi D. Ogunleye
- From the Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA
| | - Scott Telfer
- From the Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA
| | - Mia S. Hagen
- From the Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA
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Andriollo L, Pietramala S, Polizzi A, Niccoli G, Zattoni G, Morea V. Computer-Assisted Navigation in Reverse Shoulder Arthroplasty: Surgical Experience and Clinical Outcomes. J Clin Med 2024; 13:2512. [PMID: 38731041 PMCID: PMC11084768 DOI: 10.3390/jcm13092512] [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: 02/27/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Background: The primary cause of medium- to long-term complications in reverse shoulder arthroplasty (RSA) is the failure of the glenoid component. The purpose of this study was to evaluate both the achievement of planning through computer-assisted navigation and the clinical outcomes at a minimum follow-up (FU) of 12 months. Methods: From December 2019 to December 2022, 57 Equinoxe RSAs with computer-assisted navigation were performed. The average age was 72.8 ± 6.6 years. Using the Orthoblue software, the version and inclination of the glenoid were evaluated from a preoperative CT scan, and planning was performed. Intraoperative navigation data were evaluated, and the clinical outcomes were assessed at a minimum follow-up of 12 months. Results: The average follow-up was 30.7 ± 13.5 months. The planning was reproduced in all implants. No errors in the computer-assisted navigation system were detected. No intraoperative or postoperative complications were recorded. At the final FU, the average active anterior elevation was 143° ± 36°, external rotation was 34° ± 5°, QuickDASH score was 19 ± 16 points, and constant score was 77 ± 18. Conclusions: Computer-assisted navigation is a reliable system for positioning prosthetic implants on challenging glenoids. A longer follow-up period is necessary to confirm the reduction in postoperative complications and the increase in survival compared to traditional RSA.
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Affiliation(s)
- Luca Andriollo
- Orthopedics and Traumatology, Fondazione Poliambulanza Hospital, 25124 Brescia, Italy
- Department of Orthopedics, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Silvia Pietramala
- Orthopedics and Traumatology, Fondazione Poliambulanza Hospital, 25124 Brescia, Italy
- Department of Orthopedics, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Alberto Polizzi
- Orthopedics and Traumatology, Fondazione Poliambulanza Hospital, 25124 Brescia, Italy
| | - Giuseppe Niccoli
- Orthopedics and Traumatology, Fondazione Poliambulanza Hospital, 25124 Brescia, Italy
| | - Guido Zattoni
- Orthopedics and Traumatology, Fondazione Poliambulanza Hospital, 25124 Brescia, Italy
| | - Vincenzo Morea
- Orthopedics and Traumatology, Fondazione Poliambulanza Hospital, 25124 Brescia, Italy
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Winter R, Citarel A, Chabrand P, Chenel A, Bronsard N, Poujade T, Gauci MO. An Evaluation of the Reliability of Manual Landmark Identification on 3D Segmented Wrists. J Bone Joint Surg Am 2024; 106:315-322. [PMID: 37995208 DOI: 10.2106/jbjs.23.00173] [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: 11/25/2023]
Abstract
BACKGROUND Three-dimensional (3D) preoperative planning is increasingly used in orthopaedic surgery. Two-dimensional (2D) characterization of distal radial deformities remains inaccurate, and 3D planning requires a reliable reference frame at the wrist. We aim to evaluate the reliability of the determination of anatomical points placed manually on 3D models of the radius to determine which of those points allow reliable morphometric measurements. METHODS Twenty-three radial scans were reconstructed in 3D. Five operators specialized in the upper limb manually positioned 8 anatomical points on each model. One of the operators repeated the operation 6 times. The anatomical points were based on previously published 3D models used for radial inclination and dorsopalmar tilt measurements. The repeatability and reproducibility of the measurements derived using this manual landmarking were calculated using different measurement methods based on the identified points. An error of ≤2° was considered clinically acceptable. RESULTS This study of intraobserver and interobserver variability of the anatomic points allowed us to determine the least variable and most accurately defined points. The middle of the ulnar border of the radius, the radial styloid, and the midpoint of the ulnar incisura of the radius were the least variable. The palmar and dorsal ends of the ridge delineating the scaphoid and lunate facets were the most variable. Only 1 of the radial inclination measurement methods was clinically acceptable; the others had a repeatability and reproducibility limit of >2°, making those measurements clinically unacceptable. CONCLUSIONS The use of isolated points seems insufficient for the development of a wrist reference frame, especially for the purpose of measuring dorsopalmar tilt. If one concurs that an error of 2° is unacceptable for all distal radial measurements, then clinicians should avoid using 3D landmarked points, due to their unreliability, except for radial inclination measured using the radial styloid and the midpoint of the ulnar edge of the radius. A characterization of the wrist using 3D shapes that fit the articular surface of the radius should be considered. LEVEL OF EVIDENCE Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Rémy Winter
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
- Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Nice, France
- Newclip Technics, Haute-Goulaine, France
| | | | - Patrick Chabrand
- Institut des Sciences Mouvement, Aix-Marseille University, French National Centre for Scientific Research, Marseille, France
| | | | - Nicolas Bronsard
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
- Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Nice, France
| | | | - Marc-Olivier Gauci
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
- Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Nice, France
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12
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Dalmas Y, Thélu CE, Laumonerie P, Mathieu E, Robert S, Mansat P, Bonnevialle N. The arthroscopic double-button Latarjet does not modify the static posterior translation of the humeral head. Orthop Traumatol Surg Res 2024; 110:103662. [PMID: 37460084 DOI: 10.1016/j.otsr.2023.103662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/16/2023] [Accepted: 05/10/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION The Latarjet procedure treats anterior instability of the shoulder and is based on a triple anterior lock, where the conjoint tendon straps the lower third of the subscapularis muscle. Excessive posterior translation of the humeral head is a known risk factor for shoulder osteoarthritis. No in vivo study has investigated the effect of the bone block on the posterior static translation of the humeral epiphysis. The purpose of this study was to evaluate the effect of the bone block on the static posterior translation of the humeral head. The hypothesis was that this procedure increased this translation. MATERIALS AND METHODS This retrospective study included patients treated arthroscopically for anterior shoulder instability by a double-button Latarjet. An independent examiner analyzed the CT scans preoperatively, at 15 days, and at least 6 months postoperatively according to a standardized protocol. The analysis focused on the position of the bone block in the axial and coronal planes relative to the glenoid. The posterior translation was automatically calculated using the Blueprint© planning software. RESULTS Thirty-five patients were included with a mean age of 25 years (16-43), according to a 4M/1F sex ratio. The graft was perfectly flush to the subchondral bone in 63% (n=22) of cases and subequatorial in 91% (n=32). Preoperative posterior humeral translation was 52%. The mean immediate postoperative posterior humeral translation was 56%, and 57% at more than 6 months. The change in mean posterior humeral translation between preoperative/6 months was +0.94% [-20%; +12%] (p=0.29) and immediate postoperative/6 months +0.34% [-18%; +15%] (p=0.84). Gender, hypermobility and the axial position of the bone block did not influence the change in posterior humeral translation. The equatorial position of the bone block appeared to increase posterior humeral translation by +10%±5.2% [-0.427; 20.823] (p=0.07). CONCLUSION This work refutes our initial hypothesis. The change in static posterior humeral translation after arthroscopic Latarjet bone block remains stable at more than 6 months of follow-up. This procedure does not alter the anatomical position of the humeral head in relation to the glenoid. On the other hand, a more cranial positioning of the bone block could have an influence. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yoann Dalmas
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France.
| | - Charles-Edouard Thélu
- Clinique du sport et de chirurgie orthopédique, 199, rue de la Rianderie, 59700 Marcq-en-Barœul, France
| | - Pierre Laumonerie
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France
| | - Emilie Mathieu
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France
| | - Suzanne Robert
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France
| | - Pierre Mansat
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France; Laboratoire de biomécanique, IMFT-UMR-CNRS 5502, hôpital Pierre Paul Riquet, Toulouse, France
| | - Nicolas Bonnevialle
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France; Laboratoire de biomécanique, IMFT-UMR-CNRS 5502, hôpital Pierre Paul Riquet, Toulouse, France
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Lee KS, Jung SH, Kim DH, Chung SW, Yoon JP. Artificial intelligence- and computer-assisted navigation for shoulder surgery. J Orthop Surg (Hong Kong) 2024; 32:10225536241243166. [PMID: 38546214 DOI: 10.1177/10225536241243166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/28/2024] Open
Abstract
Background: Over the last few decades, shoulder surgery has undergone rapid advancements, with ongoing exploration and the development of innovative technological approaches. In the coming years, technologies such as robot-assisted surgeries, virtual reality, artificial intelligence, patient-specific instrumentation, and different innovative perioperative and preoperative planning tools will continue to fuel a revolution in the medical field, thereby pushing it toward new frontiers and unprecedented advancements. In relation to this, shoulder surgery will experience significant breakthroughs. Main body: Recent advancements and technological innovations in the field were comprehensively analyzed. We aimed to provide a detailed overview of the current landscape, emphasizing the roles of technologies. Computer-assisted surgery utilizing robotic- or image-guided technologies is widely adopted in various orthopedic specialties. The most advanced components of computer-assisted surgery are navigation and robotic systems, with functions and applications that are continuously expanding. Surgical navigation requires a visual system that presents real-time positional data on surgical instruments or implants in relation to the target bone, displayed on a computer monitor. There are three primary categories of surgical planning that utilize navigation systems. The initial category involves volumetric images, such as ultrasound echogram, computed tomography, and magnetic resonance images. The second type is based on intraoperative fluoroscopic images, and the third type incorporates kinetic information about joints or morphometric data about the target bones acquired intraoperatively. Conclusion: The rapid integration of artificial intelligence and deep learning into the medical domain has a significant and transformative influence. Numerous studies utilizing deep learning-based diagnostics in orthopedics have remarkable achievements and performance.
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Affiliation(s)
- Kang-San Lee
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seung Ho Jung
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong-Hyun Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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14
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Harding GT, Bois AJ, Cavanagh JT, Bouliane MJ. The Use of an External Cutting Guide for Patient-Specific Bone Grafting in Reverse Total Shoulder Arthroplasty: A Novel Technique. J Shoulder Elb Arthroplast 2023; 7:24715492231219566. [PMID: 38106518 PMCID: PMC10722917 DOI: 10.1177/24715492231219566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/01/2023] [Accepted: 11/10/2023] [Indexed: 12/19/2023] Open
Abstract
Glenoid bone loss remains a substantial challenge in reverse shoulder arthroplasty and failure to address such bone loss may lead to implant malpositioning, instability and/or premature baseplate loosening. Currently, management of glenoid bone loss can be achieved by metal augmentation or bone grafting (ie, autograft or allograft). At the present time, options for creating and shaping glenoid bone grafts include free-hand techniques and simple reusable cutting guides that create the graft at a standard shape/angle. To our knowledge, there is no external guide available that enables surgeons to accurately prepare the bone graft to the desired dimensions/shape (ie, trapezoid or biplanar) to correct the glenoid deformity. In this article, we present a novel surgical technique that utilizes an external guide for creating a patient-specific bone graft to address glenoid deformity in the setting of reverse total shoulder arthroplasty.
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Affiliation(s)
- Graeme T Harding
- Department of Orthopaedic Surgery, University of Alberta, Edmonton, AB, Canada
| | - Aaron J Bois
- Section of Orthopaedic Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Joseph T Cavanagh
- Department of Orthopaedic Surgery, University of Alberta, Edmonton, AB, Canada
| | - Martin J Bouliane
- Department of Orthopaedic Surgery, University of Alberta, Edmonton, AB, Canada
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15
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Youderian AR, Greene AT, Polakovic SV, Davis NZ, Parsons M, Papandrea RF, Jones RB, Byram IR, Gobbato BB, Wright TW, Flurin PH, Zuckerman JD. Two-year clinical outcomes and complication rates in anatomic and reverse shoulder arthroplasty implanted with Exactech GPS intraoperative navigation. J Shoulder Elbow Surg 2023; 32:2519-2532. [PMID: 37348780 DOI: 10.1016/j.jse.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION We compared the 2-year clinical outcomes of both anatomic and reverse total shoulder arthroplasty (ATSA and RTSA) using intraoperative navigation compared to traditional positioning techniques. We also examined the effect of glenoid implant retroversion on clinical outcomes. HYPOTHESIS In both ATSA and RTSA, computer navigation would be associated with equal or better outcomes with fewer complications. Final glenoid version and degree of correction would not show outcome differences. MATERIAL AND METHODS A total of 216 ATSAs and 533 RTSAs were performed using preoperative planning and intraoperative navigation with a minimum of 2-year follow-up. Matched cohorts (2:1) for age, gender, and follow-up for cases without intraoperative navigation were compared using all standard shoulder arthroplasty clinical outcome metrics. Two subanalyses were performed on navigated cases comparing glenoids positioned greater or less than 10° of retroversion and glenoids corrected more or less than 15°. RESULTS For ASTA, no statistical differences were found between the navigated and non-navigated cohorts for postoperative complications, glenoid implant loosening, or revision rate. No significant differences were seen in any of the ATSA outcome metrics besides higher internal and external rotation in the navigated cohort. For RTSA, the navigated cohort showed an ARR of 1.7% (95% CI 0%, 3.4%) for postoperative complications and 0.7% (95% CI 0.1%, 1.2%) for dislocations. No difference was found in the revision rate, glenoid implant loosening, acromial stress fracture rates, or scapular notching. Navigated RTSA patients demonstrated significant improvements over non-navigated patients in internal rotation, external rotation, maximum lifting weight, the Simple Shoulder Test (SST), Constant, and Shoulder Arthroplasty Smart (SAS) scores. For the navigated subcohorts, ATSA cases with a higher degree of final retroversion showed significant improvement in pain, Constant, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), SST, University of California-Los Angeles shoulder score (UCLA), and Shoulder Pain and Disability Index (SPADI) scores. No significant differences were found in the RTSA subcohort. Higher degrees of version correction showed improvement in external rotation, SST, and Constant scores for ATSA and forward elevation, internal rotation, pain, SST, Constant, ASES, UCLA, SPADI, and SAS scores for RTSA. CONCLUSION The use of intraoperative navigation shoulder arthroplasty is safe, produces at least equally good outcomes at 2 years as standard instrumentation does without any increased risk of complications. The effect of final implant position above or below 10° of glenoid retroversion and correction more or less than 15° does not negatively impact outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Bruno B Gobbato
- Department of Orthopedic Surgery, Idomed University, Jaragua do Sul, Brazil
| | - Thomas W Wright
- Department of Orthopaedics, University of Florida, Gainesville, FL, USA
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16
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Baumgarten KM. Patients who have intraoperative deviations in their preoperative plan have inferior clinical and radiographic outcomes after anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:e451-e463. [PMID: 36868298 DOI: 10.1016/j.jse.2023.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/08/2023] [Accepted: 01/22/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Three-dimensional computed tomography preoperative planning has become adopted among shoulder arthroplasty surgeons. Prior studies have not examined outcomes in patients in whom the surgeon implanted prostheses that deviated from the preoperative plan compared with patients in whom the surgeon followed the preoperative plan. The hypothesis of this study was that clinical and radiographic outcomes would be equivalent between patients undergoing anatomic total shoulder arthroplasty that had a deviation in the components predicted in the preoperative plan and patients who did not have a change in the components predicted in the preoperative plan. METHODS A retrospective review of patients who had preoperative planning for anatomic total shoulder arthroplasty from March 2017 through October 2022 was performed. Patients were stratified into 2 groups: patients in whom the surgeon used components that deviated from those anticipated by the preoperative plan (changed group), and patients in whom the surgeon used all of the components anticipated by the preoperative plan (planned group). Patient-determined outcomes including the Western Ontario Osteoarthritis Index, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test (SST), and Shoulder Activity Level were recorded preoperatively, at 1 year, and at 2 years. Preoperative and 1-year postoperative range of motion was recorded. Radiographic parameters to assess restoration of proximal humeral anatomy included humeral head height, humeral neck angle, humeral centering on the glenoid, and postoperative restoration of the anatomic center of rotation. RESULTS A total of 159 patients had intraoperative changes to their preoperative plan, and 136 patients underwent arthroplasty without changes to their preoperative plan. The planned group had higher scores than the group that had a deviation in the preoperative plan for every patient-determined outcome metric at every postoperative time point with statistically significant improvements found in the SST and Single Assessment Numeric Evaluation at 1-year and the SST and American Shoulder and Elbow Surgeons score at 2-year follow-up. No differences were found in range of motion metrics between the groups. Patients who did not have a deviation in their preoperative plan had more optimal restoration of their postoperative radiographic center of rotation than patients who did have a deviation in their preoperative plan. CONCLUSIONS Patients who have intraoperative changes to their preoperative plan have (1) inferior postoperative patient-determined outcome scores at 1 and 2 years after surgery and (2) a larger deviation in the postoperative radiographic restoration of the humeral center of rotation than patients who did not have intraoperative changes from the initial plan.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
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17
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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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La Banca V, Giglio L, Palagi Viganó AV, Michaelis LF, Bonadiman JA, Vieira Lima GH, Ikemoto RY. Use of 3D-Printed Patient-Specific Guide for Latarjet Procedure in Patients With Anterior Shoulder Instability: Technical Note. Arthrosc Tech 2023; 12:e915-e922. [PMID: 37424644 PMCID: PMC10323828 DOI: 10.1016/j.eats.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/12/2023] [Indexed: 07/11/2023] Open
Abstract
Anterior shoulder instability can lead to anterior glenoid bone loss associated with humeral posterior deformity (bipolar bone loss). Latarjet procedure is a commonly used surgical option in such cases. However, the procedure is associated with complications in up 15% of the cases often associated with inadequate positioning of coracoid bone graft and screws. Considering that acknowledgment of patient anatomy and use of surgical planning intraoperatively can reduce such complications, we describe the use of 3D printing tools to obtain a 3D Patient-Specific Surgical Guide to aid in the Latarjet procedure. Such tools present advantages and limitations compared to other tools available, which are also discussed in this article.
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Affiliation(s)
- Vitor La Banca
- Orthopedic Surgery Department, Centro Universitário Faculdade de Medicina do ABC (FMABC), São Paulo, Brazil
- Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, Brazil
| | - Luiz Giglio
- Orthopedic Surgery Department, Centro Universitário Faculdade de Medicina do ABC (FMABC), São Paulo, Brazil
- Hospital Ipiranga, São Paulo, Brazil
| | - Ana Victória Palagi Viganó
- Orthopedic Surgery Department, Centro Universitário Faculdade de Medicina do ABC (FMABC), São Paulo, Brazil
- Hospital Ipiranga, São Paulo, Brazil
| | - Luiz Fernando Michaelis
- Orthopedic Surgery Department, Centro Universitário Faculdade de Medicina do ABC (FMABC), São Paulo, Brazil
| | | | - Guilherme Henrique Vieira Lima
- Orthopedic Surgery Department, Centro Universitário Faculdade de Medicina do ABC (FMABC), São Paulo, Brazil
- Hospital Ipiranga, São Paulo, Brazil
| | - Roberto Yukio Ikemoto
- Orthopedic Surgery Department, Centro Universitário Faculdade de Medicina do ABC (FMABC), São Paulo, Brazil
- Hospital Ipiranga, São Paulo, Brazil
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Edwards GA, Coghlan J, Hughes J, Wright W, Dallalana R, Bell ASN. Encouraging outcomes of stemless ceramic head anatomic shoulder arthroplasty in severe primary osteoarthritis (Walch type B glenoids). Shoulder Elbow 2023; 15:28-36. [PMID: 36895605 PMCID: PMC9990115 DOI: 10.1177/17585732211048120] [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: 03/26/2021] [Revised: 08/19/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
Background: We report the radiological and functional outcomes at five years in patients with severe osteoarthritis of the glenohumeral joint and a Walch type B glenoid who have undergone stemless anatomic total shoulder replacement. Methods: A retrospective analysis of case notes, computed tomography scans and plain radiographs of patients undergoing anatomic total shoulder replacement for primary glenohumeral osteoarthritis were performed. Patients were grouped by the severity of their osteoarthritis using the modified Walch classification, glenoid retroversion and posterior humeral head subluxation. An evaluation was made using modern planning software. Functional outcomes were assessed using the American shoulder and elbow surgeons score, shoulder pain and disability index and visual analogue scale. Annual Lazarus scores were reviewed as regard to glenoid loosening. Results: Thirty patients were reviewed at 5 years. Analysis of all patient-reported outcome measures demonstrated significant improvement at 5-year review, American shoulder and elbow surgeons (p = <0.0001), shoulder pain and disability index (p = 0.0001), visual analogue scale (p = 0.0001). Radiological associations between Walch scores and Lazarus scores were not statistically significant (p = 0.1251) at 5 years. There were no associations between features of glenohumeral osteoarthritis and patient-reported outcome measures. Discussion: The severity of osteoarthritis did not show any association with glenoid component survivorship or with patient-reported outcome measures at 5 years review. Level of evidence: IV.
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Affiliation(s)
| | - Jennifer Coghlan
- Melbourne Shoulder and Elbow Centre, Melbourne, Australia
- Department of Surgery (School of Clinical Sciences at Monash
Health), Monash University, Melbourne, Australia
| | - Jeff Hughes
- North Shore Private
Hospital, Chatswood, Sydney, Australia
| | | | | | - A/Prof Simon Nicolas Bell
- Melbourne Shoulder and Elbow Centre, Melbourne, Australia
- Department of Surgery (School of Clinical Sciences at Monash
Health), Monash University, Melbourne, Australia
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Early clinical outcomes following navigation-assisted baseplate fixation in reverse total shoulder arthroplasty: a matched cohort study. J Shoulder Elbow Surg 2023; 32:302-309. [PMID: 35998780 DOI: 10.1016/j.jse.2022.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/24/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Accurate placement of the glenoid baseplate is an important technical goal of reverse total shoulder arthroplasty (RSA). The use of computer navigated instrumentation has been shown to improve the accuracy and precision of intraoperative execution of preoperative planning. The purpose of this study was to compare early clinical outcomes of patients undergoing navigated RSA vs. a non-navigated matched cohort. METHODS A retrospective review of a prospectively collected shoulder arthroplasty database was used to identify 113 patients from a single institution who underwent navigated primary RSA with a minimum 2-year follow-up. A matched cohort of 113 non-navigated RSAs was created based on sex, age, follow-up, and preoperative diagnosis. Preoperative and postoperative range of motion, functional outcome scores, and complications were reported. RESULTS A total of 226 shoulders with a mean age of 71 years were evaluated after navigated (113) or non-navigated (113) RSAs. The mean follow-up was 32.8 months (range: 21-54 months). At the final postoperative follow-up, the navigated group had better active forward elevation (135° vs. 129°, P = .023), active external rotation (39° vs. 32°, P = .003), and Constant scores (71.1 vs. 65.5, P = .003). However, when comparing improvements from the preoperative state, there was no statistically significant difference in range of motion or functional outcome scores between the groups. Complications occurred in 1.8% (2) of patients undergoing navigated RSA compared with 5.3% (6) in the non-navigated group (P = .28). Scapular notching (3.1% vs. 8.0%, P = .21) and revision surgery (0.9% vs. 3.5%, P = .37) were more common in non-navigated shoulders. CONCLUSION At early follow-up, navigated and non-navigated RSAs yielded similar rates of improvement in range of motion and functional outcome scores. Notching and reoperation was more common in non-navigated shoulders, but did not reach statistical significance. Longer follow-up and larger cohort size are needed to determine if intraoperative navigation lengthens the durability of RSA results and reduces the incidence of postoperative complications.
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Karpyshyn JN, Bois AJ, Logan H, Harding GT, Bouliane MJ. 3D Printed Patient-Specific Cutting Guides for Bone Grafting in Reverse Shoulder Arthroplasty: A Novel Technique. J Shoulder Elb Arthroplast 2023; 7:24715492231162285. [PMID: 36937107 PMCID: PMC10017943 DOI: 10.1177/24715492231162285] [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: 10/10/2022] [Revised: 02/01/2023] [Accepted: 02/19/2023] [Indexed: 03/15/2023] Open
Abstract
Glenoid bone loss remains a challenge in shoulder arthroplasty. Addressing substantial bone loss is essential to ensure proper function and stability of the shoulder prosthesis and to prevent baseplate loosening and subsequent revision surgery. Current options for creating and shaping glenoid bone grafts include free-hand techniques and simple reusable cutting guides that cut the graft at a standard angle. There is currently no patient-specific device available that enables surgeons to accurately prepare the bone graft and correct glenoid deformity. We present a novel surgical technique using three-dimensional (3D)-printed cutting guides to create a patient-specific bone graft to address glenoid deformity in the setting of reverse shoulder arthroplasty.
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Affiliation(s)
- Jillian N Karpyshyn
- Department of Orthopaedic Surgery, University of Alberta, Canada
- Jillian Karpyshyn, Department of Orthopaedic Surgery, University of Alberta, 10620 21 Ave NW, Edmonton, Canada, T6J-5G9.
| | - Aaron J Bois
- Section of Orthopaedic Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Heather Logan
- Institute for Reconstructive Sciences in Medicine, University of Alberta, Canada
| | - Graeme T Harding
- Department of Orthopaedic Surgery, University of Alberta, Canada
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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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Rojas JT, Jost B, Hertel R, Zipeto C, Van Rooij F, Zumstein MA. Patient-specific instrumentation reduces deviations between planned and postosteotomy humeral retrotorsion and height in shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:1929-1937. [PMID: 35346846 DOI: 10.1016/j.jse.2022.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/23/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patient-specific instrumentation (PSI) may potentially improve humeral osteotomy in shoulder arthroplasty. The purpose of this study was to compare the deviation between planned and postosteotomy humeral inclination, retrotorsion, and height in shoulder arthroplasty, using PSI vs. standard cutting guides (SCG). METHODS Twenty fresh-frozen cadaveric specimens were allocated to undergo humeral osteotomy using either PSI or SCG, such that the 2 groups have similar age, gender, and side. Preosteotomy computed tomography (CT) scan was performed and used for the 3-dimensional (3D) planning. The osteotomy procedure was performed using a PSI designed for each specimen or an SCG depending on the group. A postosteotomy CT scan was performed. The preosteotomy and postosteotomy 3D CT scan reconstructions were superimposed to calculate the deviation between planned and postosteotomy inclination, retrotorsion, and height. Outliers were defined as cases with 1 or more of the following deviations: >5° inclination, >10° retrotorsion, and >3 mm height. The deviation and outliers in inclination, retrotorsion, and height were compared between the 2 groups. RESULTS The deviations between planned and postosteotomy parameters were similar among the PSI and SCG groups for inclination (P = .260), whereas they were significantly greater in the SCG group for retrotorsion (P < .001) and height (P = .003). There were 8 outliers in the SCG group, compared with only 1 outlier in the PSI group (P = .005). Most outliers in the SCG group were due to deviation >10° in retrotorsion. CONCLUSION After 3D planning, PSI had less deviation between planned and postosteotomy humeral retrotorsion and height, relative to SCG.
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Affiliation(s)
- J Tomás Rojas
- Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland; Department of Orthopaedics and Trauma Surgery, Hospital San José-Clínica Santa María, Santiago, Chile
| | - Bernhard Jost
- Department of Orthopaedics and Traumatology, Kantonsspital, St.Gallen, Switzerland
| | - Ralph Hertel
- Department of Orthopaedics and Trauma Surgery, Lindenhofspital, Bern, Switzerland
| | - Claudio Zipeto
- Shoulder R & D Department, Medacta International SA, Castel San Pietro, Switzerland
| | | | - Matthias A Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland; Shoulder, Elbow Unit, Sportsclinicnumber1, Bern, Switzerland; Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland; Campus Stiftung Lindenhof Bern, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland.
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Gauci MO, Chaoui J, Berhouet J, Jacquot A, Walch G, Boileau P. Can surgeons optimize range of motion and reduce scapulohumeral impingements in reverse shoulder arthroplasty? A computational study. Shoulder Elbow 2022; 14:385-394. [PMID: 35846405 PMCID: PMC9284303 DOI: 10.1177/1758573221994141] [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: 09/23/2020] [Revised: 12/12/2020] [Accepted: 01/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Early glenohumeral impingement leads to poor range of motion and notching in reverse shoulder arthroplasty. The aim was to find from planning software which implant configuration provides the best motions in reverse shoulder arthroplasty. PATIENTS AND METHODS Reverse shoulder arthroplasty planning (Glenosys) was made in 31 patients (12 men, 19 women, 76 ± 6 yo) and impingements were analyzed. Inlay (155°-inclined) and Onlay (145°-inclined) humeral designs were tested. Four configurations were tested for each shoulder: "INLAY": non-lateralized glenoid-inlay humerus, "BIO-INLAY": lateralized glenoid (BIO-RSA)-inlay humerus, "ONLAY": non-lateralized glenoid-onlay humerus, and "BIO-ONLAY": lateralized (BIO-RSA) glenoid-onlay humerus. RESULTS BIO-ONLAY and BIO-INLAY groups presented a significantly better result in all tested motion (p < 0.001 for all tests). BIO-ONLAY allowed a significantly better external rotation, extension and adduction than BIO-INLAY with decreased impingements with the pilar. BIO-INLAY presented a significantly better abduction. In abduction, an abutment of the greater tuberosity against the acromion was associated with a lower range of motion (p < 0.0001) and did not depend on the lateralization. CONCLUSION Glenoid lateralization delays the glenohumeral impingement in reverse shoulder arthroplasty and gives the best rotations, adduction and extension when associated with neutral inclination and humeral 145° inclination. Greater tuberosity abutment has to be avoided in abduction and the Inlay design provides the best abduction.
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Affiliation(s)
- Marc-Olivier Gauci
- Institut Universitaire Locomoteur et du Sport
(IULS), Unité de Recherche Clinique Côte d’Azur (UR2CA), CHU de Nice, Université Côte d’Azur
(UCA), Nice, France,Marc-Olivier Gauci, IULS, CHU de Nice, UR2CA,
Université Côte d'Azur, 30 Voie Romaine, CHU de Nice, Consultation de Chirurgie
orthopédique, Nice 06000, France.
| | | | | | | | - Gilles Walch
- Ramsay Générale de Santé, Hôpital Privé Jean
Mermoz, Lyon, France
| | - Pascal Boileau
- Institut Universitaire Locomoteur et du Sport
(IULS), Unité de Recherche Clinique Côte d’Azur (UR2CA), CHU de Nice, Université Côte d’Azur
(UCA), Nice, France
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Kwak JM, Jeon IH, Kim H, Choi S, Lee H, Koh KH. Patient-specific instrumentation improves the reproducibility of preoperative planning for the positioning of baseplate components with reverse total shoulder arthroplasty: a comparative clinical study in 39 patients. J Shoulder Elbow Surg 2022; 31:1488-1498. [PMID: 35041969 DOI: 10.1016/j.jse.2021.12.012] [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: 07/11/2021] [Revised: 12/07/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The application of patient-specific instrumentation (PSI) for reverse total shoulder replacement has been rapidly increasing, which could reduce errors in implant positioning. Although PSI theoretically holds promise, evidence of the accuracy and reliability of PSI in shoulder replacement surgery is limited. METHODS Thirty-nine shoulders that underwent reverse total shoulder arthroplasty were included in this study and categorized into two groups: the conventional (n = 20) and PSI (n = 19) groups. Screw (length and angle) and baseplate (version, inclination, translation, and rotation) positioning were calculated based on postoperative computed tomography images using a three-dimensional measurement tool. The difference between the values of the preoperative target and postoperative measurement was calculated to evaluate the reproducibility of preoperative planning. Screw involvement in the suprascapular and spinoglenoid notches was assessed. Thus, the correlation between the position of the baseplate and the screws was assessed. RESULTS The mean differences between the planned length and angle (anteroposterior and superoinferior angles) and postoperative measurement in the PSI group were significantly smaller than those in the conventional group. Similarly, the mean difference in baseplate rotation between the planned and postoperative measurements in the PSI group was significantly lower than that in the conventional group (4.5° vs 10.6°; P < .001). The spinoglenoid notch was involved in 10 cases in the conventional group and 2 cases in the PSI group, and this difference was significant (P = .014). Overall, the mean difference between the preoperative and postoperative version, inferior inclination, and rotation values for the baseplate position was significantly correlated with the values for screw position (length and angle). CONCLUSIONS PSI improves the reproducibility of preoperative planning for baseplate and screw positioning and reduces the risk of neurovascular injury in reverse total shoulder arthroplasty.
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Affiliation(s)
- Jae-Man Kwak
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, College of Medicine, Eulji University, Uijeongbu, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyojune Kim
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | | | | | - Kyoung Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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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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Clinical applications and prospects of 3D printing guide templates in orthopaedics. J Orthop Translat 2022; 34:22-41. [PMID: 35615638 PMCID: PMC9117878 DOI: 10.1016/j.jot.2022.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 12/05/2022] Open
Abstract
Background With increasing requirements for medical effects, and huge differences among individuals, traditional surgical instruments are difficult to meet the patients' growing medical demands. 3D printing is increasingly mature, which connects to medical services critically as well. The patient specific surgical guide plate provides the condition for precision medicine in orthopaedics. Methods In this paper, a systematic review of the orthopedic guide template is presented, where the history of 3D-printing-guided technology, the process of guides, and basic clinical applications of orthopedic guide templates are described. Finally, the limitations of the template and possible future directions are discussed. Results The technology of 3D printing surgical templates is increasingly mature, standard, and intelligent. With the help of guide templates, the surgeon can easily determine the direction and depth of the screw path, and choose the angle and range of osteotomy, increasing the precision, safety, and reliability of the procedure in various types of surgeries. It simplifies the difficult surgical steps and accelerates the growth of young and mid-career physicians. But some problems such as cost, materials, and equipment limit its development. Conclusions In different fields of orthopedics, the use of guide templates can significantly improve surgical accuracy, shorten the surgical time, and reduce intraoperative bleeding and radiation. With the development of 3D printing, the guide template will be standardized and simplified from design to production and use. 3D printing guides will be further sublimated in the application of orthopedics and better serve the patients. The translational potential of this paper Precision, intelligence, and individuation are the future development direction of orthopedics. It is more and more popular as the price of printers falls and materials are developed. In addition, the technology of meta-universe, digital twin, and artificial intelligence have made revolutionary effects on template guides. We aim to summarize recent developments and applications of 3D printing guide templates for engineers and surgeons to develop more accurate and efficient templates.
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Advances in the Application of Three-dimensional Printing for the Clinical Treatment of Osteoarticular Defects. Curr Med Sci 2022; 42:467-473. [PMID: 35451806 DOI: 10.1007/s11596-022-2565-9] [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: 04/15/2021] [Accepted: 10/26/2021] [Indexed: 11/03/2022]
Abstract
As a promising manufacturing technology, three-dimensional (3D) printing technology is widely used in the medical field. In the treatment of osteoarticular defects, the emergence of 3D printing technology provides a new option for the reconstruction of functional articular surfaces. At present, 3D printing technology has been used in clinical applications such as models, patient-specific instruments (PSIs), and customized implants to treat joint defects caused by trauma, sports injury, and tumors. This review summarizes the application status of 3D printing technology in the treatment of osteoarticular defects and discusses its advantages, disadvantages, and possible future research strategies.
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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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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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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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The Accuracy of Three-Dimensional CT Scan Software in Predicting Prosthetic Utilization in Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2022; 30:e223-e232. [PMID: 34613949 DOI: 10.5435/jaaos-d-21-00641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/03/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Recent innovations in shoulder arthroplasty include three-dimensional (3D) CT software imaging that can be used to predict which prosthetic implants will be used intraoperatively. Correct prediction of the implants may optimize supply chain logistics for the surgeon, hospital, ambulatory surgery center, and the implant company. The purpose of this study was to examine a single surgeon's experience with this software to determine its predictive accuracy in determining which implants would be used intraoperatively. METHODS A retrospective review of patients undergoing total shoulder arthroplasty (TSA) performed by a single surgeon was performed. Inclusion criteria were patients undergoing anatomic (aTSA) or reverse (rTSA) TSA examined preoperatively with the 3D CT planning software. A chart review was performed to compare the accuracy of the preoperative plan in predicting the actual prostheses implanted at surgery. RESULTS Two hundred seventy-eight shoulders from 260 patients were included. One hundred fifty-one shoulders underwent aTSA, and 127 shoulders underwent rTSA. The surgeon was able to predict the type of arthroplasty (anatomic versus reverse) implanted in 269 of 278 (97%) shoulders. Using the 3D CT software, the surgeon was able to predict all the implants implanted in 68 shoulders (24%). For aTSA, 3D CT imaging successfully predicted all implants implanted in 43 shoulders (28%), glenoid implants implanted in 120 of 148 shoulders (81%), and humeral implants implanted in 54 shoulders (36%). For rTSA, 3D CT imaging successfully predicted all implants implanted in 26 shoulders (20%), glenoid implants implanted in 106 shoulders (83%), and humeral implants implanted in 39 shoulders (31%). CONCLUSIONS The 3D CT software combined with surgeon's judgment provided a high accuracy (97%) in determining the type of arthroplasty, a moderately high accuracy in determining the glenoid implants (81% to 83%), a low accuracy in determining humeral implants (31% to 36%), and a low accuracy in determining all prostheses used for each surgery (20% to 28%). LEVEL OF EVIDENCE LOE IV-Diagnostic Case Series.
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Hao KA, Sutton CD, Wright TW, Schoch BS, Wright JO, Struk AM, Haupt ET, Leonor T, King JJ. Influence of glenoid wear pattern on glenoid component placement accuracy in shoulder arthroplasty. JSES Int 2022; 6:200-208. [PMID: 35252914 PMCID: PMC8888204 DOI: 10.1016/j.jseint.2021.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Accurate glenoid component placement in shoulder arthroplasty is often difficult even with the use of preoperative planning. Computer navigation and patient-specific guides increase component placement accuracy, but which patients benefit most is unknown. Our purpose was to assess surgeons' accuracy in placing a glenoid component in vivo using 3-dimensional preoperative planning and standard instruments among various glenoid wear patterns. Methods We conducted a retrospective review of 170 primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) performed at a single institution. Commercially available preoperative planning software was used in all arthroplasties with multiplanar 2-dimensional computed tomography and a 3-dimensional implant overlay. After registration of intraoperative bony landmarks to the navigation system, participating surgeons with knowledge of the preoperative plan were blinded to the computer screen and attempted to implement their preoperative plan by simulating placement of a central-axis glenoid guide pin. Two hundred thirty-three screenshots of surgeon's simulated guide pin placement were included. Glenoid displacement, error in version and inclination, and overall malposition from the preoperatively planned target point were stratified by posterior wear status (with [Walch B2 or B3] or without [A1, A2, or B1]) and Walch classification (A1, A2, B1, B2, or B3). The glenoid component was considered malpositioned when version or inclination errors exceeded 10° or the starting point displacement exceeded 4 mm. Results For rTSA, errors in version were greater for glenoids with posterior wear compared with those without (8.1° ± 5.6° vs. 4.7° ± 4.0°; P < .001). On post hoc analysis, B2 glenoids had greater version error than A1, A2, and B1 glenoids. A greater proportion of glenoids undergoing rTSA that possessed posterior wear had an error in version >10° compared with those without (31% vs. 8%; P < .001). Consequently, glenoids undergoing rTSA with posterior wear were malpositioned at a greater rate compared with those without (73% vs. 53%). In contrast, glenoids undergoing aTSA with and without posterior wear did not differ based on displacement error, version error, inclination error, or malposition occurrence. Conclusions Posterior glenoid bone loss more commonly resulted in glenoid version errors exceeding 10 degrees and component malposition in rTSA, but not for aTSA. Malposition was still relatively high in patients without significant posterior wear for both aTSA (36%) and rTSA (53%). Surgeons should consider alternate techniques beyond preoperative planning and standard instrumentation when performing shoulder arthroplasty in patients with posteriorly worn glenoids.
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Blakeney WG, Urvoy M, Chaoui J, Raiss P, Athwal GS, Walch G. Development and assessment of 3-dimensional computed tomography measures of proximal humeral bone density: a comparison to established 2-dimensional measures and intraoperative findings in patients undergoing shoulder arthroplasty. JSES Int 2021; 5:1008-1013. [PMID: 34766077 PMCID: PMC8569005 DOI: 10.1016/j.jseint.2021.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The purpose of this study was to develop novel three-dimensional (3D) measures of bone density from computed tomography (CT) scans and to compare them with validated two-dimensional (2D) radiographic assessments of bone density. Patient demographic data were also analyzed to see if there were any predictors of bone density (age, sex, etiology). Methods The study group consisted of 290 consecutive patients undergoing primary shoulder arthroplasty surgery (total anatomic, reverse, and hemiarthroplasty). All underwent preoperative CT imaging. Three 3D CT measurements (metaphysis cancellous, metaphysis cortical, and proximal diaphysis) were developed and automated into software. The developed 3D measurements were compared with validated 2D measures (Tingart and Gianotti Index). Patient demographic data were correlated with these measurements. The difference between the size of the final sounder and of the final stem was calculated as Delta. Results There was moderately strong correlation between Tingart and Gianotti measures (0.674, P < .001), as well as between 3D metaphysis cancellous measurements and Tingart (0.645, P < .001). Decreased bone density was highly correlated with female sex. Tingart (area under the curve [AUC]: 0.87, 95% confidence interval [CI]: 0.82-0.91) and 3D metaphysis cancellous (AUC: 0.78, 95% CI: 0.72-0.84) had the highest correlation. These were significantly more than other measures of bone density (P < .01). Decreased bone density measured with Tingart also had moderate correlation with advanced age (AUC: 0.67, 95% CI: 0.6-0.73), but less so for etiology (AUC: 0.62, 95% CI: 0.55-0.69). The 3D metaphysis cancellous measure had lower correlation with age (AUC: 0.59, 95% CI: 0.52-0.66) and etiology (AUC: 0.59, 95% CI: 0.52-0.65). The highest correlation with Delta (the difference between the final sounder and the stem size) was with the 3D metaphysis cancellous measure (AUC: 0.67, 95% CI: 0.59-0.73), followed by Tingart (AUC: 0.647, 95% CI: 0.57-0.671). A multiple regression model to predict Delta demonstrated the stronger prediction using 3D metaphysis cancellous (analysis of variance F-ratio of 42.6, P < .001) than Tingart (35.9, P < .001). Conclusion This study demonstrates that automated measures of bone density can be obtained from 3D CT scans. Of the three novel 3D measurements of bone density, the humeral metaphysis cancellous measurement was most correlated to the known 2D measures and most correlated to the intraoperative assessment of bone density (delta).
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Affiliation(s)
| | | | | | - Patric Raiss
- Klinik für Orthopädie und Unfallchirurgie, Universität Heidelberg, Heidelberg, Germany
| | - George S Athwal
- St Joseph's Health Centre, University of Western Ontario, London, ON, Canada
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Aminov O, Regan W, Giles JW, Simon MJK, Hodgson AJ. Targeting repeatability of a less obtrusive surgical navigation procedure for total shoulder arthroplasty. Int J Comput Assist Radiol Surg 2021; 17:283-293. [PMID: 34611779 DOI: 10.1007/s11548-021-02503-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/17/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE Surgical navigation systems have demonstrated improvements in alignment accuracy in a number of arthroplasty procedures, but they have not yet been widely adopted for use in total shoulder arthroplasty (TSA). We believe this is due in part to the obtrusiveness of conventional optical tracking systems, as well as the need for additional intraoperative steps such as calibration and registration. The purpose of this study is to evaluate the feasibility of adapting a less-intrusive dental navigation system for use in TSA. METHODS We developed a proof-of-concept system based on validated laser-engraved surgical tools recently introduced for use in dental surgery that are calibrated once when manufactured and not recalibrated at time of use. The design also features a notably smaller bone-mounted tracker that can be tracked from a wide range of viewing angles. To assess our system's performance, we modified the dental surgical software to support guidance of a TSA procedure. We then conducted a user study in which three participants with varying surgical experience used the system to drill 30 holes in a glenoid model. Using a coordinate measuring machine, we determined the resulting drilled trajectory and compared this to the pre-planned trajectory. Since we used a model glenoid rather than anatomical specimens, we report on targeting precision rather than overall procedure precision or accuracy. RESULTS We found targeting precision < 1 mm (standard deviation) for locating the entry hole and < ~ 1° (SD) for both version and inclination. The latter value was markedly lower than the end-to-end angular precision achieved by previously reported TSA navigation systems (approximately 3°-5° SD). CONCLUSION We conclude that variability during the targeting phase represents a small fraction of the overall variability exhibited by existing systems, so a less obtrusive navigation system for TSA based on laser-engraved tooling is likely feasible, which could improve the uptake rates of surgical navigation for TSA, thereby potentially leading to improved overall surgical outcomes.
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Affiliation(s)
- Oded Aminov
- Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada.
| | - William Regan
- Department of Orthopedics, UBC, Vancouver, BC, Canada
| | - Joshua W Giles
- Mechanical Engineering, University of Victoria, Victoria, BC, Canada
| | - Maciej J K Simon
- Department of Orthopedics, UBC, Vancouver, BC, Canada.,Department of Orthopaedic and Trauma Surgery, University Medical Center Schleswig-Holstein - Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Antony J Hodgson
- Mechanical Engineering, University of British Columbia, Vancouver, BC, Canada
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Three-dimensional measures of posterior bone loss and retroversion in Walch B2 glenoids predict the need for an augmented anatomic glenoid component. J Shoulder Elbow Surg 2021; 30:2386-2392. [PMID: 33753274 DOI: 10.1016/j.jse.2021.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/14/2021] [Accepted: 02/21/2021] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose of this study is to evaluate whether the amount of measured posterior bone loss on 2- and 3-dimensional (2D and 3D) imaging of Walch B2 glenoids can reliably predict the plan for an augmented anatomic glenoid component. METHODS Patients with Walch B2 glenoids and preoperative computed tomography (CT) scans were retrospectively identified. 2D axial CT scans were reviewed and posterior bone loss was measured by 3 independent reviewers. Images were then formatted into BluePrint (Wright Medical) preoperative planning software. The same 3 reviewers again measured posterior bone loss on 3D imaging. Additionally, all cases were planned with BluePrint software. An augment was used when the following criteria were unable to be satisfied with standard implants: <10° retroversion, <10° superior inclination, ≥90% backside contact, <2 mm medial reaming, and ≤1 peg perforation. RESULTS Forty-two patients were included in the final analysis with a mean age of 63.1 ± 6.3 years. As measured by BluePrint, the mean retroversion was 23° ± 7° (range = 9°-40°), the mean superior inclination was 5° ± 6° (range = -9° to 22°), and the mean posterior subluxation was 80% ± 17% (range = 41%-95%). The mean 2D bone loss measurements (3.5 ± 1.6 mm) were significantly lower than the mean 3D bone loss (4.0 ± 1.8 mm) measurements (P = .03). There was substantial agreement between reviewers on both 2D and 3D measurements with an interclass correlation of 0.815 (95% confidence interval [CI] 0.714-0.889, P < .001) and an interclass correlation of 0.802 (95% CI 0.683-0.884, P < .001), respectively. Augments were used in 73.8%, 63.4%, and 63.4% of cases by reviewers 1, 2, and 3, respectively, with moderate agreement with a Fleiss kappa of 0.592 (95% CI 0.416-0.769, P < .001). Augment size was moderately, positively correlated with the amount of bone loss on 3D imaging but not with 2D imaging. After multivariate logistic regression, both 3D bone loss and retroversion were found to be predictive for a plan to use an augment. CONCLUSION Planning for a posterior augment in Walch B2 glenoids is better predicted with 3D imaging than with 2D imaging, as 2D imaging may underestimate posterior bone loss. Additionally, use of a larger augment size is moderately correlated with posterior bone loss on 3D imaging but not 2D imaging. Standard 2D imaging may be limited in cases of posterior bone loss, and 3D imaging may be beneficial for preoperative planning in Walch B2 glenoids.
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Gauci MO, Athwal GS, Sanchez-Sotelo J, Chaoui J, Urvoy M, Boileau P, Walch G. Identification of threshold pathoanatomic metrics in primary glenohumeral osteoarthritis. J Shoulder Elbow Surg 2021; 30:2270-2282. [PMID: 33813011 DOI: 10.1016/j.jse.2021.03.140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND An assessment of the pathoanatomic parameters of the arthritic glenohumeral joint (GHJ) has the potential to identify discriminating metrics to differentiate glenoid types in shoulders with primary glenohumeral osteoarthritis (PGHOA). The aim was to identify the morphometric differences and threshold values between glenoid types including normal and arthritic glenoids with the various types in the Walch classification. We hypothesized that there would be clear morphometric discriminators between the various glenoid types and that specific numeric threshold values would allow identification of each glenoid type. METHODS The computed tomography scans of 707 shoulders were analyzed: 585 obtained from shoulders with PGHOA and 122 from shoulders without glenohumeral pathology. Glenoid morphology was classified according to the Walch classification. All computed tomography scans were imported in a dedicated automatic 3D-software program that referenced measurements to the scapular body plane. Glenoid and humeral modeling was performed using the best-fit sphere method, and the root-mean-square error was calculated. The direction and orientation of the glenoid and humerus described glenohumeral relationships. RESULTS Among shoulders with PGHOA, 90% of the glenoids and 85% of the humeral heads were directed posteriorly in reference to the scapular body plane. Several discriminatory pathoanatomic parameters were identified: GHJ narrowing < 3 mm was a discriminatory metric for type A glenoids. Posterior humeral subluxation > 70% discriminated type B1 from normal GHJs. The root-mean-square error was a discriminatory metric to distinguish type B2 from type A, type B3, and normal GHJs. Type B3 glenoids differed from type A2 by greater retroversion (>13°) and subluxation (>71%). The type C glenoid retroversion inferior limit was 21°, whereas normal glenoids never presented with retroversion > 16°. CONCLUSION Pathoanatomic metrics with the identified threshold values can be used to discriminate glenoid types in shoulders with PGHOA.
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Affiliation(s)
- Marc-Olivier Gauci
- Institut Universitaire Locomoteur & Sport, Unité de Recherche Clinique Côte d'Azur (UR2CA), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France.
| | | | | | | | | | - Pascal Boileau
- Institut Universitaire Locomoteur & Sport, Unité de Recherche Clinique Côte d'Azur (UR2CA), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France
| | - Gilles Walch
- Hôpital Privé Jean Mermoz-Generale De Santé (GDS) Ramsay, Lyon, France
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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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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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Accuracy evaluation of a 3D printing surgical guide for breast-conserving surgery using a realistic breast phantom. Comput Biol Med 2021; 137:104784. [PMID: 34438204 DOI: 10.1016/j.compbiomed.2021.104784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 11/22/2022]
Abstract
To prevent recurrence after breast-conserving surgery (BCS), it is imperative to secure a clear resection margin, and magnetic resonance imaging (MRI) is useful for predicting this. Although MRI is highly accurate in predicting the extent of a tumor, it is difficult to quantitatively mark the tumor area directly on the patient's breast skin using MRI. Therefore, we developed a 3D-printed breast surgical guide (3DP-BSG). The 3DP-BGS is positioned on the breast using the guideline pointing to the opposite nipple and clavicle notch, centering on the nipple of the breast with the tumor. Then, the tumor was visualized by injecting blue-dye into the breast along the guide's columns using a syringe. For the quantitative evaluation of 3DP-BSG, the experiment must be done in the simulated environment. However, since it is difficult to construct the environment in the clinical field, we have fabricated a realistic breast phantom using an MRI. For modeling the 3DP-BSG, the phantom was scanned using computed tomography (CT), and. Based on these images, the 3DP-BSG was modeled to mark a 5-mm safety margin on a patient's breast skin by inserting a 16-gauge intravenous catheter. Then, the breast phantom was scanned by CT for quantitative evaluation. The insertion point measurement error (mean ± standard deviation) was 2.513 ± 0.914 mm, and the cosine similarity of the trajectories was 0.997 ± 0.005. This 3DP-BSG exhibits high accuracy in tumor targeting and is expected to facilitate precise BCS by providing a quantitative measure of the tumor area to surgeons.
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Simulation in shoulder arthroplasty education using three-dimensional planning software: the role of guidelines and predicted range of motion. INTERNATIONAL ORTHOPAEDICS 2021; 45:2653-2661. [PMID: 34383105 DOI: 10.1007/s00264-021-05155-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
AIM To demonstrate how reverse shoulder arthroplasty (RSA) planning software could be used to improve how the trainees position glenoid and humeral implants and obtain optimal simulated range of motion (ROM). METHODS We selected four groups of five various level participants: medical student (MS), junior resident (JR), senior resident (SR), and shoulder expert (SE). Thereafter, the 20 participants planned five cases of arthritic shoulders for a RSA on a validated planning software following three phases: (1) no guidelines and no ROM feedback, (2) guidelines but no ROM feedback, and (3) guidelines and ROM feedback. We evaluated the final simulated impingement-free ROM, the choice of the implant (baseplate size, graft, glenosphere), and the glenoid implant positioning. RESULTS MS planning were significantly improved by the ROM feedback only. JR took the best advantage of both guidelines and ROM in final results. SR planning were less performant than SE into phase 1 regarding flexion, external rotation, and adduction (respectively - 10°, p = 0.03; - 11°, p = 0.003; and - 3°, p = 0,03), but reached similar results into phase 3 (respectively - 2°, p = 0.329; - 4°, p = 0.44; - 2°, p = 0.319). For MS, JR, and SR, we observed a systematic improvement in the agreement over the study course. The glenoid diameter remained highly variable even for SE. Comparing glenoid implant position to SE, the distance error decreased with advancing phases. CONCLUSION Planning software can be used as a simulation training tool to improve implant positioning in shoulder arthroplasty procedures.
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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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Schiffman CJ, Prabhakar P, Hsu JE, Shaffer ML, Miljacic L, Matsen FA. Assessing the Value to the Patient of New Technologies in Anatomic Total Shoulder Arthroplasty. J Bone Joint Surg Am 2021; 103:761-770. [PMID: 33587515 DOI: 10.2106/jbjs.20.01853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Publications regarding anatomic total shoulder arthroplasty (TSA) have consistently reported that they provide significant improvement for patients with glenohumeral arthritis. New TSA technologies that have been introduced with the goal of further improving these outcomes include preoperative computed tomography (CT) scans, 3-dimensional preoperative planning, patient-specific instrumentation, stemless and short-stemmed humeral components, as well as metal-backed, hybrid, and augmented glenoid components. The benefit of these new technologies in terms of patient-reported outcomes is unknown. METHODS We reviewed 114 articles presenting preoperative and postoperative values for commonly used patient-reported metrics. The results were analyzed to determine whether patient outcomes have improved over the 20 years during which new technologies became available. RESULTS The analysis did not identify evidence that the results of TSA were statistically or clinically improved over the 2 decades of study or that any of the individual technologies were associated with significant improvement in patient outcomes. CONCLUSIONS Additional research is required to document the clinical value of these new technologies to patients with glenohumeral arthritis. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Corey J Schiffman
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Pooja Prabhakar
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | | | - Ljubomir Miljacic
- The Mountain-Whisper-Light Statistical Consulting, Seattle, Washington
| | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
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Comparison in clinical performance of surgical guides for mandibular surgery and temporomandibular joint implants fabricated by additive manufacturing techniques. J Mech Behav Biomed Mater 2021; 119:104512. [PMID: 33930652 DOI: 10.1016/j.jmbbm.2021.104512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/01/2020] [Accepted: 04/07/2021] [Indexed: 01/27/2023]
Abstract
Additive manufacturing (AM) offers great design freedom that enables objects with desired unique and complex geometry and topology to be readily and cost-effectively fabricated. The overall benefits of AM are well known, such as increased material and resource efficiency, enhanced design and production flexibility, the ability to create porous structures and on-demand manufacturing. When AM is applied to medical devices, these benefits are naturally assumed. However, hard clinical evidence collected from clinical trials and studies seems to be lacking and, as a result, systematic assessment is yet difficult. In the present work, we have reviewed 23 studies on the clinical use of AM patient-specific surgical guides (PSGs) for the mandible surgeries (n = 17) and temporomandibular joint (TMJ) patient-specific implants (PSIs) (n = 6) with respect to expected clinical outcomes. It is concluded that the data published on these AM medical devices are often lacking in comprehensive evaluation of clinical outcomes. A complete set of clinical data, including those on time management, costs, clinical outcomes, range of motion, accuracy of the placement with respect to the pre-operative planning, and extra complications, as well as manufacturing data are needed to demonstrate the real benefits gained from applying AM to these medical devices and to satisfy regulatory requirements.
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3D Printed Guides and Preoperative Planning for Uncemented Stem Anteversion Reconstruction during Hip Arthroplasty: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6621882. [PMID: 33681357 PMCID: PMC7910057 DOI: 10.1155/2021/6621882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/16/2021] [Accepted: 01/30/2021] [Indexed: 11/24/2022]
Abstract
Objective To investigate if 3D printed guides and preoperative planning can accurately control femoral stem anteversion. Methods A prospective comparative study was carried out from 2018 to 2020, including 53 patients who underwent hip arthroplasty for femoral neck fracture. The target rotation center of the femoral head is determined by three-dimensional planning. In group A, planning was made by 2D templates. In group B, preoperative 3D planning and 3D printed osteotomy/positioning guides were performed. After the operation, 3D model registration was performed to calculate the accuracy of anteversion restoration. Results We screened 60 patients and randomized a total of 53 to 2 parallel study arms: 30 patients to the group A (traditional operation) and 23 patients to the group B (3D preoperative planning and 3D printed guide). There were no significant differences in demographic or perioperative data between study groups. The restoration accuracy of group A was 5.42° ± 3.65° and of group B was 2.32° ± 1.89°. The number and rate of abnormal cases was 15 (50%) and 2 (8.7%), respectively. Significant statistical differences were found in angle change, restoration accuracy, and number of abnormal cases. Conclusion Three-dimensional preoperative planning and 3D printed guides can improve the accuracy of the restoration of femoral anteversion during hip arthroplasty.
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Gauci MO, Deransart P, Chaoui J, Urvoy M, Athwal GS, Sanchez-Sotelo J, Boileau P, Walch G. Three-dimensional geometry of the normal shoulder: a software analysis. J Shoulder Elbow Surg 2020; 29:e468-e477. [PMID: 32807728 DOI: 10.1016/j.jse.2020.03.042] [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: 11/02/2019] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Three-dimensional (3D) geometry of the normal glenohumeral bone anatomy and relations is poorly documented. Our aims were (1) to determine the 3D geometry of the normal glenohumeral joint (GHJ) with reference to the scapular body plane and (2) to identify spatial correlations between the orientation and direction of the humeral head and the glenoid. METHODS Computed tomographies (CTs) of the normal, noninjured GHJ were collected from patients who had undergone CTs in the setting of (1) polytrauma, (2) traumatic head injury, (3) chronic acromioclavicular joint dislocations, and (4) unilateral trauma with a contralateral normal shoulder. We performed 3D segmentation and measurements with a fully automatic software (Glenosys; Imascap). Measurements were made in reference to the scapular body plane and its transverse axis. Geometric measurements included version, inclination, direction, orientation, best-fit sphere radius (BFSR), humeral subluxation, critical shoulder angle, reverse shoulder angle, glenoid area, and glenohumeral distance. Statistical correlations were sought between glenoid and humeral 3D measurements (Pearson correlation). RESULTS A total of 122 normal GHJs (64 men, 58 women, age: 52 ± 17 years) were studied. The glenoid BFSR was always larger than the humerus BFSR (constant factor of 1.5, standard deviation = 0.2). The mean glenoid version and inclination were -6° ± 4° and 7° ± 5°, respectively. Men and women were found to have significantly different values for inclination (6° vs. 9°, P = .02), but not for version. Humeral subluxation was 59% ± 7%, with a linear correlation with glenoid retroversion (r = -0.70, P < .001) regardless of age. There was a significant and linear correlation between glenoid and humeral orientation and direction (r = 0.72 and r = 0.70, P < .001). CONCLUSION The 3D geometry of the glenoid and humeral head present distinct limits in normal shoulders that can be set as references in daily practice: version and inclination are -6° and 7°, respectively, and humeral posterior subluxation is 59%; interindividual variations, regardless of the size, are relative to the scapular plane. There exists a strong correlation between the position of the humeral head and the glenoid orientation and direction.
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Affiliation(s)
- Marc-Olivier Gauci
- Institut Universitaire Locomoteur & Sport, Hôpital Pasteur 2, UR2CA, Côte d'Azur University, CHU de Nice, Nice, France.
| | | | | | | | | | | | - Pascal Boileau
- Institut Universitaire Locomoteur & Sport, Hôpital Pasteur 2, UR2CA, Côte d'Azur University, CHU de Nice, Nice, France
| | - Gilles Walch
- Hôpital Privé Jean-Mermoz-GDS Ramsay, Lyon, France
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Wang KC, Jones A, Kambhampati S, Gilotra MN, Liacouras PC, Stuelke S, Shiu B, Leong N, Hasan SA, Siegel EL. CT-Based 3D Printing of the Glenoid Prior to Shoulder Arthroplasty: Bony Morphology and Model Evaluation. J Digit Imaging 2020; 32:816-826. [PMID: 30820811 DOI: 10.1007/s10278-019-00177-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
To demonstrate the 3D printed appearance of glenoid morphologies relevant to shoulder replacement surgery and to evaluate the benefits of printed models of the glenoid with regard to surgical planning. A retrospective review of patients referred for shoulder CT was performed, leading to a cohort of nine patients without arthroplasty hardware and exhibiting glenoid changes relevant to shoulder arthroplasty planning. Thin slice CT images were used to create both humerus-subtracted volume renderings of the glenoid, as well as 3D surface models of the glenoid, and 11 printed models were created. Volume renderings, surface models, and printed models were reviewed by a musculoskeletal radiologist for accuracy. Four fellowship-trained orthopaedic surgeons specializing in shoulder surgery reviewed each case individually as follows: First, the source CT images were reviewed, and a score for the clarity of the bony morphologies relevant to shoulder arthroplasty surgery was given. The volume rendering was reviewed, and the clarity was again scored. Finally, the printed model was reviewed, and the clarity again scored. Each printed model was also scored for morphologic complexity, expected usefulness of the printed model, and physical properties of the model. Mann-Whitney-Wilcoxon signed rank tests of the clarity scores were calculated, and the Spearman's ρ correlation coefficient between complexity and usefulness scores was computed. Printed models demonstrated a range of glenoid bony changes including osteophytes, glenoid bone loss, retroversion, and biconcavity. Surgeons rated the glenoid morphology as more clear after review of humerus-subtracted volume rendering, compared with review of the source CT images (p = 0.00903). Clarity was also better with 3D printed models compared to CT (p = 0.00903) and better with 3D printed models compared to humerus-subtracted volume rendering (p = 0. 00879). The expected usefulness of printed models demonstrated a positive correlation with morphologic complexity, with Spearman's ρ 0.73 (p = 0.0108). 3D printing of the glenoid based on pre-operative CT provides a physical representation of patient anatomy. Printed models enabled shoulder surgeons to appreciate glenoid bony morphology more clearly compared to review of CT images or humerus-subtracted volume renderings. These models were more useful as glenoid complexity increased.
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Affiliation(s)
- Kenneth C Wang
- Baltimore VA Medical Center, Baltimore, MD, USA. .,Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, School of Medicine, Baltimore, MD, USA.
| | - Anja Jones
- Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Mohit N Gilotra
- Baltimore VA Medical Center, Baltimore, MD, USA.,Department of Orthopaedics, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Peter C Liacouras
- 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Radiology and Radiological Services & Naval Postgraduate Dental School, Uniform Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Brian Shiu
- Department of Orthopaedics, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Natalie Leong
- Baltimore VA Medical Center, Baltimore, MD, USA.,Department of Orthopaedics, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - S Ashfaq Hasan
- Baltimore VA Medical Center, Baltimore, MD, USA.,Department of Orthopaedics, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Eliot L Siegel
- Baltimore VA Medical Center, Baltimore, MD, USA.,Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, School of Medicine, Baltimore, MD, USA
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Schoch BS, Haupt E, Leonor T, Farmer KW, Wright TW, King JJ. Computer navigation leads to more accurate glenoid targeting during total shoulder arthroplasty compared with 3-dimensional preoperative planning alone. J Shoulder Elbow Surg 2020; 29:2257-2263. [PMID: 32586595 DOI: 10.1016/j.jse.2020.03.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/15/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Commercially available preoperative planning software is now widely available for shoulder arthroplasty. However, without the use of patient-specific guides or intraoperative visual guidance, surgeons have little in vivo feedback to ensure proper execution of the preoperative plan. The purpose of this study was to assess surgeons' ability to implement a preoperative plan in vivo during shoulder arthroplasty. METHODS Fifty primary shoulder arthroplasties from a single institution were retrospectively reviewed. All surgical procedures were planned using a commercially available software package with both multiplanar 2-dimensional computed tomography and a 3-dimensional implant overlay. Following registration of intraoperative visual navigation trackers, the surgeons (1 attending and 1 fellow) were blinded to the computer navigation screen and attempted to implement the plan by simulating placement of a central-axis guide pin. Malposition was assessed (>4 mm of displacement or >10° error in version or inclination). Data were then blinded, measured, and evaluated. RESULTS Mean displacement from the planned starting point was 3.2 ± 2.0 mm. The mean error in version was 6.4° ± 5.6°, and the mean error in inclination was 6.6° ± 4.9°. Malposition was observed in 48% of cases after preoperative planning. Malposition errors were more commonly made by fellow trainees vs. attending surgeons (58% vs. 38%, P = .047). CONCLUSIONS Despite preoperative planning, surgeons of various training levels were unable to reproducibly replicate the planned component position consistently. Following completion of fellowship training, significantly less malposition resulted. Even in expert hands, the orientation of the glenoid component would have been malpositioned in 38% of cases. This study further supports the benefit of guided surgery for accurate placement of glenoid components, regardless of fellowship training.
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Affiliation(s)
- Bradley S Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Edward Haupt
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | | | - Kevin W Farmer
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL, USA
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Trivedi NN, Shimberg JL, Sivasundaram L, Mengers S, Salata MJ, Voos JE, Gillespie RJ. Advances in Glenoid Design in Anatomic Total Shoulder Arthroplasty. J Bone Joint Surg Am 2020; 102:1825-1835. [PMID: 33086353 DOI: 10.2106/jbjs.19.01294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Nikunj N Trivedi
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Letissier H, Chaoui J, Bercik MJ, Boileau P, Le Nen D, Stindel E, Walch G. Glenoid subchondral bone density in osteoarthritis: A comparative study of asymmetric and symmetric erosion patterns. Orthop Traumatol Surg Res 2020; 106:1127-1134. [PMID: 32807698 DOI: 10.1016/j.otsr.2020.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 05/07/2020] [Accepted: 06/02/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Recent studies have shown variations in glenoid bone density in asymmetric wear patterns but have yet to analyze non-arthritic or concentrically worn glenoids. QUESTIONS/PURPOSES The purpose of this study is to characterize and compare subchondral glenoid bone densities in both non-arthritic and A1, A2, B1, B2 and B3 osteoarthritic glenoids, as well as to assess uniformity in symmetric and asymmetric erosion wear patterns. METHODS In all, 150 computerized tomography (CT) scans containing equal numbers of non-arthritic (N), A1, A2, B1, B2 and B3 glenoids were segmented semi-automatically. Each reconstructed glenoid was divided first into anterior and posterior quadrants, and then further subdivided into four quadrants. Volumes of interest (VOI) were defined at depths of 0-2.5mm (Zone A), 2.5-5mm (Zone B) and 5-7.5mm (Zone C). Average bone densities were measured at each VOI depth and in each quadrant. RESULTS Osteoarthritic glenoids had higher mean bone densities than N glenoids. Mean bone densities were uniform amongst all quadrants for N glenoids, but not for osteoarthritic glenoids. In A1 glenoids, the antero-superior quadrant was less dense in Zone C. A2 glenoids had increased bone density measured posteriorly in Zones B and C. In B1 and B2 glenoids, Zones B and C demonstrated increased bone densities of posterior quadrants compared to anterior quadrants. B3 glenoids presented similar results as A1 and A2 glenoids. Cystic changes were more pronounced in anterior quadrants of A2, B1, B2 and B3 glenoids. CONCLUSION This study demonstrates that osteoarthritic glenoids have greater bone density than non-arthritic glenoids, independent of depth of interest. It also confirms that N glenoids have uniform erosion wear patterns and that B1 and B2 glenoids have irregular wear patterns. It is the first study to reveal that A1, A2 and B3 glenoids, though geometrically symmetrical, have irregular bony densities similar to B2 glenoids. These findings have clinical implications for reaming the glenoid and implant fixation. LEVEL OF EVIDENCE Basic Science, Anatomy, Imaging.
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Affiliation(s)
- Hoel Letissier
- Service de chirurgie orthopédique et traumatologique, CHRU de la Cavale Blanche, 29200 Brest, France; Laboratoire de traitement de l'information médicale (LaTIM, UMR1101), bâtiment IBRBS, 22, avenue Camille-Desmoulins, 29200 Brest, France.
| | | | - Michael J Bercik
- Lancaster Orthopedic Group, 231 Granite Run Drive, Lancaster, PA 17601, USA
| | | | - Dominique Le Nen
- Service de chirurgie orthopédique et traumatologique, CHRU de la Cavale Blanche, 29200 Brest, France
| | - Eric Stindel
- Service de chirurgie orthopédique et traumatologique, CHRU de la Cavale Blanche, 29200 Brest, France; Laboratoire de traitement de l'information médicale (LaTIM, UMR1101), bâtiment IBRBS, 22, avenue Camille-Desmoulins, 29200 Brest, France
| | - Gilles Walch
- Hôpital Privé J Mermoz Ramsay-GDS-Centre orthopédique Santy, 69008 Lyon, France
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