Preoperative planning for accurate glenoid component positioning in reverse shoulder arthroplasty

Berhouet, Julien; Gulotta, Lawrence V.; Dines, David M.; Craig, Edward V.; Warren, Russell F.; Choi, Daniel; Chen, X.; Kontaxis, Andreas

doi:10.1016/j.otsr.2016.12.019

Cited by 78 publications

(43 citation statements)

References 36 publications

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“…Even if glenoid component positioning is considered to be a major factor in survivorship [ 10 , 11 ], there is still a debate about the ideal position. Historically, literature on the subject only focused on two-dimensional positioning including version (0–15° of retroversion recommended) and inclination (0–10° of inferior inclination recommended), but the use of pre-operative 3D-planning [ 39 ] proved that rotation, entry point and reaming depth are also very important parameters to consider. Finally, other authors [ 40 – 43 ] determined the normal pre-morbid glenoid anatomy using a software based on the pre-operative CT scan and constructed the implant positioning parameters accordingly.…”

Section: Discussionmentioning

confidence: 99%

Use of Patient-Specific Instrumentation (PSI) for glenoid component positioning in shoulder arthroplasty. A systematic review and meta-analysis

Villatte

Müller

Pereira³

et al. 2018

PLoS ONE

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IntroductionTotal Shoulder Arthroplasty (TSA) anatomical, reverse or both is an increasingly popular procedure but the glenoid component is still a weak element, accounting for 30–50% of mechanical complications and contributing to the revision burden. Component mal-positioning is one of the main aetiological factors in glenoid failure and thus Patient-Specific Instrumentation (PSI) has been introduced in an effort to optimise implant placement. The aim of this systematic literature review and meta-analysis is to compare the success of PSI and Standard Instrumentation (STDI) methods in reproducing pre-operative surgical planning of glenoid component positioning.Material and methodsA search (restricted to English language) was conducted in November 2017 on MEDLINE, the Cochrane Library, EMBASE and ClinicalTrials.gov. Using the search terms “Patient-Specific Instrumentation (PSI)”, “custom guide”, “shoulder”, “glenoid” and “arthroplasty”, 42 studies were identified. The main exclusion criteria were: no CT-scan analysis results; studies done on plastic bone; and use of a reusable or generic guide. Eligible studies evaluated final deviations from the planning for version, inclination, entry point and rotation. Reviewers worked independently to extract data and assess the risk of bias on the same studies.ResultsThe final analysis included 12 studies, comprising 227 participants (seven studies on 103 humans and five studies on 124 cadaveric specimens). Heterogeneity was moderate or high for all parameters. Deviations from the pre-operative planning for version (p<0.01), inclination (p<0.01) and entry point (p = 0.02) were significantly lower with the PSI than with the STDI, but not for rotation (p = 0.49). Accuracy (deviation from planning) with PSI was about 1.88° to 4.96°, depending on the parameter. The number of component outliers (>10° of deviation or 4mm) were significantly higher with STDI than with PSI (68.6% vs 15.3% (p = 0.01)).ConclusionThis review supports the idea that PSI enhances glenoid component positioning, especially a decrease in the number of outliers. However, the findings are not definitive and further validation is required. It should be noted that no randomised clinical studies are available to confirm long-term outcomes.

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Section: Discussionmentioning

confidence: 99%

Use of Patient-Specific Instrumentation (PSI) for glenoid component positioning in shoulder arthroplasty. A systematic review and meta-analysis

Villatte

Müller

Pereira³

et al. 2018

PLoS ONE

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“…Although this may not perfectly simulate TSA operative conditions, our intent was to perform a controlled evaluation in a cadaveric model before it can be tested a clinical environment because this device has not previously been described in the literature. Previous studies have evaluated patient-specific systems in TSA by using Sawbones (Vashon, WA, USA) or polymer scapular models, as well as cadaveric scapular specimens without any associated soft tissue 1, 9, 19, 24, 34. In addition, we were unable to specifically request and obtain cadaveric specimens with glenohumeral osteoarthritis.…”

Section: Discussionmentioning

confidence: 99%

Novel 3-dimensionally printed patient-specific guide improves accuracy compared with standard total shoulder arthroplasty guide: a cadaveric study

et al. 2019

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Background Patient-specific instrumentation (PSI) systems for total shoulder arthroplasty (TSA) can improve glenoid component placement, but may involve considerable expense and production delays. The purpose of this study was to evaluate a novel technique for in-house production of 3-dimensionally printed, patient-specific glenoid guides. We hypothesized that our PSI guide would improve the accuracy of glenoid guide pin placement compared with a standard TSA guide. Methods We randomized 20 cadaveric shoulders to receive pin placement via the PSI guide (n = 10, study group) or standard TSA guide (n = 10, control group). PSI guides were designed to fit each glenoid based on 3-dimensional scapular models constructed from computed tomography scans. A presurgical plan was created for the guide pin trajectory in neutral version and inclination based on individual scapular anatomy. After pin placement, 3-dimensional models from repeated computed tomography scans were superimposed to calculate deviation from the presurgical plan for each specimen. Results Inclination deviation was significantly lower in the PSI group than in the standard guide group (1.5° ± 1.6° vs. 6.4° ± 5.0°, P = .009). The glenoid entry site exhibited significantly less deviation in the PSI group (0.8 ± 0.6 mm vs. 2.1 ± 1.2 mm, P = .008). The average production cost and time for the PSI guides were $29.95 and 4 hours 40 minutes per guide, respectively. Conclusions The PSI guide significantly improved the accuracy of glenoid pin placement compared with the standard TSA guide. Our PSI guides can be produced in-house, inexpensively, and with substantially reduced time compared with commercially available guides.

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“…3D preoperative planning software and PSI are becoming gradually commercially more and more available as a guide in the insertion of the glenoid component in TSA and RTSA. 23 …”

Section: D Printing: How Does It Work?mentioning

confidence: 99%

“…In RTSA, the rotation of the baseplate and the length and orientation of the screws can be accurately guided with selected PSI systems optimizing the final implantation of the glenoid component. 23 Regardless of the system used, it is essential that sufficient exposure of the glenoid is obtained, including the anterosuperior part of the glenoid rim, and that all soft tissues are removed before the PSI guide is positioned on the native glenoid. The PSI should have a stable fit onto the glenoid just like on the bone model.…”

Section: D Printing: How Does It Work?mentioning

confidence: 99%

3D printing in shoulder surgery

Campana¹,

Cardona²,

Vismara³

et al. 2020

Orthop Rev (Pavia)

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Three-dimensional (3D) printing is a novel modality with the potential to make a huge impact in the surgical field. The aim of this paper is to provide an overview on the current use of 3D printing in shoulder surgery. We have reviewed the use of this new method in 3 fields of shoulder surgery: shoulder arthroplasty, recurrent shoulder instability and orthopedic shoulder traumatology. In shoulder arthroplasty, several authors have shown that the use of the 3D printer improves the positioning of the glenoid component, even if longer clinical follow-up is needed to determine whether the cost of this system rationalizes the potential improved functional outcomes and decreases glenoid revision rates. In the treatment of anterior shoulder instability, the literature agrees on the fact that the use of the 3D printing can: enhance the dept and size of bony lesions, allowing a patient tailored surgical planning and potentially reducing operative times; allow the production of personalized implants to restore substantial bone loss; restore glenohumeral morphology and instability. In orthopedic trauma, the use of 3D printing can be helpful to increase the understanding of fracture patterns, facilitating a more personalized planning, and can be used for resident training and education. We can conclude the current literature regarding the use of 3D printed models in orthopedic surgery agrees finding objective improvements to preoperative planning and to the surgical procedure itself, by shortening the intraoperative time and by the possibility to develop custom-made, patient-specific surgical instruments, and it suggests that there are tangible benefits for its implementation.

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Preoperative planning for accurate glenoid component positioning in reverse shoulder arthroplasty

Abstract: Basic science study. Level III.

Cited by 78 publications

References 36 publications

Use of Patient-Specific Instrumentation (PSI) for glenoid component positioning in shoulder arthroplasty. A systematic review and meta-analysis

Use of Patient-Specific Instrumentation (PSI) for glenoid component positioning in shoulder arthroplasty. A systematic review and meta-analysis

Novel 3-dimensionally printed patient-specific guide improves accuracy compared with standard total shoulder arthroplasty guide: a cadaveric study

3D printing in shoulder surgery

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