Accuracy of patient-specific guided implantation of the glenoid component in reversed shoulder arthroplasty

Verborgt, Olivier; Hachem, Abdul-ilah; Eid, Karim; Vuylsteke, Kristien; Ferrand, Michèle; Hardy, Philippe

doi:10.1016/j.otsr.2018.01.010

Cited by 42 publications

(22 citation statements)

References 23 publications

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“…No study has evaluated the accuracy of 3D planning alone using standard instruments without PSI in the setting of RTSA. Our results are comparable to those of Verborgt et al 15 who utilized PSI and planning where they were able to get within 5 of planning and we were able to get within 6 of planning on average. Although larger sample sizes and confirmation of our results by other centers will be necessary to make firm conclusion, based upon our results 3D planning alone is reasonable to accurately place the baseplate even in the setting of severe erosions in the coronal and axial planes requiring bone grafting.…”

Section: Discussionsupporting

confidence: 87%

“…In the setting of RTSA, 3D computer planning using standard instrumentation without PSI has not been clinically evaluated. Verborgt et al 15 determined that the mean deviation of baseplate version and inclination from the planned version and inclination was on average 4 -5 in a series of patients who underwent RTSA with 3D planning and intraoperative PSI. Dallalana et al 16 also reported deviations of baseplate inclination and version from the planned inclination and version using patient specific guides on average of 1 and 2 .…”

Section: Discussionmentioning

confidence: 99%

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Preoperative three-dimensional computer planning for reverse total shoulder arthroplasty and bone grafting for severe glenoid deformity

et al. 2020

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Background Computer assisted planning without patient specific instrumentation may be utilized to guide reverse total shoulder arthroplasty baseplate placement. The purpose of this study was to determine the difference between planned and achieved inclination and retroversion correction with three-dimensional preoperative computer assisted planning in reverse total shoulder arthroplasty without patient specific instrumentation with bone grafting for severe glenoid erosion. Methods Preoperative three-dimensional computer assisted planning without patient specific instrumentation was performed on 15 patients undergoing primary reverse total shoulder arthroplasty with glenoid bone grafting for severe glenoid erosion. On preoperative and immediate postoperative computed tomography slices, two-dimensional retroversion and inclination were measured. Preoperative three-dimensional baseline retroversion and inclination and planned postoperative three-dimensional retroversion and inclination were measured. Planned and achieved version and inclination changes were compared. Results The planned and achieved retroversion corrections were 18° and 12°, respectively (p < 0.001). The planned and achieved inclination corrections were 11° and 11°, respectively (p = 0.803). Conclusions Three-dimensional computer assisted planning without patient specific instrumentation in the setting of reverse total shoulder arthroplasty with severe glenoid erosion requiring bone grafting can accurately guide baseplate placement. All cases in which failure to correct retroversion or inclination within 10° of planning occurred in patients with severe erosion (B3 or E3 glenoids), therefore patient specific guides may be warranted in these cases to improve accuracy of implantation. Level of evidence Level IV, retrospective case series.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Preoperative three-dimensional computer planning for reverse total shoulder arthroplasty and bone grafting for severe glenoid deformity

et al. 2020

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“…Similarly, Humphrey et al 14 performed a cadaveric study analyzing screw orientation using both fixed-angle and variable-angle baseplates and reported that 4 of 10 fixed-angle baseplates positioned the superior screw near the suprascapular nerve compared with 0 of 10 variable-angle baseplates. In addition to variable-angle baseplates, new technologies are available to improve rTSA screw positioning and/or length, including 3-dimensional preoperative planning, 15 , 19 , 26 patient-specific glenoid instruments, 12 , 23 , 41 , 42 and intraoperative computer navigation 6 , 21 , 26 , 40 , 42 . If used correctly, these new technologies can also ensure screw placement in the “scapular safe zone” as described by Shishido and Kikuchi 36 to avoid the suprascapular nerve and artery.…”

Section: Discussionmentioning

confidence: 99%

Impact of screw length and screw quantity on reverse total shoulder arthroplasty glenoid fixation for 2 different sizes of glenoid baseplates

et al. 2019

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BackgroundLittle guidance exists regarding the minimum screw length and screw quantity necessary to achieve fixation in reverse total shoulder arthroplasty (rTSA); to that end, this study quantified the displacement of 2 different sizes of glenoid baseplates using multiple different screw lengths and quantities of screws in a low-density polyurethane bone-substitute model.MethodsTesting of rTSA glenoid loosening was conducted according to ASTM F 2028-17. To independently evaluate the impact of screw quantity and screw length on rTSA glenoid fixation for 2 different sizes of glenoid baseplates, baseplates were constructed using 2 screws, 4 screws, or 6 screws (with the latter being used for the larger baseplate only) with 3 different poly-axial locking compression screw lengths.ResultsBoth sizes of glenoid baseplates remained well fixed after cyclic loading regardless of screw length or screw quantity. Baseplates with 2 screws had significantly greater displacement than baseplates with 4 or 6 screws. No differences were observed between baseplates with 4 screws and those with 6 screws (used for the larger baseplate). Both sizes of baseplates with 18-mm screws had significantly greater displacement than baseplates with 30- or 46-mm screws. For larger baseplates, those with 30-mm screws had significantly greater displacement than those with 46-mm screws in the superior-inferior direction.DiscussionFor the 2 different sizes of baseplates tested in this study, rTSA glenoid fixation was impacted by both screw quantity and screw length. Irrespective of screw quantity, longer screws showed significantly better fixation. Irrespective of screw length, the use of more screws showed significantly better fixation, up to a point, as the use of more than 4 screws showed no incremental benefit. Finally, longer screws can be used as a substitute for additional fixation if it is not feasible to use more screws.

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“…Preoperative planning and use of patient-specific guides can help improve implant positioning 14–19 and reduce the risk of complications resulting from malpositioning. Software can be of great help in preoperative planning and creating patient-specific guides.…”

Section: Introductionmentioning

confidence: 99%

Three dimensional patient-specific guides for guide pin positioning in reverse shoulder arthroplasty: An experimental study on different glenoid types

Sadeghi

Keçeci

Kapıcıoğlu

et al. 2022

J Orthop Surg (Hong Kong)

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Introduction Incorrect positioning is one of the main factors for glenoid component loosening in reverse shoulder arthroplasty and component placement can be challenging. This study aimed to assess whether Patient-Specific Instrumentation (PSI) provides better guide pin positioning accuracy and is superior to standard guided and freehand instrumentation methods in cases of glenoid bone deformity. Materials and Methods Based on the Walch classification, five different scapula types were acquired by computed tomography (CT). For each type, two different surgeons placed a guide pin into the scapula using three different methods: freehand method, conventional non-patient-specific guide, and PSI guide. Each method was repeated five times by both surgeons. In these experiments, a total of 150 samples of scapula models were used (5 × 2 × 3 × 5 = 150). Post-operative CT scans of the samples with the guide pin were digitally assessed and the accuracy of the pin placement was determined by comparison to the preoperative planning on a three-dimensional (3D) model. Results The PSI method showed accuracies to the preoperative plan of 2.68 (SD 2.10) degrees for version angle ( p < .05), 2.59 (SD 2.68) degrees for inclination angle ( p < .05), and 1.55 (SD 1.26) mm for entry point offset ( p < .05). The mean and standard deviation errors compared to planned values of version angle, inclination angle, and entry point offset were statistically significant for the PSI method for the type C defected glenoid and non-arthritic glenoid. Conclusion Using the PSI guide created by an image processing software tool for guide pin positioning showed advantages in glenoid component positioning over other methods, for defected and intact glenoid types, but correlation with clinical outcomes should be examined.

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Accuracy of patient-specific guided implantation of the glenoid component in reversed shoulder arthroplasty

Abstract: Level 3.

Cited by 42 publications

References 23 publications

Preoperative three-dimensional computer planning for reverse total shoulder arthroplasty and bone grafting for severe glenoid deformity

Preoperative three-dimensional computer planning for reverse total shoulder arthroplasty and bone grafting for severe glenoid deformity

Impact of screw length and screw quantity on reverse total shoulder arthroplasty glenoid fixation for 2 different sizes of glenoid baseplates

Three dimensional patient-specific guides for guide pin positioning in reverse shoulder arthroplasty: An experimental study on different glenoid types

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