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Spek RW, Hoogervorst LA, Brink RC, Schoones JW, van Deurzen DF, van den Bekerom MP. Ten technical aspects of baseplate fixation in reverse total shoulder arthroplasty for patients without glenoid bone loss: a systematic review. Clin Shoulder Elb 2024; 27:88-107. [PMID: 38147872 PMCID: PMC10938023 DOI: 10.5397/cise.2023.00493] [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: 06/17/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 12/28/2023] Open
Abstract
The aim of this systematic review was to collect evidence on the following 10 technical aspects of glenoid baseplate fixation in reverse total shoulder arthroplasty (rTSA): screw insertion angles; screw orientation; screw quantity; screw length; screw type; baseplate tilt; baseplate position; baseplate version and rotation; baseplate design; and anatomical safe zones. Five literature libraries were searched for eligible clinical, cadaver, biomechanical, virtual planning, and finite element analysis studies. Studies including patients >16 years old in which at least one of the ten abovementioned technical aspects was assessed were suitable for analysis. We excluded studies of patients with: glenoid bone loss; bony increased offset-reversed shoulder arthroplasty; rTSA with bone grafts; and augmented baseplates. Quality assessment was performed for each included study. Sixty-two studies were included, of which 41 were experimental studies (13 cadaver, 10 virtual planning, 11 biomechanical, and 7 finite element studies) and 21 were clinical studies (12 retrospective cohorts and 9 case-control studies). Overall, the quality of included studies was moderate or high. The majority of studies agreed upon the use of a divergent screw fixation pattern, fixation with four screws (to reduce micromotions), and inferior positioning in neutral or anteversion. A general consensus was not reached on the other technical aspects. Most surgical aspects of baseplate fixation can be decided without affecting fixation strength. There is not a single strategy that provides the best outcome. Therefore, guidelines should cover multiple surgical options that can achieve adequate baseplate fixation.
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Affiliation(s)
- Reinier W.A. Spek
- Department of Orthopaedic Surgery, Flinders University and Flinders Medical Center, Adelaide, Australia
- Department of Orthopaedic Surgery, OLVG Amsterdam, Amsterdam, the Netherlands
- Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lotje A. Hoogervorst
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
- Department of Biomedical Data Sciences and Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob C. Brink
- Department of Orthopaedic Surgery, OLVG Amsterdam, Amsterdam, the Netherlands
| | - Jan W. Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Michel P.J. van den Bekerom
- Department of Orthopaedic Surgery, OLVG Amsterdam, Amsterdam, the Netherlands
- Shoulder and Elbow Expertise Center, Amsterdam, the Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Lopiz Y, Rodriguez-Gonzalez A, Martín-Albarrán S, Moreu Gamazo M, Ponz-Lueza V, García-Fernandez C, Marco F. Suprascapular nerve injury after reverse total shoulder arthroplasty: correlation with screw out of vault penetration and functional situation: prospective study. J Shoulder Elbow Surg 2023; 32:2421-2429. [PMID: 37499787 DOI: 10.1016/j.jse.2023.06.026] [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: 04/04/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Baseplate screws have been suggested as a possible cause of suprascapular neuropathy after reverse total shoulder arthroplasty. This study aims to investigate the association between screw penetration out of the vault, electromyographic study, and the clinical outcomes. METHODS A total of 31 patients who underwent reverse total shoulder arthroplasty for cuff tear arthropathy were prospectively enrolled. They were followed up for a minimum of 24 months. All patients underwent computed tomography 6 months postoperatively to determine the extraosseous position of the screws (perforation of the second bone cortex and protrusion into the supra- or infraspinatus fossa). Electrodiagnostic evaluation was performed preoperatively and postoperatively to stablish any relation between cortex perforation of the screw and suprascapular nerve (SSN) injury. Clinical outcomes pre- and postoperatively (Constant score, ranges of motion, and visual analog scale) of patients with and without documented injury were recorded. RESULTS A total of 14 patients (45.2%) had an abnormal preoperative SSN electrodiagnostic study (chronic or disuse injuries), and 6 patients (19.4%) had an abnormal postoperative study (acute injury). Of the 6 patients, 2 cases appeared over the pre-existing lesion and 4 appeared over an intact preoperative nerve, all of them affecting the infraspinatus branch of the SSN. Perforation of the second cortex was detected for 60% of superior screws and 40% of posterior screws. The mean lengths of the superior and posterior screws were 30 and 18.2 mm, respectively. Patients with screw perforation of the second cortex were assessed as having a high risk of nerve injury (40% vs. 9.5%). CONCLUSIONS Preoperative SSN injuries do not have a significant clinical impact and do not predispose to an acute postoperative SSN lesion. The Constant score and visual analog scale score for patients with acute SSN injuries were not statistically different from those without SSN injury. The extraosseous position of the screw increases the probability of an SSN injury to 31%. This risk is higher with the posterior screw, which leads us to question whether it is really necessary to use it.
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Affiliation(s)
- Yaiza Lopiz
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain; Department of Surgery, Complutense University, Madrid, Spain.
| | - Alberto Rodriguez-Gonzalez
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | | | - Manuel Moreu Gamazo
- Musculoskeletal Radiology Unit of the Radiodiagnostic Department, Clínico San Carlos Hospital, Madrid, Spain
| | - Virginia Ponz-Lueza
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Carlos García-Fernandez
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain; Department of Surgery, Complutense University, Madrid, Spain
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Jennewine BR, Brolin TJ. Emerging Technologies in Shoulder Arthroplasty: Navigation, Mixed Reality, and Preoperative Planning. Orthop Clin North Am 2023; 54:209-225. [PMID: 36894293 DOI: 10.1016/j.ocl.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Shoulder arthroplasty is a rapidly improving and utilized management for end-stage arthritis that is associated with improved functional outcomes, pain relief, and long-term implant survival. Accurate placement of the glenoid and humeral components is critical for improved outcomes. Traditionally, preoperative planning was limited to radiographs and 2-dimensional computed tomography (CT); however, 3-dimensional CT is becoming more commonly utilized and necessary to understand complex glenoid and humeral deformities. To further increase accurate component placement, intraoperative assistive devices-patient-specific instrumentation, navigation, and mixed reality-minimize malpositioning, increase surgeon accuracy, and maximize fixation. These intraoperative technologies likely represent the future of shoulder arthroplasty.
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Affiliation(s)
- Brenton R Jennewine
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 920 Madison Avenue, Memphis, TN 38163, USA; Campbell Clinic Orthopaedics, 1211 Union Avenue #500, Memphis, TN 38104, USA
| | - Tyler J Brolin
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 920 Madison Avenue, Memphis, TN 38163, USA; Campbell Clinic Orthopaedics, 1400 South Germantown Road, Germantown, TN 38138, USA.
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Archie AT, Freehill MQ, Ponce BA. Suprascapular nerve injury secondary to cement extravasation in an anatomic total shoulder arthroplasty: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:546-549. [PMID: 37588459 PMCID: PMC10426478 DOI: 10.1016/j.xrrt.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
| | | | - Brent A. Ponce
- University of Alabama at Birmingham, Birmingham, AL, USA
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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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Jang YH, Oh SY, Kim SH. Three-dimensional analysis of baseplate screw penetration in reverse total shoulder arthroplasty: risk of iatrogenic suprascapular neuropathy by screw violation. J Shoulder Elbow Surg 2022; 31:940-947. [PMID: 34808348 DOI: 10.1016/j.jse.2021.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Baseplate screws have been suggested to be a possible cause of suprascapular neuropathy after reverse total shoulder arthroplasty (RTSA). Three-dimensional analyses of screw penetration and confirmation of its clinical impacts are relevant. The study aims to investigate the association between screw penetration and the clinical outcomes. MATERIALS AND METHODS Eighty-two patients who underwent RTSA for a massive rotator cuff tear, cuff tear arthropathy, or osteoarthritis with rotator cuff tear were retrospectively enrolled. They were followed up for a minimum of 12 months, and all underwent computed tomography at 1 year postoperatively. The lengths of the superior and posterior baseplate screws were documented. Postoperative computed tomography images were subjected to 3-dimensional analysis to determine whether superior or posterior screws penetrated the glenoid vault and the location to which they penetrated, and screw-to-nerve distances were measured to estimate risks of screw nerve violation and iatrogenic suprascapular neuropathy. Patients with any screw <5 mm from the suprascapular nerve were deemed to have a high risk. Clinical outcomes (functional scores, ranges of motion, and isometric strengths) of patients in the high- and lower-risk groups were compared. RESULTS The mean lengths of the superior and posterior screws were 28 ± 4 mm and 18 ± 3 mm, respectively. Penetration was detected for 13% of superior screws and 64% of posterior screws. Sixty-three percent of penetrating superior screws and 5% of penetrating posterior screws were <5 mm from the suprascapular nerve, and therefore, 12% of patients who received RTSA were assessed to have a high risk of iatrogenic suprascapular neuropathy. However, no significant difference was detected in clinical outcomes between the high- and lower-risk patients after a mean follow-up period of 20 months. CONCLUSION Twelve percent of patients who received RTSA were assessed to be at high risk of iatrogenic suprascapular neuropathy by baseplate screw penetration. However, the clinical outcomes of RTSA at a minimum follow-up of 1 year were similar in the high- and lower-risk groups.
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Affiliation(s)
- Young Hoon Jang
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu-si, Gyeonggi-do, Republic of Korea
| | - Seung Yeol Oh
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
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Patel MS, Daher M, Fuller DA, Abboud JA. Incidence, Risk Factors, Prevention, and Management of Peripheral Nerve Injuries Following Shoulder Arthroplasty. Orthop Clin North Am 2022; 53:205-213. [PMID: 35365265 DOI: 10.1016/j.ocl.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In this article, the authors review the incidence and causes of iatrogenic peripheral nerve injuries following shoulder arthroplasty and provide preventative measures to decrease nerve injury rate and management options. They describe common direct and indirect causes of injury such as laceration and retractor use versus arm positioning and lengthening, respectively. Preventative measures include an understanding of anatomy and high-risk locations in the shoulder, minimizing extreme ranges of arm motion and utilization of intraoperative nerve monitoring. Lastly, the authors review diagnosis and management of neurologic symptoms including how and when to use electrodiagnostic studies, nerve grafts, transfers, or muscle/tendon transfers.
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Affiliation(s)
- Manan S Patel
- Department of Orthopaedic Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Mohammad Daher
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - David A Fuller
- Department of Orthopaedic Surgery, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Joseph A Abboud
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut Street 5th Floor, Philadelphia, PA 19107, USA.
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8
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Miyatake K, Fukuta S, Tonogai I, Wada K, Higashino K, Mikami H, Yonezu H, Sairyo K, Tsuruo Y. Influence of the glenoid baseplate position on the direction and length of the superior and inferior locking screws. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:185-190. [DOI: 10.2152/jmi.69.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Katsutoshi Miyatake
- Department of Orthopaedic Surgery, Yoshinogawa Medical Center, Tokushima, Japan
| | - Shoji Fukuta
- Department of Orthopaedic Surgery, Kochi National Hospital, Kochi, Japan
| | - Ichiro Tonogai
- Department of Orthopaedic Surgery, Tokushima University, Tokushima, Japan
| | - Keizo Wada
- Department of Orthopaedic Surgery, Tokushima University, Tokushima, Japan
| | - Kosaku Higashino
- Department of Orthopaedic Surgery, Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | - Hiroshi Mikami
- Department of Orthopaedic Surgery, Yoshinogawa Medical Center, Tokushima, Japan
| | - Hiroshi Yonezu
- Department of Orthopaedic Surgery, Yoshinogawa Medical Center, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopaedic Surgery, Tokushima University, Tokushima, Japan
| | - Yoshihiro Tsuruo
- Department of Anatomy and Cell biology, Tokushima University, Tokushima, Japan
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9
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Hones KM, King JJ, Schoch BS, Struk AM, Farmer KW, Wright TW. The in vivo impact of computer navigation on screw number and length in reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:e629-e635. [PMID: 33647443 DOI: 10.1016/j.jse.2021.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/21/2020] [Accepted: 01/10/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little information exists regarding the benefit of computer navigation in shoulder arthroplasty in the clinical setting. This study aimed to quantify how computer navigation affects the number and length of screws used during in vivo reverse total shoulder arthroplasty (RSA) placement. METHODS We performed a retrospective review of a research database to identify patients who underwent primary RSA before and after the use of computer navigation between January 1, 2015, and December 31, 2019. One hundred consecutive RSAs were selected from the computer navigation implantation date; then, 100 consecutive sex-matched RSAs were chosen prior to navigation implantation in reverse chronologic order. Baseplate augmentations were chosen based on surgeon discretion, with the goal of restoring version to within 10° of neutral and inclination to neutral or slightly inferior with removal of the smallest amount of subchondral bone possible. Screws were placed with the goal of ≥3 screws with good purchase and were added as needed, with up to 5 screws used. We compared demographic factors, comorbidities, preoperative diagnosis, number of screws, screw length, number of wasted screws, and number of cases with bone graft used behind the baseplate between the 2 groups. We used the χ2 test for bivariate analysis and the Student t test for continuous variables. RESULTS A total of 200 RSAs were included, with 100 primary RSAs (mean age, 69.3 years) performed prior to computer navigation compared with 100 primary RSAs (mean age, 69.7 years) performed using computer navigation. The total number of screws used in RSAs without computer navigation was 414; the total used in the computer navigation cases was 344. RSAs placed with computer navigation used significantly fewer screws per case (3.4 screws vs. 4.1 screws, P < .001) and had a significantly greater average screw length (35.0 mm vs. 32.6 mm, P < .001). Three screws were implanted in 61% of computer navigation cases vs. 1% of cases without computer navigation (P < .001). Screws ≥ 30 mm in length were more commonly used in patients undergoing RSA using computer navigation (84.6% vs. 73.7%, P < .001). CONCLUSION This study shows that computer navigation in RSA leads to longer and fewer glenoid baseplate screws being implanted. Computer navigation appears to assist with better screw placement, which may have similar clinical benefits of better glenoid fixation. Additionally, using fewer screws can save glenoid bone stock, avoid added glenoid stress risers, and decrease operative time.
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Affiliation(s)
- Keegan M Hones
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.
| | - Bradley S Schoch
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Aimee M Struk
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Kevin W Farmer
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
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Eroğlu ON, Hüsemoğlu B, Başçı O, Özkan M, Havıtçıoğlu H, Hapa O. Scapular spine base fracture with long outside-in superior or posterior screws with reverse shoulder arthroplasty. Clin Shoulder Elb 2021; 24:141-146. [PMID: 34488294 PMCID: PMC8423534 DOI: 10.5397/cise.2021.00213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of the present study was to determine how long superior screws alone or in combination with posterior placement of metaglene screws protruding and penetrating into the scapular spine in reverse total shoulder arthroplasty affect the strength of the scapular spine in a fresh cadaveric scapular model. Methods Seven fresh cadaver scapulas were allocated to the control group (short posterior and superior screws) and seven scapulars to the study group (spine base fixation with a four long screws, three with both long superior and long posterior screws). Results The failure load was lower in the spine fixation group (long screw, 869 N vs. short screw, 1,123 N); however, this difference did not reach statistical significance (p>0.05). All outside-in long superior or superior plus posterior screws failed due to scapular spine base fracture; failures in the short screw group were due to acromion fracture. An additional posterior outside-in screw failed to significantly decrease the failure load of the acromion spine. Conclusions The present study highlights the significance of preventing a cortical breach or an outside-in configuration when a superior or posterior screw is inserted into the scapular spine base.
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Affiliation(s)
- Osman Nuri Eroğlu
- Department of Orthopedics and Traumatology, Dokuz Eylül University School of Medicine, İzmir, Turkey.,Department of Biomechanics, Graduate School of Sciences, Dokuz Eylül University, İzmir, Turkey
| | - Buğra Hüsemoğlu
- Department of Biomechanics, Graduate School of Sciences, Dokuz Eylül University, İzmir, Turkey
| | - Onur Başçı
- Department of Orthopedics and Traumatology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Mustafa Özkan
- Department of Orthopedics and Traumatology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Hasan Havıtçıoğlu
- Department of Orthopedics and Traumatology, Dokuz Eylül University School of Medicine, İzmir, Turkey.,Department of Biomechanics, Graduate School of Sciences, Dokuz Eylül University, İzmir, Turkey
| | - Onur Hapa
- Department of Orthopedics and Traumatology, Dokuz Eylül University School of Medicine, İzmir, Turkey
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Vajapey SP, Contreras ES, Cvetanovich GL, Neviaser AS. Neurologic complications in primary anatomic and reverse total shoulder arthroplasty: A review. J Clin Orthop Trauma 2021; 20:101475. [PMID: 34178600 PMCID: PMC8213914 DOI: 10.1016/j.jcot.2021.06.005] [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: 02/11/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
Neurologic injury during shoulder replacement is one of the less common complications of the procedure, however the clinical implications can be significant. The purpose of this paper is to review the current literature on neurologic complications in various types of shoulder replacement and provide recommendations regarding avoidance, evaluation, and management of these complications.
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Affiliation(s)
- Sravya P. Vajapey
- Corresponding author. Department of Orthopaedics, The Ohio State University Wexner Medical Center, 241 W. 11th Avenue, Suite 6081, Columbus, Ohio, 43201.
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12
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Florczynski M, Paul R, Leroux T, Baltzer H. Prevention and Treatment of Nerve Injuries in Shoulder Arthroplasty. J Bone Joint Surg Am 2021; 103:935-946. [PMID: 33877057 DOI: 10.2106/jbjs.20.01716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Nerve injuries during shoulder arthroplasty have traditionally been considered rare events, but recent electrodiagnostic studies have shown that intraoperative nerve trauma is relatively common. ➤ The brachial plexus and axillary and suprascapular nerves are the most commonly injured neurologic structures, with the radial and musculocutaneous nerves being less common sites of injury. ➤ Specific measures taken during the surgical approach, component implantation, and revision surgery may help to prevent direct nerve injury. Intraoperative positioning maneuvers and arm lengthening warrant consideration to minimize indirect injuries. ➤ Suspected nerve injuries should be investigated with electromyography preferably at 6 weeks and no later than 3 months postoperatively, allowing for primary reconstruction within 3 to 6 months of injury when indicated. Primary reconstructive options include neurolysis, direct nerve repair, nerve grafting, and nerve transfers. ➤ Secondary reconstruction is preferred for injuries presenting >12 months after surgery. Secondary reconstructive options with favorable outcomes include tendon transfers and free functioning muscle transfers.
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Affiliation(s)
- Matthew Florczynski
- Departments of Orthopaedic Surgery (M.F., R.P., and T.L.) and Plastic and Reconstructive Surgery (R.P. and H.B.), University of Toronto, Toronto, Ontario, Canada
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13
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Vance DD, O'Donnell JA, Baldwin EL, Cheah JW, Pereira G, Klifto C, Lassiter TE, Anakwenze OA. Risk of suprascapular nerve injury during glenoid baseplate fixation for reverse total shoulder arthroplasty: a cadaveric study. J Shoulder Elbow Surg 2021; 30:532-537. [PMID: 32707330 DOI: 10.1016/j.jse.2020.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (rTSA) is an effective treatment for patients with advanced rotator cuff arthropathy. During implantation of the glenoid baseplate, screws are inserted through the glenoid face into the scapular body to achieve adequate fixation. Placement of peripheral baseplate screws in the superior and posterior glenoid may increase the risk of injury to the suprascapular nerve (SSN). The purpose of this cadaveric study was to evaluate the risk of SSN injury with placement of baseplate screws in the superior and posterior direction. METHODS Twelve cadaveric shoulders were implanted with glenoid baseplates. A bicortical 44-mm screw was placed in both the superior and posterior glenoid baseplate screw holes. Following implantation, the SSN was dissected and visualized through a posterior shoulder approach. The distance from the tip of the screws to the SSN and the distance from the screw's scapular exiting hole to the SSN was recorded. Average distances were calculated for each measurement. RESULTS The superior screw contacted the SSN in 8 of the 12 specimens (66%). For the superior screw, the average distance from the exiting point in the scapula to the SSN was 9.2 ± 6.3 mm, with the shortest distance being 3.9 mm. The posterior screw contacted the SSN in 6 of 12 specimens (50%). For the posterior screw, the average distance from the exiting point to the SSN was 8.9 ± 3.8 mm, with the shortest distance to the nerve being 2.2 mm. CONCLUSION Placement of the superior and posterior screws in the glenoid baseplate during rTSA risks injury to the SSN. The safe zone for superior- and posterior-directed baseplate screw is <2 mm from its exiting point on the scapula. Therefore, precise measurements of screw lengths in this area is important in avoiding injury to the SSN.
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Affiliation(s)
- Danica D Vance
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Jeffrey A O'Donnell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Edward L Baldwin
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jonathan W Cheah
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Gregory Pereira
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Tally E Lassiter
- Department of Orthopaedic Surgery, Duke University Medical Center, Raleigh, NC, USA
| | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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14
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Li J, Zhou J, Wang D, Li D, Zhang W. Applied anatomical study on suprascapular nerve protection in reverse total shoulder arthroplasty. J Orthop Surg Res 2020; 15:524. [PMID: 33176828 PMCID: PMC7661197 DOI: 10.1186/s13018-020-02061-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to investigate the three-dimensional (3D) anatomical relationship between the suprascapular nerve and scapula, and the method of protecting the suprascapular nerve in reverse total shoulder arthroplasty (RTSA) METHODS: In the present study, 12 fresh adult cadaver shoulder specimens were dissected. X-ray and computed tomography (CT) were used to investigate the 3D scapular and suprascapular nerve images. RESULTS The results revealed that the best fitting baseplate diameter was 24.73 ± 1.56 mm. Furthermore, the baseplate diameter correlated with the glenoid cavity width. After the osteotomy, a simulated screw placement on the baseplate was performed. The dangerous area for the posterior screw placement was at the angle between the upper edge and transverse axis exceeding 38° and between the lower edge and transverse axis exceeding 76°. The distance between the nearest point of the nerve and osteotomy plane was 15.38 ± 2.02 mm, and the angle between the projection point of the nearest point and transverse axis was 27.33 ± 7.96°, which was the dangerous area for retractor placement. The suitable angle between the superior screw and longitudinal axis was 21.67 ± 13.27°, and the suitable superior screw length was 34.66 ± 2.41 mm. CONCLUSION In RTSA, the baseplate size correlates with the glenoid cavity width. The relationship between the screw and suprascapular nerve and retractor placement position should be carefully considered to avoid damaging the suprascapular nerve.
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Affiliation(s)
- Jianfeng Li
- Department of Orthopaedics, Beijing Chaoyang Hospital of Capital Medical University, No. 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, PR China
| | - Junlin Zhou
- Department of Orthopaedics, Beijing Chaoyang Hospital of Capital Medical University, No. 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, PR China.
| | - Dong Wang
- Department of Orthopaedics, Beijing Chaoyang Hospital of Capital Medical University, No. 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, PR China
| | - Dacun Li
- Department of Upper Limb Surgery, Beijing Shunyi District Hospital, No. 3 of Guangming Nanjie, Shunyi District, Beijing, 101300, PR China
| | - Wentong Zhang
- Department of Upper Limb Surgery, Beijing Shunyi District Hospital, No. 3 of Guangming Nanjie, Shunyi District, Beijing, 101300, PR China
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15
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Kahan JB, Iannotti J, Donohue K. Suprascapular Neuropathy From Malpositioned Baseplate Screws in Primary Reverse Shoulder Arthroplasty: Two Case Reports. JBJS Case Connect 2020; 10:e20.00096. [PMID: 33512938 DOI: 10.2106/jbjs.cc.20.00096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASES Two patients presented to different surgeons complaining of persistent shoulder pain after reverse total shoulder arthroplasty. Workups for fracture, instability, and periprosthetic infection were negative. Advanced imaging, nerve conduction studies, and diagnostic injections localized symptoms to the suprascapular nerve. Revision arthroplasty with removal of the offending screws improved pain in both patients. CONCLUSION Suprascapular nerve irritation because of the malposition of baseplate screws in reverse total shoulder arthroplasty can be a source of postoperative pain. Removal of the offending screw without formal nerve exploration may result in symptomatic improvement.
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Affiliation(s)
- Joseph B Kahan
- Department of Orthopaedics and Rehabilitation, Yale University, New Haven, Connecticut
| | - Joseph Iannotti
- Department of Orthopaedic Surgery, The Cleveland Clinic, Cleveland, Ohio
| | - Kenneth Donohue
- Department of Orthopaedics and Rehabilitation, Yale University, New Haven, Connecticut
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16
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Kim HJ, Kwon TY, Jeon YS, Kang SG, Rhee YG, Rhee SM. Neurologic deficit after reverse total shoulder arthroplasty: correlation with distalization. J Shoulder Elbow Surg 2020; 29:1096-1103. [PMID: 32081632 DOI: 10.1016/j.jse.2019.11.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 11/15/2019] [Accepted: 11/23/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Neurologic problems after reverse total shoulder arthroplasty (RTSA) have been reported, but there are a lack of studies regarding which nerve(s) are damaged and the outcomes for the patients who had neurologic complications after RTSA. The purpose of this study was to assess the prevalence and outcomes of neurologic deficit after RTSA and to evaluate the correlation between nonanatomic rearrangement of the shoulder joint and neurologic complications after RTSA. We hypothesized that the neurologic deficit was associated with excessive distalization or lateralization of the humerus after RTSA. METHODS RTSA was performed on 182 consecutive shoulders with cuff tear arthropathy. Comparative analysis was performed on 34 shoulders with (group 1) and 148 shoulders without (group 2) neurologic deficit. RESULTS The mean follow-up period in the study was 58.5 months (range: 24-124). The mean age was 71.5 ± 7.7 years in group 1 and 73.1 ± 7.2 years in group 2. Neurologic deficit after RTSA was found in 34 shoulders (19%). The mean postoperative acromiohumeral distance was 34.1 ± 11.0 mm in group 1 and 29.4 ± 7.6 mm in group 2 (P = .015). Significant differences in terms of postoperative distalization of the humerus were seen between group 1 (24.5 ± 9.4 mm) and group 2 (20.5 ± 8.3 mm) (P = .009). The most common forms of neurologic deficit after RTSA were axillary nerve (41.2%) and radial nerve (15%) injuries. Thirty shoulders (88%) had neuropraxia, and 4 shoulders (12%) had axonotmesis. By conservative treatment, all patients with neurologic complications achieved complete recovery without any additional surgery; the mean recovery period was 7.4 months (range: 2-38 months). CONCLUSION Neurologic deficit occurred in 19% of patients who underwent RTSA, and it was significantly correlated with humeral distalization after surgery. Axillary nerve was mostly involved, and all patients with neurologic deficit achieved complete recovery without any additional surgery.
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Affiliation(s)
- Hwan Jin Kim
- Shoulder & Elbow Clinic. Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Tae Yoon Kwon
- Shoulder & Elbow Clinic. Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yoon Sang Jeon
- Department of Orthopaedic Surgery, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Se Gu Kang
- Shoulder & Elbow Clinic. Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic. Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sung-Min Rhee
- Shoulder & Elbow Clinic. Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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17
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The precision of patient-specific instrumentation guides for the positioning of the glenoid component in total reverse shoulder arthroplasty: an in vivo scanographic study. INTERNATIONAL ORTHOPAEDICS 2020; 44:1761-1766. [DOI: 10.1007/s00264-020-04524-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
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18
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Roche C, DiGeorgio C, Yegres J, VanDeven J, Stroud N, Flurin PH, Wright T, Cheung E, Zuckerman JD. Impact of screw length and screw quantity on reverse total shoulder arthroplasty glenoid fixation for 2 different sizes of glenoid baseplates. JSES OPEN ACCESS 2019; 3:296-303. [PMID: 31891029 PMCID: PMC6928260 DOI: 10.1016/j.jses.2019.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Little 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. Methods Testing 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. Results Both 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. Discussion For 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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Affiliation(s)
| | | | | | | | | | | | - Thomas Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
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19
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Nashikkar PS, Scholes CJ, Haber MD. Role of intraoperative navigation in the fixation of the glenoid component in reverse total shoulder arthroplasty: a clinical case-control study. J Shoulder Elbow Surg 2019; 28:1685-1691. [PMID: 31262637 DOI: 10.1016/j.jse.2019.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/28/2019] [Accepted: 03/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fixation of the glenoid baseplate in reverse total shoulder arthroplasty (rTSA) is an important factor in the success of the procedure. There is limited information available regarding the effect of navigation on fixation characteristics. Therefore, the aims of this study were to determine whether computed tomography-based computer navigation improved the glenoid base plate fixation by (1) increasing the length of screw purchase, (2) altering screw angulation, and (3) decreasing central cage perforation in patients undergoing rTSA. METHODS Patients undergoing rTSAs using navigation (NAV, N = 27) and manual technique (MAN, N = 23) from January 2014 to July 2017 were analyzed in a case-control design. Screw purchase length and central cage perforation were assessed using multiplanar computed tomography. RESULTS Median screw purchase length was significantly longer in the NAV group for both anterior (20 mm vs. 15 mm, P < .01) and posterior screws (20 mm vs. 13 mm, P < .01). In addition, the NAV group displayed significantly lower incidences of inadequate screw purchase (<22 mm) for the anterior (64.7% vs. 95.2%, P = .03) and posterior (70.6% vs. 100%, P = .01) screws. Significant differences in axial and coronal screw angulation were observed between groups. Similarly, the NAV group displayed significantly reduced incidence of central cage perforation (17.7% vs. 52.4%, P = .04). CONCLUSION The use of computer-assisted navigated rTSA contributes to significant alterations in screw purchase length, screw angulation, and central cage perforation of the glenoid baseplate compared with non-navigated methods.
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Affiliation(s)
| | | | - Mark D Haber
- Southern Orthopaedics, Wollongong, NSW, Australia.
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20
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Barrett I, Ramakrishnan A, Cheung E. Safety and Efficacy of Intraoperative Computer-Navigated Versus Non-Navigated Shoulder Arthroplasty at a Tertiary Referral. Orthop Clin North Am 2019; 50:95-101. [PMID: 30477710 DOI: 10.1016/j.ocl.2018.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Emerging technologies in shoulder arthroplasty, such as 3-dimensional planning software and real-time intraoperative navigation, are now available for surgeons to perform more accurate placement of the glenoid component without malposition or perforation. Using these tools, the surgeon can visualize the version, inclination, and containment of the implant and determine whether augmented components would be necessary. This review provides an updated investigation of the present literature to elucidate the role of computer navigation in modern shoulder arthroplasty.
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Affiliation(s)
- Ian Barrett
- Department of Orthopedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94062, USA.
| | - Anna Ramakrishnan
- Department of Orthopedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94062, USA
| | - Emilie Cheung
- Department of Orthopedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94062, USA
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Lopiz Y, Rodriguez-González A, Martín-Albarrán S, Marcelo H, García-Fernández C, Marco F. Injury to the axillary and suprascapular nerves in rotator cuff arthropathy and after reverse shoulder arthroplasty: a prospective electromyographic analysis. J Shoulder Elbow Surg 2018; 27:1275-1282. [PMID: 29475786 DOI: 10.1016/j.jse.2017.12.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/08/2017] [Accepted: 12/26/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Neurologic pre- and postoperative injuries to the axillary and/or suprascapular nerve (SSN) have a higher incidence than expected and may lead to significantly decreased functional outcomes and increased risk of reverse shoulder arthroplasty (RSA) failure. METHODS Patients who underwent a RSA for rotator cuff tear arthropathy (RCTA) were included from December 2014 to December 2015. This study focused on the clinical (Constant score), radiographic, and pre- and postoperative electromyographic evaluations at 3 and 6 months. RESULTS Twenty patients met the inclusion criteria. One was lost to follow-up. Preoperatively, 15 patients showed changes on electromyography (9 SSN and 15 axillary nerve lesions); all of them were chronic and disuse injuries. The mean preoperative relative Constant score (rCS) of all included patients was 39 ± 9 (range, 19-64). At 3 months postsurgery, the prevalence of acute injuries for both nerves was 31.5%. At 6 months postsurgery, 2 axillary nerve injuries and 6 SSN injuries remain unchanged, and the rest improved or normalized. The mean postsurgery rCS of the entire cohort at 6-month follow-up was 78 ± 6.5. Mean postoperative rCS for acute postoperative nerve injury was 71 ± 3 for the axillary nerve and 64 ± 5 for SSN. CONCLUSIONS Axillary and SSN injuries in RCTA have a much higher incidence than expected. Most of these axillary lesions are transient, with an almost complete recovery seen on electromyography at 6 months and with scarce functional impact. However, SSN lesions appear to behave differently, with poor functional results and having a lower potential for a complete recovery.
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Affiliation(s)
- Yaiza Lopiz
- Department of Orthopaedic Surgery and Traumatology, Shoulder and Elbow Unit, Clínico San Carlos Hospital, Madrid, Spain; Surgery Department, Complutense University, Madrid, Spain.
| | - Alberto Rodriguez-González
- Department of Orthopaedic Surgery and Traumatology, Shoulder and Elbow Unit, Clínico San Carlos Hospital, Madrid, Spain
| | - Susana Martín-Albarrán
- Department of Clinical Neurophysiology, Shoulder and Elbow Unit, Clínico San Carlos Hospital, Madrid, Spain
| | - Hector Marcelo
- Department of Orthopaedic Surgery and Traumatology, Shoulder and Elbow Unit, Clínico San Carlos Hospital, Madrid, Spain
| | - Carlos García-Fernández
- Department of Orthopaedic Surgery and Traumatology, Shoulder and Elbow Unit, Clínico San Carlos Hospital, Madrid, Spain
| | - Fernando Marco
- Department of Orthopaedic Surgery and Traumatology, Shoulder and Elbow Unit, Clínico San Carlos Hospital, Madrid, Spain; Surgery Department, Complutense University, Madrid, Spain
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22
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The risk of suprascapular and axillary nerve injury in reverse total shoulder arthroplasty: An anatomic study. Injury 2017; 48:2042-2049. [PMID: 28711169 DOI: 10.1016/j.injury.2017.06.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/21/2017] [Accepted: 06/26/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Implantation of a reverse total shoulder arthroplasty (rTSA) places the axillary and suprascapular nerves at risk. The aim of this anatomic study was to digitally analyse the location of these nerves in relation to bony landmarks in order to predict their path and thereby help to reduce the risk of neurological complications during the procedure. METHODS A total of 22 human cadaveric shoulder specimens were used in this study. The axillary and suprascapular nerves were dissected, and radiopaque threads were sutured onto the nerves without mobilizing the nerves from their native paths. Then, 3D X-ray scans of the specimens were performed, and the distance of the nerves to bony landmarks at the humerus and the glenoid were measured. RESULTS The distance of the inferior glenoid rim to the axillary nerve averaged 13.6mm (5.8-27.0mm, ±5.1mm). In the anteroposterior direction, the distance between the axillary nerve and the humeral metaphysis averaged 8.1mm (0.6-21.3mm, ±6.5mm). The distance of the glenoid centre to the suprascapular nerve passing point under the transverse scapular ligament measured 28.4mm (18.9-35.1mm, ±3.8mm) in the mediolateral direction and 10.8mm (-4.8 to 25.3mm, ±6.1mm) in the anteroposterior direction. The distance to the spinoglenoid notch was 16.6mm (11.1-24.9mm, ±3.4mm) in the mediolateral direction and -11.8mm posterior (-19.3 to -4.7mm, ±4.7mm) in the anteroposterior direction. CONCLUSIONS Implantation of rTSA components endangers the axillary nerve because of its proximity to the humeral metaphysis and the inferior glenoid rim. Posterior and superior drilling and extraosseous screw placement during glenoid baseplate implantation in rTSA place the suprascapular nerve at risk, with safe zones to the nerve passing the spinoglenoid notch of 11mm and to the suprascapular notch of 19mm.
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23
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Glenoid morphology and the safe zone for protecting the suprascapular nerve during baseplate fixation in reverse shoulder arthroplasty. INTERNATIONAL ORTHOPAEDICS 2017; 42:587-593. [PMID: 28956117 DOI: 10.1007/s00264-017-3646-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to investigate glenoid morphology and define the safe zone for protecting the suprascapular nerve baseplate screw during baseplate fixation in reverse shoulder arthroplasty (RSA) in a Chinese population. METHODS Shoulder computed tomography (CT) scans from 56 subjects were retrospectively reviewed. Three-dimensional (3D) reconstruction was performed using Mimics software, and corresponding bony references were used to evaluate glenoid morphology. To standardize evaluation, the coronal scapular plane was defined. Safe fixation distances and screw placements were investigated by constructing a simulated cutting plane of the baseplate during RSA. RESULTS Mean glenoid height was 35.83 ± 2.95 mm, and width was 27.32 ± 2.78 mm, with significant sexual dimorphism (p < 0.01). According to the cutting plane morphology, the average baseplate radius was 13.84 ± 1.34 mm. The distances from the suprascapular notch and from two bony reference points at the base of the scapular spine to the cutting plane were 30.27 ± 2.77 mm, 18.39 ± 1.67 mm and 16.52 ± 1.52 mm, respectively, with a gender-related difference. Based on the clock face indication system, the danger zone caused by the suprascapular nerve projection was oriented between the two o'clock and eight o'clock positions in reference to the right shoulder. CONCLUSIONS Glenoid size and the safe zone for screw fixation during RSA were characterized in a Chinese population. Careful consideration of baseplate fixation and avoidance of suprascapular nerve injury are important for improved clinical outcome.
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Wagner ER, Welp K, Chang MJ, Woodmass JM, Borque KA, Warner JJ. Common pain generators after total shoulder arthroplasty and their pesky relatives. ACTA ACUST UNITED AC 2017. [DOI: 10.1053/j.sart.2017.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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Mathews S, Burkhard M, Serrano N, Link K, Häusler M, Frater N, Franke I, Bischofberger H, Buck FM, Gascho D, Thali M, Serowy S, Müller-Gerbl M, Harper G, Qureshi F, Böni T, Bloch HR, Ullrich O, Rühli FJ, Eppler E. Glenoid morphology in light of anatomical and reverse total shoulder arthroplasty: a dissection- and 3D-CT-based study in male and female body donors. BMC Musculoskelet Disord 2017; 18:9. [PMID: 28068966 PMCID: PMC5223371 DOI: 10.1186/s12891-016-1373-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 12/19/2016] [Indexed: 11/19/2022] Open
Abstract
Background Placement of the glenoid baseplate is of paramount importance for the outcome of anatomical and reverse total shoulder arthroplasty. However, the database around glenoid size is poor, particularly regarding small scapulae, for example, in women and smaller individuals, and is derived from different methodological approaches. In this multimodality cadaver study, we systematically examined the glenoid using morphological and 3D-CT measurements. Methods Measurements of the glenoid and drill hole tunnel length for superior baseplate screw placement were recorded to define size of the glenoid and the distance to the scapular notch on cadaveric specimens. Glenoid angles were determined on both, 3D-CT-scans of the thoraxes using the Friedman method and on subsequently isolated scapulae from 18 male and female donors (average 84 years, range 60–98 years). Results Mean glenoid height was 36.6 mm ± 3.6, and width 27.8 mm ± 3.1 with a significant sex dimorphism (p ≤ 0.001): in males, glenoid height 39.5 mm ± 3.5, and width 30.3 mm ± 3.3, and in females, glenoid height 34.8 mm ± 2.2, and width 26.2 mm ± 1.6. The average distance from the superior screw entry to its exit in the scapular notch measured by calliper was 27.2 mm ± 6.0 with a sex difference: in males, 29.4 mm ± 5.7, and in females, 25.8 mm ± 5.9 mm with a minimum recorded distance of 15 mm. Measured by CT, the mean inclination angle for male and female donors combined was 13.0° ± 7.0, and the ante-/retroversion angle −1.0° ± 4.0°. Conclusion This study is one of the first to combine dissection, including drill holes, with anatomical measurements and radiological data. In some women and smaller individuals, smaller baseplates should be selected. The published safe zone of 20 mm is generally feasible for superior screw placement, however, in small patients this distance may be substantially shorter than expected and start as of 13 and 15 mm, respectively. No correlation between glenoid height or width with the length of our drilling canal towards the scapular notch was found. Preoperative CT-based treatment planning to determine version and inclination angles is recommended.
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Affiliation(s)
- Sandra Mathews
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.
| | - Marco Burkhard
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Nabil Serrano
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.,Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Karl Link
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.,Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Martin Häusler
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.,Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Nakita Frater
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland
| | - Ingeborg Franke
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Helena Bischofberger
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Florian M Buck
- Medical Radiology Institute, Schulthess Clinic, Zurich, Switzerland.,Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Dominic Gascho
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Michael Thali
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Steffen Serowy
- Institute of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Magdalena Müller-Gerbl
- Musculoskeletal Research Unit, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Gareth Harper
- Shoulder Unit, Queen Alexandra Hospital, Portsmouth, UK
| | - Ford Qureshi
- Shoulder Unit, Doncaster Royal Infirmary, Doncaster, UK
| | - Thomas Böni
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.,Technical Orthopedics Unit, University Hospital Balgrist, Zurich, Switzerland
| | | | - Oliver Ullrich
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Frank-Jakobus Rühli
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland
| | - Elisabeth Eppler
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland.,Institute of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany.,Musculoskeletal Research Unit, Department of Biomedicine, University of Basel, Basel, Switzerland
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Neurological Complications Related to Elective Orthopedic Surgery: Part 1: Common Shoulder and Elbow Procedures. Reg Anesth Pain Med 2016; 40:431-42. [PMID: 26192546 DOI: 10.1097/aap.0000000000000178] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
UNLABELLED Many anesthesiologists are unfamiliar with the rate of surgical neurological complications of the shoulder and elbow procedures for which they provide local anesthetic-based anesthesia and/or analgesia. Part 1 of this narrative review series on neurological complications of elective orthopedic surgery describes the mechanisms and likelihood of peripheral nerve injury associated with some of the most common shoulder and elbow procedures, including open and arthroscopic shoulder procedures, elbow arthroscopy, and total shoulder and elbow replacement. Despite the many articles available, the overall number of studied patients is relatively low. Large prospective trials are required to establish the true incidence of neurological complications following elective shoulder and elbow surgery. WHAT'S NEW As the popularity of regional anesthesia increases with the development of ultrasound guidance, anesthesiologists should have a thoughtful understanding of the nerves at risk of surgical injury during elective shoulder and elbow procedures.
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Eraly K, Stoffelen D, Vander Sloten J, Jonkers I, Debeer P. A patient-specific guide for optimizing custom-made glenoid implantation in cases of severe glenoid defects: an in vitro study. J Shoulder Elbow Surg 2016; 25:837-45. [PMID: 26700554 DOI: 10.1016/j.jse.2015.09.034] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/21/2015] [Accepted: 09/29/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid component and screw malpositioning in cases of severe glenoid defects might result in complications. We examined the efficacy of a surgical method to treat severe glenoid defects, including a custom-made glenoid component and accurate screw positioning, using a patient-specific positioning guide. METHODS Glenoid defects were created in 10 cadaveric shoulders. Computed tomography images were used to plan reversed shoulder arthroplasty and design patient-specific glenoid components. A patient-specific positioning guide was designed for 5 specimens. The remaining 5 specimens were implanted without the guide. Computed tomography images were used to determine the postoperative glenoid component and screw positions. Differences from the preoperatively planned implant and screw positions were calculated. RESULTS The patient-specific positioning guide significantly reduced the angular deviations from the planned glenoid implant positioning (P < .05) and also significantly improved the positioning of the screws (P < .001). In the group without the guide, the average total intraosseous screw length was 52% of the ideal preoperatively planned length compared with 89% for the group with the guide. A strong correlation (r = -0.85) was found between the orientation of the implant and the postoperative total intraosseous screw length. CONCLUSIONS A patient-specific positioning guide significantly improves the position and fixation of a custom-made glenoid component in cases of severe glenoid defects.
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Affiliation(s)
- Koen Eraly
- Department of Mechanical Engineering, Katholieke Universiteit Leuven, Heverlee, Belgium; R&D Department, Mobelife, Heverlee, Belgium
| | - Danny Stoffelen
- Orthopaedics, GasthuisZusters Antwerpen (GZA) St Augustinus Hospital, Wilrijk, Belgium
| | - Jos Vander Sloten
- Department of Mechanical Engineering, Katholieke Universiteit Leuven, Heverlee, Belgium
| | - Ilse Jonkers
- Department of Kinesiology, Katholieke Universiteit Leuven, Heverlee, Belgium
| | - Philippe Debeer
- Orthopaedics, University Hospitals Leuven and Department of Development and Regeneration, Katholieke Universiteit Leuven, Pellenberg, Belgium.
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Mayne IP, Bell SN, Wright W, Coghlan JA. Acromial and scapular spine fractures after reverse total shoulder arthroplasty. Shoulder Elbow 2016; 8:90-100. [PMID: 27583005 PMCID: PMC4950466 DOI: 10.1177/1758573216628783] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/04/2016] [Indexed: 11/16/2022]
Abstract
Acromial and scapular spine fractures after reverse total shoulder arthroplasty occur predominantly as a result of bony insufficiency secondary to patient and intra-operative technical factors. The spectrum of the pathology can range from a stress reaction to an undisplaced or displaced fracture. Prompt diagnosis of these fractures requires a high suspicion in the postoperative patient with a clinical presentation of acute onset of pain along the acromion or scapular spine and/or deterioration of shoulder function. Conventional shoulder radiographs are frequently unreliable in identifying these fractures, especially if they are undisplaced. Computed tomography (CT) and/or single photon emission computed tomography/CT scans are useful imaging modalities for obtaining a definitive diagnosis. Early diagnosis and non-operative treatment of a stress reaction or undisplaced fracture is essential for preventing further displacement and potential disability. The management of displaced fractures is challenging for the orthopaedic surgeon as a result of high rates of mal-union or non-union, decreased functional outcomes, and variable results after open reduction and internal fixation. Strategies for preventing these fractures include optimizing the patient's bone health, correct glenoid baseplate screw length and position, and avoiding excessive deltoid tension. Further research is required to identify the specific patient and fracture characteristics that will benefit from conservative versus operative management.
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Affiliation(s)
- Ian P Mayne
- Department of Surgery, Melbourne Shoulder and Elbow Centre, Monash University, Melbourne, Australia,Ian Mayne, Melbourne Shoulder & Elbow Centre, 31 Normanby Street, Brighton, VIC 3186, Australia. Tel: +61 4 1018 2635.
| | - Simon N Bell
- Department of Surgery, Melbourne Shoulder and Elbow Centre, Monash University, Melbourne, Australia
| | | | - Jennifer A Coghlan
- Department of Surgery, Melbourne Shoulder and Elbow Centre, Monash University, Melbourne, Australia
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Stephens BF, Hebert CT, Azar FM, Mihalko WM, Throckmorton TW. Optimal baseplate rotational alignment for locking-screw fixation in reverse total shoulder arthroplasty: a three-dimensional computer-aided design study. J Shoulder Elbow Surg 2015; 24:1367-71. [PMID: 25819730 DOI: 10.1016/j.jse.2015.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/19/2015] [Accepted: 01/21/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Baseplate loosening in reverse total shoulder arthroplasty (RTSA) remains a concern. Placing peripheral screws into the 3 pillars of the densest scapular bone is believed to optimize baseplate fixation. Using a 3-dimensional computer-aided design (3D CAD) program, we investigated the optimal rotational baseplate alignment to maximize peripheral locking-screw purchase. METHODS Seventy-three arthritic scapulae were reconstructed from computed tomography images and imported into a 3D CAD software program along with representations of an RTSA baseplate that uses 4 fixed-angle peripheral locking screws. The baseplate position was standardized, and the baseplate was rotated to maximize individual and combined peripheral locking-screw purchase in each of the 3 scapular pillars. RESULTS The mean ± standard error of the mean positions for optimal individual peripheral locking-screw placement (referenced in internal rotation) were 6° ± 2° for the coracoid pillar, 198° ± 2° for the inferior pillar, and 295° ± 3° for the scapular spine pillar. Of note, 78% (57 of 73) of the screws attempting to obtain purchase in the scapular spine pillar could not be placed without an in-out-in configuration. In contrast, 100% of coracoid and 99% of inferior pillar screws achieved full purchase. The position of combined maximal fixation was 11° ± 1°. CONCLUSIONS These results suggest that approximately 11° of internal rotation is the ideal baseplate position for maximal peripheral locking-screw fixation in RTSA. In addition, these results highlight the difficulty in obtaining optimal purchase in the scapular spine.
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Affiliation(s)
- Byron F Stephens
- University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA
| | - Casey T Hebert
- University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA
| | - Frederick M Azar
- University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA
| | - William M Mihalko
- University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA
| | - Thomas W Throckmorton
- University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA.
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Ackland DC, Patel M, Knox D. Prosthesis design and placement in reverse total shoulder arthroplasty. J Orthop Surg Res 2015; 10:101. [PMID: 26135298 PMCID: PMC4493953 DOI: 10.1186/s13018-015-0244-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/22/2015] [Indexed: 12/13/2022] Open
Abstract
The management of irreparable rotator cuff tears associated with osteoarthritis of the glenohumeral joint has long been challenging. Reverse total shoulder arthroplasty (RSA) was designed to provide pain relief and improve shoulder function in patients with severe rotator cuff tear arthropathy. While this procedure has been known to reduce pain, improve strength and increase range of motion in shoulder elevation, scapular notching, rotation deficiency, early implant loosening and dislocation have attributed to complication rates as high as 62%. Patient selection, surgical approach and post-operative management are factors vital to successful outcome of RSA, with implant design and component positioning having a significant influence on the ability of the shoulder muscles to elevate, axially rotate and stabilise the humerus. Clinical and biomechanical studies have revealed that component design and placement affects the location of the joint centre of rotation and therefore the force-generating capacity of the muscles and overall joint mobility and stability. Furthermore, surgical technique has also been shown to have an important influence on clinical outcome of RSA, as it can affect intra-operative joint exposure as well as post-operative muscle function. This review discusses the behaviour of the shoulder after RSA and the influence of implant design, component positioning and surgical technique on post-operative joint function and clinical outcome.
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Affiliation(s)
- David C Ackland
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Minoo Patel
- Epworth Healthcare, Richmond, Victoria, 3121, Australia
| | - David Knox
- Epworth Healthcare, Richmond, Victoria, 3121, Australia
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Benefit of intraoperative navigation on glenoid component positioning during total shoulder arthroplasty. Arch Orthop Trauma Surg 2015; 135:41-7. [PMID: 25450305 DOI: 10.1007/s00402-014-2126-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The objective of this study was to review and synthesize the current best evidence for the use of intraoperative navigation in the implantation of glenoid components in total shoulder prostheses. METHODS We conducted a systematic, online search using PubMed, EMBASE, CCTR, and CINAHL using "Arthroplasty, Replacement"(Mesh) AND (shoulder) AND (navi* OR computer). Data on study design and quality as well as accuracy of positioning and complications were extracted independently and in duplicate. After assessment of study heterogeneity, DerSimonian-Laird random effect models were used to pool data from the individual studies. RESULTS The systematic search revealed 359 manuscripts in total. After exclusion of duplicates and irrelevant publications, 6 groups of 247 shoulders from 5 studies were included. The pooled weighted mean difference for deviation from neutral version was -6.4° (95 %CI -7.9 to -5.3) in favor of navigation, which is consistent with a statistically significant difference (p < 0.01). In the navigation group, 2 superior glenoid screws were reported as perforating compared to 5 screws (1 inferior, 4 superior) in the control group. There was no difference in tilt at a WMD of 2.7 (95 %CI -1.4 to 6.8, p = 0.192). CONCLUSIONS Navigation allows for significantly more accurate glenoid version, but the clinical meaningfulness of the absolute improvement over standard techniques is questionable. However, navigation is a valuable teaching tool that might prove very beneficial not for the patient at hand, but for those treated by the operating surgeon in the future. LEVEL OF EVIDENCE Level II-meta-analysis of non-homogenous controlled trials.
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Wiater BP, Moravek JE, Wiater JM. The evaluation of the failed shoulder arthroplasty. J Shoulder Elbow Surg 2014; 23:745-58. [PMID: 24618199 DOI: 10.1016/j.jse.2013.12.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 12/04/2013] [Accepted: 12/05/2013] [Indexed: 02/01/2023]
Abstract
As the incidence of shoulder arthroplasty continues to rise, the orthopedic shoulder surgeon will be increasingly faced with the difficult problem of evaluating a failed shoulder arthroplasty. The patient is usually dissatisfied with the outcome of the previous arthroplasty as a result of pain, but may complain of poor function due to limited range of motion or instability. A thorough and systematic approach is necessary so that the most appropriate treatment pathway can be initiated. A comprehensive history and physical examination are the first steps in the evaluation. Diagnostic studies are numerous and include laboratory values, plain radiography, computed tomography, ultrasound imaging, joint aspiration, nuclear scans, and electromyography. Common causes of early pain after shoulder arthroplasty include technical issues related to the surgery, such as malposition or improper sizing of the prosthesis, periprosthetic infection, neurologic injury, and complex regional pain syndrome. Pain presenting after a symptom-free interval may be related to chronic periprosthetic infection, component wear and loosening, glenoid erosion, rotator cuff degeneration, and fracture. Poor range of motion may result from inadequate postoperative rehabilitation, implant-related factors, and heterotopic ossification. Instability is generally caused by rotator cuff deficiency and implant-related factors. Unfortunately, determining the cause of a failed shoulder arthroplasty can be difficult, and in many situations, the source of pain and disability is multifactorial.
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Affiliation(s)
- Brett P Wiater
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA
| | | | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA; Department of Orthopaedic Surgery, Oakland University-William Beaumont School of Medicine, Rochester Hills, MI, USA.
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Hart ND, Clark JC, Wade Krause FR, Kissenberth MJ, Bragg WE, Hawkins RJ. Glenoid screw position in the Encore Reverse Shoulder Prosthesis: an anatomic dissection study of screw relationship to surrounding structures. J Shoulder Elbow Surg 2013; 22:814-20. [PMID: 23158042 DOI: 10.1016/j.jse.2012.08.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 07/30/2012] [Accepted: 08/16/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fixation of the baseplate to the glenoid for the Reverse Shoulder Prosthesis (DJO Surgical, Austin, TX, USA) requires secure screw purchase to avoid excessive micromotion and baseplate failure. The best screw length for fixation is unknown. In addition, excessively long screws or a plunge of the drill bit during baseplate insertion could injure surrounding structures. METHODS Reverse Shoulder Prosthesis baseplates were inserted in 10 fresh-frozen shoulders by use of a 6.5-mm central screw and four 5.0-mm peripheral locking screws placed 90° to the baseplate. The top superior screw was placed into the base of the coracoid, corresponding to the 1-o'clock position in a right shoulder. The distances to surrounding vital structures were recorded, screws were removed, and screw hole lengths were measured to determine the most effective lengths in different parts of the glenoid scapula. RESULTS The screw length was 30 mm for the superior screw holes, 28 mm for the inferior screw holes, 13 mm for the anterior screw holes, and 15 mm for the posterior screw holes. The central screw trajectory was through the anterior cortex. The anterior screw trajectory violated the subscapularis belly in all specimens. The posterior screw touched the suprascapular nerve or artery in 3 of 10 specimens. DISCUSSION The superior and inferior screws have the longest bony fixation. Drill bit plunge during placement of the anterior screw poses a risk to the subscapularis muscle. Drilling for the posterior screw risks injury to the suprascapular nerve and artery at the spinoglenoid notch. CONCLUSIONS The posterior screw should be placed with care to avoid neurovascular complications.
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Affiliation(s)
- Nathan D Hart
- Permanente Medical Group, Department of Orthopaedics, Walnut Creek, CA, USA
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