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Healy KM, Ritter J, Barr E, Churchill JL, Trasolini NA, Waterman BR, Reynolds AW. Osteoporosis Management for Shoulder Surgeons. Curr Rev Musculoskelet Med 2024:10.1007/s12178-024-09927-6. [PMID: 39276194 DOI: 10.1007/s12178-024-09927-6] [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] [Accepted: 09/09/2024] [Indexed: 09/16/2024]
Abstract
PURPOSE OF REVIEW The aim of this review is to aggregate currently available literature as it pertains to treating surgical shoulder pathology in patients with osteoporosis. RECENT FINDINGS Emerging data surrounding perioperative use of anti-osteoporosis medications for patients undergoing shoulder surgery have not shown definitively favorable or unfavorable outcomes. Similar evaluations in animal studies have shown promising results as a biologic augment to tendon and bone healing, especially with newer, anabolic agents. The mainstay of bone health management remains pre-operative evaluation, using opportunistic radiographic and CT based validated measurements, along with optimization of risk factors. Surgical techniques continue to incorporate implants that perform well in osteopenic bone. Promising pre-clinical studies have identified anabolic anti-osteoporosis medications as viable biologic augments to shoulder surgery, which has not been borne out in any clinical studies at this time.
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Affiliation(s)
- Kelsey M Healy
- Department of Orthopaedic Surgery and Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Jacob Ritter
- Campbell University School of Osteopathic Medicine, Lillington, USA
| | - Emily Barr
- Department of Orthopaedic Surgery and Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, USA
| | | | - Nicholas A Trasolini
- Department of Orthopaedic Surgery and Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Brian R Waterman
- Department of Orthopaedic Surgery and Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Alan W Reynolds
- Department of Orthopaedic Surgery and Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, USA.
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Rolf O, Blana A, Hagedorn P. Implantation of Reverse Shoulder Endoprothesis Using Navigation. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024. [PMID: 39251203 DOI: 10.1055/a-2346-9916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
The implantation of a reverse shoulder arthroplasty (RSA) is a proven method for pain relief and improvement in shoulder function. Results vary, depending on the patient's age, the severity of the disease, and the experience of the surgeon. Indications for RSA are diverse, ranging from rotator cuff arthropathy to fractures. Recent studies show improved survival rates and reduced complications after primary implantation. Preoperative planning using 3D-CT or MRI is considered to be the gold standard. Patient-specific instruments (PSI) have been introduced, but are associated with costs and waiting times. Navigation with augmented reality (AR) provides a more efficient alternative. The intraoperative transfer of the plan to the patient is carried out via AR glasses, allowing real-time information without having to divert the surgeon's attention from the surgical site. This optimises the workflow and potentially yields more precise implantation results. In summary, the combination of 3D planning, navigation, and AR offers a promising method for precise and efficient RSA-implantations. Nevertheless, long-term results and functional scores are not yet available.
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Affiliation(s)
- Olaf Rolf
- Franziskus-Hospital Harderberg, Department for Orthopedics and Traumatology, Niels-Stensen-Kliniken GmbH, Georgsmarienhütte, Deutschland
| | - Andreas Blana
- Franziskus-Hospital Harderberg, Department for Orthopedics and Traumatology, Niels-Stensen-Kliniken GmbH, Georgsmarienhütte, Deutschland
| | - Philipp Hagedorn
- Franziskus-Hospital Harderberg, Department for Orthopedics and Traumatology, Niels-Stensen-Kliniken GmbH, Georgsmarienhütte, Deutschland
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Rocha Motta Filho GD, Amaral MV, Cohen M, Carvalho MSDS, Fonseca RSD, Oliveira ACLD. Comparison of Manual Two-dimensional and Automated Three-dimensional Methods of Assessing Shoulder Joint Morphology through Computed Tomography Images. Rev Bras Ortop 2024; 59:e590-e598. [PMID: 39239582 PMCID: PMC11374392 DOI: 10.1055/s-0044-1786821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/05/2024] [Indexed: 09/07/2024] Open
Abstract
Objective To evaluate the interobserver agreement in the measurement of anatomical parameters of the shoulder using manual methods of two-dimensional (2D) computed tomography (CT) unformatted in the plane of the scapula and to compare them with the automated measurement obtained through the Blueprint (Wright Medical, Memphis, TN, United States) software, which uses reconstructed three-dimensional (3D) images. Methods The present is a cross-sectional study in which 2D CT images of 38 patients with different diagnoses were used. The anatomical parameters were measured by the manual methods described by Friedman et al., the glenoid vault method, the Maurer et al. method, and shoulder subluxation according to Walch et al., by five independent qualified surgeons and compared with the parameters obtained through the Blueprint automated software. Results Significant differences were found between the manual measurement version obtained through the Friedman et al. method and the automated version. The mean values found for inclination did not show statistically significant differences among the methods. The mean value found for subluxation showed significant differences between the average observed in the analyses performed by the automated method and those performed by the surgeons. Conclusion The manual measurements of glenoid version and inclination performed by experienced surgeons are effective, and the vault method is superior to the Friedman et al. method in the analysis of severe glenoid deformities.
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Affiliation(s)
- Geraldo da Rocha Motta Filho
- Centro de Cirurgia de Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
- Divisão de Traumatologia e Ortopedia (DITRO), Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | - Marcus Vinícius Amaral
- Centro de Cirurgia de Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
- Divisão de Traumatologia e Ortopedia (DITRO), Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | - Márcio Cohen
- Centro de Cirurgia de Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | | | - Raphael Soares da Fonseca
- Centro de Cirurgia de Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
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Berhouet J, Samargandi R. Emerging Innovations in Preoperative Planning and Motion Analysis in Orthopedic Surgery. Diagnostics (Basel) 2024; 14:1321. [PMID: 39001212 PMCID: PMC11240316 DOI: 10.3390/diagnostics14131321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/15/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024] Open
Abstract
In recent years, preoperative planning has undergone significant advancements, with a dual focus: improving the accuracy of implant placement and enhancing the prediction of functional outcomes. These breakthroughs have been made possible through the development of advanced processing methods for 3D preoperative images. These methods not only offer novel visualization techniques but can also be seamlessly integrated into computer-aided design models. Additionally, the refinement of motion capture systems has played a pivotal role in this progress. These "markerless" systems are more straightforward to implement and facilitate easier data analysis. Simultaneously, the emergence of machine learning algorithms, utilizing artificial intelligence, has enabled the amalgamation of anatomical and functional data, leading to highly personalized preoperative plans for patients. The shift in preoperative planning from 2D towards 3D, from static to dynamic, is closely linked to technological advances, which will be described in this instructional review. Finally, the concept of 4D planning, encompassing periarticular soft tissues, will be introduced as a forward-looking development in the field of orthopedic surgery.
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Affiliation(s)
- Julien Berhouet
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Régional Universitaire (CHRU) de Tours, 1C Avenue de la République, 37170 Chambray-les-Tours, France
- Equipe Reconnaissance de Forme et Analyse de l'Image, Laboratoire d'Informatique Fondamentale et Appliquée de Tours EA6300, Ecole d'Ingénieurs Polytechnique Universitaire de Tours, Université de Tours, 64 Avenue Portalis, 37200 Tours, France
| | - Ramy Samargandi
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Régional Universitaire (CHRU) de Tours, 1C Avenue de la République, 37170 Chambray-les-Tours, France
- Department of Orthopedic Surgery, Faculty of Medicine, University of Jeddah, Jeddah 23218, Saudi Arabia
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Meeker DG, Bozoghlian MF, Hartog TD, Corlette J, Nepola JV, Patterson BM. Rate of incidental findings on routine preoperative computed tomography for shoulder arthroplasty. Clin Shoulder Elb 2024; 27:169-175. [PMID: 38556913 PMCID: PMC11181057 DOI: 10.5397/cise.2023.00836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/18/2023] [Accepted: 12/17/2023] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Incidental findings are commonly noted in advanced imaging studies. Few data exist regarding the rate of incidental findings on computed tomography (CT) for preoperative shoulder arthroplasty planning. This study aims to identify the incidence of these findings and the rate at which they warrant further work-up to help guide orthopedic surgeons in counseling patients. METHODS A retrospective review was performed to identify patients with available preoperative shoulder CT who subsequently underwent shoulder arthroplasty procedures at a single institution between 2015 and 2021. Data including age, sex, and smoking status were obtained. Radiology reports for CTs were reviewed for incidental findings and categorized based on location, tissue type, and/or body system. The rate of incidental findings and the rate at which further follow-up was recommended by the radiologist were determined. RESULTS A total of 617 patients was identified. There were 173 incidental findings noted in 146 of these patients (23.7%). Findings ranged from pulmonary (59%), skin/soft tissue (16%), thyroid (13%), vascular (9%), spinal (2%), and abdominal (1%) areas. Of the pulmonary findings, 50% were pulmonary nodules and 47% were granulomatous disease. Overall, the final radiology report recommended further follow-up for 50% of the patients with incidental findings. CONCLUSIONS Incidental findings are relatively common in preoperative CTs obtained for shoulder arthroplasty, occurring in nearly one-quarter of patients. Most of these findings are pulmonary in nature. Overall, half of the patients with incidental findings were recommended for further follow-up. These results establish population data to guide orthopedic surgeons in patient counseling. Level of evidence: III.
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Affiliation(s)
- Daniel G. Meeker
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Maria F. Bozoghlian
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Taylor Den Hartog
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Jill Corlette
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - James V. Nepola
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Brendan M. Patterson
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
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Werner BC, Lin A, Lenters TR, Lutton D, Creighton RA, Port J, Doody S, Metcalfe N, Knopf D. Influence of backside seating parameters and augmented baseplate components in virtual planning for reverse shoulder arthroplasty. J Shoulder Elbow Surg 2024; 33:1352-1359. [PMID: 38081473 DOI: 10.1016/j.jse.2023.10.024] [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: 07/22/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND The primary goal of this investigation was to examine the influence of a backside seating percentage variable on volume of reamed bone and contact area in virtual planning for glenoid baseplate placement for reverse total shoulder arthroplasty (RTSA). The secondary goal was to assess how the option of augmented glenoid baseplate components affected reamed volume and cortical contact area of virtually positioned baseplates. METHODS Nine surgeons virtually planned 30 RTSA cases using a commercially available software system. The 30 cases were chosen to span a spectrum of glenoid deformity. The study consisted of 3 phases. In phase 1, cases were planned with the backside seating percentage blinded and without the option of augmented baseplate components. In phase 2, the backside seating parameter was unblinded. In phase 3, augmented baseplate components were added as an option. Implant version and inclination were recorded. By use of computer-assisted design models, total volume of bone reamed, as well as reamed cortical volume and cancellous volume, was calculated. Total, cortical, and cancellous baseplate contact areas were also calculated. Finally, total glenoid lateralization was calculated for each phase and compared. RESULTS Mean implant version was clinically similar across phases but was statistically significantly lower in phase 3 (P = .006 compared with phase 1 and P = .001 compared with phase 2). Mean implant inclination was clinically similar across phases but was statistically significantly lower in phase 3 (P < .001). Phase 3 had statistically significantly lower cancellous and total reamed bone volumes compared with phase 1 and phase 2 (P < .001 for all comparisons). Phase 3 had statistically significantly larger cortical contact area, lower cancellous contact area, and larger total contact area compared with phase 1 and phase 2 (P < .001 for all comparisons). Phase 3 had significantly greater glenoid lateralization (mean, 10.5 mm) compared with phase 1 (mean, 7.8 mm; P < .001) and phase 2 (mean, 7.9 mm; P < .001). CONCLUSIONS Across a wide range of glenoid pathology during virtual surgical planning, experienced shoulder arthroplasty surgeons chose augmented baseplates frequently, and the option of a full-wedge augmented baseplate resulted in statistically significantly greater correction of glenoid deformity, improved total and cortical baseplate contact area, less cancellous reamed bone, and greater glenoid lateralization. Backside seating information does not have a significant impact on how glenoid baseplates are virtually positioned for RTSA, nor does it impact the baseplate contact area or volume of reamed bone.
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Affiliation(s)
| | - Albert Lin
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | - David Lutton
- Washington Circle Orthopaedic Associates, Washington, DC, USA
| | | | - Joshua Port
- University Orthopaedics Center, Altoona, PA, USA
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Bischofreiter M, Sacan E, Gattringer M, Gruber MS, Breulmann FL, Kindermann H, Heuberer P, Mattiassich G, Ortmaier R. The Value of Computed Tomography-Based Planning in Shoulder Arthroplasty Compared to Intra-/Interobserver Reliability of X-ray Planning. J Clin Med 2024; 13:2022. [PMID: 38610787 PMCID: PMC11012767 DOI: 10.3390/jcm13072022] [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: 03/07/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Reversed total shoulder arthroplasty (RTSA) is an established surgery for many pathologies of the shoulder and the demand continues to rise with an aging population. Preoperative planning is mandatory to support the surgeon's understanding of the patient's individual anatomy and, therefore, is crucial for the patient's outcome. Methods: In this observational study, we identified 30 patients who underwent RTSA with two- and three-dimensional preoperative planning. Each patient underwent new two-dimensional planning from a medical student and an orthopedic resident as well as through a mid-volume and high-volume shoulder surgeon, which was repeated after a minimum of 4 weeks. The intra- and interobserver reliability was then analyzed and compared to the 3D planning and the implanted prosthesis. The evaluated parameters were the size of the pegged glenoid baseplate, glenosphere, and humeral short stem. Results: The inter-rater reliability showed higher deviations in all four raters compared to the 3D planning of the base plate, glenosphere, and shaft. The intra-rater reliability showed a better correlation in more experienced raters, especially in the planning of the shaft. Conclusions: Our study shows that 3D planning is more accurate than traditional planning on plain X-rays, despite experienced shoulder surgeons showing better results in 2D planning than inexperienced ones.
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Affiliation(s)
- Martin Bischofreiter
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
| | - Edanur Sacan
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Michael Gattringer
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Michael S. Gruber
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Franziska L. Breulmann
- Department of Orthopedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Harald Kindermann
- Department of Marketing and Electronic Business, University of Applied Sciences Upper Austria, 4400 Steyr, Austria
| | | | - Georg Mattiassich
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
| | - Reinhold Ortmaier
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
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Saraglis G, Singh H, Charfare Z, Olujinmi GJ, Devecseri G, Agbaje A, Malal JG. Mid-term Results Following Reverse Shoulder Arthroplasty and the Role of Navigation in the Management of Glenoid Bone Loss. Cureus 2024; 16:e54633. [PMID: 38524053 PMCID: PMC10959506 DOI: 10.7759/cureus.54633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Background Inaccurate positioning of the glenoid component has been well described as the most common cause of early failure following a reverse shoulder arthroplasty (RSA). Among the latest developments in operative technique, three-dimensional preoperative planning and navigation intraoperative systems have been developed to improve the accuracy of the baseplate positioning during RSA. The primary purpose of this retrospective analysis was to investigate the mid-term results of patients who underwent an elective RSA or for acute highly comminuted proximal humerus fractures. The secondary goal was to investigate the role of navigation in the execution of preoperative planning, especially in the management of glenoid bone loss. Methodology In total, 101 cases were included in this study. Patients were divided into the following two groups: 88 cases of RSA performed without the use of navigation (conventional RSA) and 13 cases performed using intraoperative navigation (navigated RSA). For all patients included in the study, preoperative planning software was employed. Patient demographics, gender, past medical history, indication of procedure, operated site, type of glenoid component used, length of baseplate screws, and clinical assessment scores (Oxford Shoulder Score, OSS) were reported for all patients. Cases of revision shoulder arthroplasty were excluded from this study. Results The postoperative clinical assessment of patients revealed that following RSA, all patients improved significantly with a consistently upward trend of the OSS noted for both groups (conventional and navigated RSA) throughout the postoperative assessment. Despite no statistically significant difference detected, the clinical scores of the navigated RSA group outperformed those of the conventional RSA group in the postoperative period. A higher incidence of augmented baseplate use was noted in the navigated RSA group than in the conventional group (23.07% vs. 5.68%, p < 0.001). Conclusions Our results indicate that the use of intraoperative navigation appears to be a valuable tool in preoperative planning, providing accurate positioning of the baseplate, a better understanding of the glenoid anatomy, and real-time monitoring of the length and direction of the baseplate screws. It is difficult to conclude if the use of navigation leads to superior clinical outcomes, and the cost-effectiveness of its use needs to be further analyzed. Prospective randomized trials are required to assess the cost-effectiveness of routine use of navigation in RSA.
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Affiliation(s)
- Georgios Saraglis
- Orthopaedics and Trauma, Bedfordshire Hospitals NHS Foundation Trust, Bedford, GBR
| | - Hamdip Singh
- Orthopaedics and Trauma, Bedfordshire Hospitals NHS Foundation Trust, Bedford, GBR
| | - Zain Charfare
- Orthopaedics and Trauma, Bedfordshire Hospitals NHS Foundation Trust, Bedford, GBR
| | | | - Gertrud Devecseri
- Orthopaedics and Trauma, Bedfordshire Hospitals NHS Foundation Trust, Bedford, GBR
| | - Adeniyi Agbaje
- Orthopaedics and Trauma, Bedfordshire Hospitals NHS Foundation Trust, Bedford, GBR
| | - Joby George Malal
- Orthopaedics and Trauma, Bedfordshire Hospitals NHS Foundation Trust, Bedford, GBR
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Andro C, Garraud C, Deransart P, Stindel E, Letissier H, Dardenne G. Orientation of the Scapula in the Standing Position. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:375-383. [PMID: 37987527 DOI: 10.1002/jum.16370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/15/2023] [Accepted: 10/22/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES A new ultrasound-based device is proposed to non-invasively measure the orientation of the scapula in the standing position to consider this parameter for Total Shoulder Arthroplasty. The aim of this study was to assess the accuracy and reliability of this device. METHODS Accuracy was assessed by comparing measurements made with the ultrasound device to those acquired with a three-dimensional (3D) optical localization system (Northern Digital, Canada) on a dedicated mechanical phantom. Three users performed 10 measurements on three healthy volunteers with different body mass (BMI) indices to analyze the reliability of the device by measuring the intra and interobserver variabilities. RESULTS The mean accuracy of the device was 0.9°± 0.7 (0.01-3.03), 1.3°± 0.8 (0.03-4.55), 1.9°± 1.5 (0.05-5.76), respectively, in the axial, coronal, and sagittal planes. The interobserver and intraobserver variabilities were excellent whatever the BMI and the users experience. CONCLUSIONS The device is accurate and reliable enough for the measurement of the scapula orientation in the standing position.
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Affiliation(s)
- Christophe Andro
- LaTIM, Inserm, Brest, France
- Hôpital d'Instruction des Armées Clermont, Brest, France
| | | | | | - Eric Stindel
- LaTIM, Inserm, Brest, France
- CHU Brest, Brest, France
- Université de Bretagne Occidentale (UBO), Brest, France
| | - Hoel Letissier
- LaTIM, Inserm, Brest, France
- CHU Brest, Brest, France
- Université de Bretagne Occidentale (UBO), Brest, France
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Dalmas Y, Thélu CE, Laumonerie P, Mathieu E, Robert S, Mansat P, Bonnevialle N. The arthroscopic double-button Latarjet does not modify the static posterior translation of the humeral head. Orthop Traumatol Surg Res 2024; 110:103662. [PMID: 37460084 DOI: 10.1016/j.otsr.2023.103662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/16/2023] [Accepted: 05/10/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION The Latarjet procedure treats anterior instability of the shoulder and is based on a triple anterior lock, where the conjoint tendon straps the lower third of the subscapularis muscle. Excessive posterior translation of the humeral head is a known risk factor for shoulder osteoarthritis. No in vivo study has investigated the effect of the bone block on the posterior static translation of the humeral epiphysis. The purpose of this study was to evaluate the effect of the bone block on the static posterior translation of the humeral head. The hypothesis was that this procedure increased this translation. MATERIALS AND METHODS This retrospective study included patients treated arthroscopically for anterior shoulder instability by a double-button Latarjet. An independent examiner analyzed the CT scans preoperatively, at 15 days, and at least 6 months postoperatively according to a standardized protocol. The analysis focused on the position of the bone block in the axial and coronal planes relative to the glenoid. The posterior translation was automatically calculated using the Blueprint© planning software. RESULTS Thirty-five patients were included with a mean age of 25 years (16-43), according to a 4M/1F sex ratio. The graft was perfectly flush to the subchondral bone in 63% (n=22) of cases and subequatorial in 91% (n=32). Preoperative posterior humeral translation was 52%. The mean immediate postoperative posterior humeral translation was 56%, and 57% at more than 6 months. The change in mean posterior humeral translation between preoperative/6 months was +0.94% [-20%; +12%] (p=0.29) and immediate postoperative/6 months +0.34% [-18%; +15%] (p=0.84). Gender, hypermobility and the axial position of the bone block did not influence the change in posterior humeral translation. The equatorial position of the bone block appeared to increase posterior humeral translation by +10%±5.2% [-0.427; 20.823] (p=0.07). CONCLUSION This work refutes our initial hypothesis. The change in static posterior humeral translation after arthroscopic Latarjet bone block remains stable at more than 6 months of follow-up. This procedure does not alter the anatomical position of the humeral head in relation to the glenoid. On the other hand, a more cranial positioning of the bone block could have an influence. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yoann Dalmas
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France.
| | - Charles-Edouard Thélu
- Clinique du sport et de chirurgie orthopédique, 199, rue de la Rianderie, 59700 Marcq-en-Barœul, France
| | - Pierre Laumonerie
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France
| | - Emilie Mathieu
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France
| | - Suzanne Robert
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France
| | - Pierre Mansat
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France; Laboratoire de biomécanique, IMFT-UMR-CNRS 5502, hôpital Pierre Paul Riquet, Toulouse, France
| | - Nicolas Bonnevialle
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France; Laboratoire de biomécanique, IMFT-UMR-CNRS 5502, hôpital Pierre Paul Riquet, Toulouse, France
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Wengle L, White LM, Naraghi A, Kamali M, Betsch M, Veillette C, Leroux T. Imaging in an academic orthopedic shoulder service: a report on incidental lung pathology findings. Skeletal Radiol 2024; 53:339-344. [PMID: 37481479 DOI: 10.1007/s00256-023-04406-4] [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: 06/04/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
INTRODUCTION Computed tomography (CT) is often utilized for both diagnostic and pre-operative planning purposes in shoulder arthroplasty. Our study reports on the incidence of pulmonary findings in our pre-operative shoulder arthroplasty population over 14 years at our institution. METHODS We conducted a retrospective review of all "shoulder CT" exams ordered by two orthopedic upper extremity surgeons between the years of 2008 and 2021. These exams were then further analyzed to include only those ordered for the purpose of pre-operative "shoulder arthroplasty" planning. All incidental findings were documented and those with pulmonary findings were then further analyzed. A detailed chart review was then performed on these patients to determine the impact on their planned shoulder arthroplasty. RESULTS A total of 363 shoulder pre-operative CTs were ordered by our two upper extremity orthopedic surgeons at our institution between the years of 2008 and 2021. Primary lung cancer in the form of adenocarcinoma (n = 3) had an incidence of 0.8% of all CT scans and 1.4% of all pulmonary incidental findings. Fifteen patients (4% of all CT scans and 7% of all pulmonary incidental findings) had no concern for malignancy and were appropriately evaluated with further imaging based on their initial shoulder CT. CONCLUSION While shoulder arthroplasty and pre-operative planning with CT imaging continue to become more common, so too is the incidence of reported pulmonary findings. From a patient care standpoint, it is important that these findings are accurately identified, appropriately triaged, and communicated clearly to our patients.
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Affiliation(s)
- Lawrence Wengle
- Division of Orthopaedic Surgery, University of Toronto, 149 College Street, Room 508-A, Toronto, Ontario, M5T 1P5, Canada.
| | - Lawrence M White
- Joint Department of Medical Imaging (JDMI), Mount Sinai Hospital, University Health Network, Women's College Hospital, ON, Toronto, Canada
| | - Ali Naraghi
- Joint Department of Medical Imaging (JDMI), Mount Sinai Hospital, University Health Network, Women's College Hospital, ON, Toronto, Canada
| | - Mahsa Kamali
- Joint Department of Medical Imaging (JDMI), Mount Sinai Hospital, University Health Network, Women's College Hospital, ON, Toronto, Canada
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Christian Veillette
- Division of Orthopaedic Surgery, University of Toronto, 149 College Street, Room 508-A, Toronto, Ontario, M5T 1P5, Canada
- The Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
| | - Timothy Leroux
- Division of Orthopaedic Surgery, University of Toronto, 149 College Street, Room 508-A, Toronto, Ontario, M5T 1P5, Canada
- The Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
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Longo UG, Franceschetti E, Carnevale A, Schena E, Cozza G, Perricone G, Cardinale ME, Papalia R. Influence of Lateralization and Distalization on Joint Function after Primary Reverse Total Shoulder Arthroplasty. Bioengineering (Basel) 2023; 10:1409. [PMID: 38136000 PMCID: PMC10740542 DOI: 10.3390/bioengineering10121409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/23/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
The purpose of this study was to investigate how lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) are related to clinical and kinematic outcomes after reverse total shoulder arthroplasty. Thirty-three patients were evaluated at least six months postoperatively. The Single Assessment Numeric Evaluation (SANE), Constant Murley Score (CMS), Simple Shoulder Test (SST), and Visual Analogue Scale (VAS) were used. Shoulder kinematics was evaluated with a stereophotogrammetric system. LSA and DSA inter-rater reliability was analysed through the interclass correlation coefficient (ICC). Stepwise forward linear regression analysis was conducted between LSA and DSA with clinical scales and kinematic measures, between which a correlation analysis was conducted. The inter-rater reliability for LSA (mean ICC = 0.93) and DSA (mean ICC = 0.97) results were good to excellent. Greater LSA values were associated with higher peaks of internal rotation (p = 0.012, R2 = 0.188) and range of motion (ROM) (p = 0.037, R2 = 0.133). SANE (p = 0.009), CMS (p = 0.031), and SST (0.026) were positively correlated to external rotation, while VAS (p = 0.020) was negatively related. Abduction peaks were positively related to CMS (p = 0.011) and SANE (p = 0.037), as well as abduction ROM (SANE, p = 0.031; CMS, p = 0.014).
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Edoardo Franceschetti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Arianna Carnevale
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
| | - Emiliano Schena
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Laboratory of Measurement and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Giulia Cozza
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
| | - Giovanni Perricone
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Marco Edoardo Cardinale
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
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Youderian AR, Greene AT, Polakovic SV, Davis NZ, Parsons M, Papandrea RF, Jones RB, Byram IR, Gobbato BB, Wright TW, Flurin PH, Zuckerman JD. Two-year clinical outcomes and complication rates in anatomic and reverse shoulder arthroplasty implanted with Exactech GPS intraoperative navigation. J Shoulder Elbow Surg 2023; 32:2519-2532. [PMID: 37348780 DOI: 10.1016/j.jse.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION We compared the 2-year clinical outcomes of both anatomic and reverse total shoulder arthroplasty (ATSA and RTSA) using intraoperative navigation compared to traditional positioning techniques. We also examined the effect of glenoid implant retroversion on clinical outcomes. HYPOTHESIS In both ATSA and RTSA, computer navigation would be associated with equal or better outcomes with fewer complications. Final glenoid version and degree of correction would not show outcome differences. MATERIAL AND METHODS A total of 216 ATSAs and 533 RTSAs were performed using preoperative planning and intraoperative navigation with a minimum of 2-year follow-up. Matched cohorts (2:1) for age, gender, and follow-up for cases without intraoperative navigation were compared using all standard shoulder arthroplasty clinical outcome metrics. Two subanalyses were performed on navigated cases comparing glenoids positioned greater or less than 10° of retroversion and glenoids corrected more or less than 15°. RESULTS For ASTA, no statistical differences were found between the navigated and non-navigated cohorts for postoperative complications, glenoid implant loosening, or revision rate. No significant differences were seen in any of the ATSA outcome metrics besides higher internal and external rotation in the navigated cohort. For RTSA, the navigated cohort showed an ARR of 1.7% (95% CI 0%, 3.4%) for postoperative complications and 0.7% (95% CI 0.1%, 1.2%) for dislocations. No difference was found in the revision rate, glenoid implant loosening, acromial stress fracture rates, or scapular notching. Navigated RTSA patients demonstrated significant improvements over non-navigated patients in internal rotation, external rotation, maximum lifting weight, the Simple Shoulder Test (SST), Constant, and Shoulder Arthroplasty Smart (SAS) scores. For the navigated subcohorts, ATSA cases with a higher degree of final retroversion showed significant improvement in pain, Constant, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), SST, University of California-Los Angeles shoulder score (UCLA), and Shoulder Pain and Disability Index (SPADI) scores. No significant differences were found in the RTSA subcohort. Higher degrees of version correction showed improvement in external rotation, SST, and Constant scores for ATSA and forward elevation, internal rotation, pain, SST, Constant, ASES, UCLA, SPADI, and SAS scores for RTSA. CONCLUSION The use of intraoperative navigation shoulder arthroplasty is safe, produces at least equally good outcomes at 2 years as standard instrumentation does without any increased risk of complications. The effect of final implant position above or below 10° of glenoid retroversion and correction more or less than 15° does not negatively impact outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Bruno B Gobbato
- Department of Orthopedic Surgery, Idomed University, Jaragua do Sul, Brazil
| | - Thomas W Wright
- Department of Orthopaedics, University of Florida, Gainesville, FL, USA
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14
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Shekhbihi A, Mazzotta A, Reichert W, Masoud M. The base plate orientation angle: a plain radiographic technique for designing the base plate's inclination in reverse shoulder arthroplasty. JSES Int 2023; 7:2507-2516. [PMID: 37969506 PMCID: PMC10638608 DOI: 10.1016/j.jseint.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background Superior inclination of the base plate in reverse shoulder arthroplasty (RSA) is underestimated and may lead to major setbacks in terms of functional outcomes due to the altered biomechanics. Joint instability, scapular notching, and loosening of the glenoid component are considered the most serious sequelae. Therefore, a thorough preoperative radiological assessment of the affected shoulder joint and customized design of the prosthesis according to the glenoid morphology are decisive and directly correlated to the outcome. In this article, we propose a simple radiographic technique to assess the inclination of the glenoid preoperatively, which identifies the need for intraoperative correction. Materials and Methods One hundred inconspicuous shoulder radiographs were included in the control group (CG) to define the normal ranges of the base plate orientation angle (BOA) and the base plate correction angle (BCA). Further, both angles were measured on 2-dimensional (2D) computed tomography scans of patients with proximal humerus fractures as well as radiographs, 2D and 3-dimensional (3D) computed tomography scans of patients with cuff tear arthropathy who underwent RSA between 2018 and 2021. The interobserver reliability among three independent testers was evaluated by calculating the intraclass correlation coefficient. In cuff tear arthropathy cases, the BOA and BCA measurements on different imaging modalities were compared using the Wilcoxon test. Possible variations of both angles' values based on glenoid erosion types, according to the Favard classification, were also investigated. Results Regardless of the imaging modality used, the interobserver reliability was excellent among three independent observers. In the CG, the mean BOA and BCA values were 118° ± 6° and 17° ± 5°, respectively. The mean corrected BOA values of the CG and fracture group were 136° ± 5° and 140° ± 5°, respectively. In contrast to the BCA values, the BOA measurements on radiographs showed a statistically significant difference compared to those obtained on 2D- and 3D scans in the cuff arthropathy group. Further, both angles' values varied according to the extent and location of the glenoid erosion. The lowest mean BOA and highest mean BCA values were observed in cases with Favard glenoid type E3. Conclusions The BOA and the BCA are reliable tools proposed to aid in precisely positioning the glenoid component in RSA in the preoperative setting. Whereas, the BOA determines the inclination of the inferior glenoid segment, the BCA represents the extent of correction required to obtain a neutral inclination of the base plate. Glenoid type E3 of the Favard classification with superior wear is particularly susceptible to base plate superior tilt.
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Affiliation(s)
- Abdelkader Shekhbihi
- Department of Trauma Surgery, Lörrach District Hospital, Baden-Württemberg, Germany
| | - Antonio Mazzotta
- Department of Trauma Surgery, Lörrach District Hospital, Baden-Württemberg, Germany
| | - Winfried Reichert
- Department of Trauma Surgery, Lörrach District Hospital, Baden-Württemberg, Germany
| | - Mohammad Masoud
- Department of Trauma Surgery, Lörrach District Hospital, Baden-Württemberg, Germany
- Department of Orthopaedics and Trauma Surgery, University Hospital of Assiut, Assiut, Egypt
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15
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Tarallo L, Giorgini A, Micheloni G, Montanari M, Porcellini G, Catani F. Navigation in reverse shoulder arthroplasty: how the lateralization of glenosphere can affect the clinical outcome. Arch Orthop Trauma Surg 2023; 143:5649-5656. [PMID: 37074371 PMCID: PMC10115375 DOI: 10.1007/s00402-023-04879-x] [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: 02/14/2023] [Accepted: 04/04/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION One of the main causes of RSA failure is attributable to the malpositioning of the glenoid component. Initial experiences with computer-assisted surgery have shown promising results in increasing the accuracy and repeatability of placement of the glenoid component and screws. The aim of this study was to evaluate the functional clinical results, in terms of joint mobility and pain, by correlating them with intraoperative data regarding the positioning of the glenoid component. The hypothesis was that the lateralization more than 25 mm of the glenosphere can led to better stability of the prosthesis but should pay in term of a reduced range of movement and increased pain. MATERIALS AND METHODS 50 patients were enrolled between October 2018 and May 2022; they underwent RSA implantation assisted by GPS navigation system. Active ROM, ASES score and VAS pain scale were recorded before surgery. Preoperative data about glenoid inclination and version were collected by pre-op X-Rays an CT. Intraoperative data-inclination, version, medialization and lateralization of the glenoid component-were recorded using computer-assisted surgery. 46 patients had been further clinically and radiographically re-evaluated at 3-months, 6-months, 1-year, and 2-years follow-up. RESULTS We found a statistically significant correlation between anteposition and glenosphere lateralization value (DM - 6.057 mm; p = 0.043). Furthermore a statistically significant correlation has been shown between abduction movement and the lateralization value (DM - 7.723 mm; p = 0.015). No other statistically significant associations were found when comparing the values of glenoid inclination and version with the range of motion achieved by the patients after reverse shoulder arthroplasty. CONCLUSION We observed that the patients with the best anteposition and abduction results had a glenosphere lateralization between 18 and 22 mm. When increasing the lateralization above 22 mm or reducing it below 18 mm, on the other hand, both movements considered decreased their range. LEVEL OF EVIDENCE Level IV; Case Series; Treatment Study.
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Affiliation(s)
- Luigi Tarallo
- Orthopedics and Traumatology Department, University of Modena and Reggio Emilia - Modena, Via del Pozzo 71, 41125, Modena, Italy.
| | - Andrea Giorgini
- Orthopedics and Traumatology Department, University of Modena and Reggio Emilia - Modena, Via del Pozzo 71, 41125, Modena, Italy
| | - Gianmario Micheloni
- Orthopedics and Traumatology Department, University of Modena and Reggio Emilia - Modena, Via del Pozzo 71, 41125, Modena, Italy
| | - Marta Montanari
- Orthopedics and Traumatology Department, University of Modena and Reggio Emilia - Modena, Via del Pozzo 71, 41125, Modena, Italy
| | - Giuseppe Porcellini
- Orthopedics and Traumatology Department, University of Modena and Reggio Emilia - Modena, Via del Pozzo 71, 41125, Modena, Italy
| | - Fabio Catani
- Orthopedics and Traumatology Department, University of Modena and Reggio Emilia - Modena, Via del Pozzo 71, 41125, Modena, Italy
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16
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Baumgarten KM. Patients who have intraoperative deviations in their preoperative plan have inferior clinical and radiographic outcomes after anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:e451-e463. [PMID: 36868298 DOI: 10.1016/j.jse.2023.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/08/2023] [Accepted: 01/22/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Three-dimensional computed tomography preoperative planning has become adopted among shoulder arthroplasty surgeons. Prior studies have not examined outcomes in patients in whom the surgeon implanted prostheses that deviated from the preoperative plan compared with patients in whom the surgeon followed the preoperative plan. The hypothesis of this study was that clinical and radiographic outcomes would be equivalent between patients undergoing anatomic total shoulder arthroplasty that had a deviation in the components predicted in the preoperative plan and patients who did not have a change in the components predicted in the preoperative plan. METHODS A retrospective review of patients who had preoperative planning for anatomic total shoulder arthroplasty from March 2017 through October 2022 was performed. Patients were stratified into 2 groups: patients in whom the surgeon used components that deviated from those anticipated by the preoperative plan (changed group), and patients in whom the surgeon used all of the components anticipated by the preoperative plan (planned group). Patient-determined outcomes including the Western Ontario Osteoarthritis Index, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test (SST), and Shoulder Activity Level were recorded preoperatively, at 1 year, and at 2 years. Preoperative and 1-year postoperative range of motion was recorded. Radiographic parameters to assess restoration of proximal humeral anatomy included humeral head height, humeral neck angle, humeral centering on the glenoid, and postoperative restoration of the anatomic center of rotation. RESULTS A total of 159 patients had intraoperative changes to their preoperative plan, and 136 patients underwent arthroplasty without changes to their preoperative plan. The planned group had higher scores than the group that had a deviation in the preoperative plan for every patient-determined outcome metric at every postoperative time point with statistically significant improvements found in the SST and Single Assessment Numeric Evaluation at 1-year and the SST and American Shoulder and Elbow Surgeons score at 2-year follow-up. No differences were found in range of motion metrics between the groups. Patients who did not have a deviation in their preoperative plan had more optimal restoration of their postoperative radiographic center of rotation than patients who did have a deviation in their preoperative plan. CONCLUSIONS Patients who have intraoperative changes to their preoperative plan have (1) inferior postoperative patient-determined outcome scores at 1 and 2 years after surgery and (2) a larger deviation in the postoperative radiographic restoration of the humeral center of rotation than patients who did not have intraoperative changes from the initial plan.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
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17
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McDonald M, Timoteo TM, Schoch N. Contralateral preoperative templating for fracture reverse total shoulder arthroplasty: technique article and case series. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:362-369. [PMID: 37588500 PMCID: PMC10426702 DOI: 10.1016/j.xrrt.2023.05.004] [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)
- Michael McDonald
- Grady Health System, Department of Orthopedic Surgery, Atlanta, GA, USA
| | - Taylor M. Timoteo
- Henry Ford Macomb, Department of Orthopedic Surgery, Clinton Township, MI, USA
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18
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Velasquez Garcia A, Abdo G, Sanchez-Sotelo J, Morrey ME. The Value of Computer-Assisted Navigation for Glenoid Baseplate Implantation in Reverse Shoulder Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev 2023; 11:01874474-202308000-00008. [PMID: 37616447 DOI: 10.2106/jbjs.rvw.23.00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND Glenoid baseplate malpositioning during reverse total shoulder arthroplasty can contribute to perimeter impingement, dislocation, and loosening. Despite advances in preoperative planning, conventional instrumentation may lead to considerable inaccuracy in implant positioning unless patient-specific guides are used. Optical navigation has the potential to improve accuracy and precision when implanting a reverse shoulder arthroplasty baseplate. This systematic review aimed to analyze the most recent evidence on the accuracy and precision of glenoid baseplate positioning using intraoperative navigation and its potential impact on component selection and surgical time. METHODS We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The PubMed, Scopus, and EMBASE databases were queried in July 2022 to identify all studies that compared navigation vs. conventional instrumentation for reverse shoulder arthroplasty. Data of deviation from the planned baseplate version and inclination, the use of standard or augmented glenoid components, and surgical time were extracted. Quantitative analysis from the included publications was performed using the inverse-variance approach and Mantel-Haenszel method. RESULTS Of the 2,048 records identified in the initial query, only 10 articles met the inclusion and exclusion criteria, comprising 667 shoulders that underwent reverse total shoulder arthroplasty. The pooled mean difference (MD) of the deviation from the planned baseplate position for the clinical studies was -0.44 (95% confidence interval [CI], -3.26; p = 0.76; I2 = 36%) for version and -8.75 (95% CI, -16.83 to -0.68; p = 0.02; I2 = 83%) for inclination, both in favor of navigation. The odds ratio of selecting an augmented glenoid component after preoperative planning and navigation-assisted surgery was 8.09 (95% CI, 3.82-17.14; p < 0.00001; I2 = 60%). The average surgical time was 12 minutes longer in the navigation group (MD 12.46, 95% CI, 5.20-19.72; p = 0.0008; I2 = 71%). CONCLUSIONS Preoperative planning integrated with computer-assisted navigation surgery seems to increase the accuracy and precision of glenoid baseplate inclination compared with the preoperatively planned placement during reverse total shoulder arthroplasty. The surgical time and proportion of augmented glenoid components significantly increase when using navigation. However, the clinical impact of these findings on improving prosthesis longevity, complications, and patient functional outcomes is still unknown. LEVEL OF EVIDENCE Level III, systematic review and meta-analysis. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ausberto Velasquez Garcia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Orthopedic Surgery, Clínica Universidad de los Andes, Santiago, Chile
| | - Glen Abdo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Internal Medicine Residency Program, New York Medical College at St Mary's General Hospital, Valhalla, New York
| | | | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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19
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Navarro RA, Chan PH, Prentice HA, Pearl M, Matsen 3rd FA, McElvany MD. Use of Preoperative CT Scans and Patient-Specific Instrumentation May Not Improve Short-Term Adverse Events After Shoulder Arthroplasty: Results from a Large Integrated Health-Care System. JB JS Open Access 2023; 8:e22.00139. [PMID: 37415725 PMCID: PMC10319369 DOI: 10.2106/jbjs.oa.22.00139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Ongoing innovation leads to a continuous influx of new technologies related to shoulder arthroplasty. These are made available to surgeons and marketed to both health-care providers and patients with the hope of improving outcomes. We sought to evaluate how preoperative planning technologies for shoulder arthroplasty affect outcomes. Methods This was a retrospective cohort study conducted using data from an integrated health-care system's shoulder arthroplasty registry. Adult patients who underwent primary elective anatomic or reverse total shoulder arthroplasty (2015 to 2020) were identified. Preoperative planning technologies were identified as (1) a computed tomography (CT) scan and (2) patient-specific instrumentation (PSI). Multivariable Cox regression and logistic regression were used to compare the risk of aseptic revision and 90-day adverse events, respectively, between procedures for which technologies were and were not used. Results The study sample included 8,117 procedures (in 7,372 patients) with an average follow-up of 2.9 years (maximum, 6 years). No reduction in the risk of aseptic revision was observed for patients having either preoperative CT scans (hazard ratio [HR] = 1.22; 95% confidence interval [CI] = 0.87 to 1.72) or PSI (HR = 1.44; 95% CI = 0.71 to 2.92). Patients having CT scans had a lower likelihood of 90-day emergency department visits (odds ratio [OR] = 0.84; 95% CI = 0.73 to 0.97) but a higher likelihood of 90-day venous thromboembolic events (OR = 1.79; 95% CI = 1.18 to 2.74). Patients with PSI use had a higher likelihood of 90-day deep infection (OR = 7.74; 95% CI = 1.11 to 53.94). Conclusions We found no reduction in the risk of aseptic revision with the use of these technologies. Patients having CT scans and PSI use had a higher likelihood of venous thromboembolism and deep infection, respectively. Ongoing research with extended follow-up is being conducted to further examine the effects of these technologies on patient outcomes. Level of Evidence Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ronald A. Navarro
- Department of Orthopaedic Surgery, Kaiser Permanente South Bay Medical Center, Southern California Permanente Medical Group, Harbor City, California
| | - Priscilla H. Chan
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California
| | - Heather A. Prentice
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California
| | - Michael Pearl
- Department of Orthopaedic Surgery, Kaiser Permanente Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles, California
| | - Frederick A. Matsen 3rd
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Matthew D. McElvany
- Department of Orthopaedic Surgery, Kaiser Permanente Santa Rosa Medical Center, The Permanente Medical Group, Santa Rosa, California
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Boekel P, Rikard-Bell M, Grant A, Brandon B, Doma K, O’Callaghan WB, Wilkinson M, Morse L. Image-derived instrumentation vs. conventional instrumentation with 3D planning for glenoid component placement in reverse total shoulder replacements: a randomized controlled trial. JSES Int 2023; 7:614-622. [PMID: 37426909 PMCID: PMC10328789 DOI: 10.1016/j.jseint.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Hypothesis Glenoid baseplate positioning for reverse total shoulder arthroplasty (rTSA) is important for stability and longevity, with techniques such as image-derived instrumentation (IDI) developed for improving implant placement accuracy. We performed a single-blinded randomized controlled trial comparing glenoid baseplate insertion accuracy with 3D preoperative planning and IDI jigs vs. 3D preoperative planning and conventional instrumentation. Methods All patients had a preoperative 3D computed tomography to create an IDI; then underwent rTSA according to their randomized method. Repeat computed tomography scans performed at six weeks postoperatively were compared to the preoperative plan to assess for accuracy of implantation. Patient-reported outcome measures and plain radiographs were collected with 2-year follow-up. Results Forty-seven rTSA patients were included (IDI n = 24, conventional instrumentation n = 23). The IDI group was more likely to have a guidewire placement within 2mm of the preoperative plan in the superior/inferior plane (P = .01); and exhibited a smaller degree of error when the native glenoid retroversion was >10° (P = .047). There was no difference in patient-reported outcome measures or other radiographic parameters between the two groups. Conclusion IDI is an accurate method for glenoid guidewire and component placement in rTSA, particularly in the superior/inferior plane and in glenoids with native retroversion >10°, when compared to conventional instrumentation.
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Affiliation(s)
- Pamela Boekel
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
| | - Matthew Rikard-Bell
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
| | - Benjamin Brandon
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
| | - Kenji Doma
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Sports and Exercise Science, James Cook University, Townsville, Queensland, Australia
| | - William B. O’Callaghan
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Cairns Hospital, Cairns, Queensland, Australia
| | - Matthew Wilkinson
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Royal Hobart Hospital and Calvary Care, University of Tasmania, Hobart, Tasmania, Australia
| | - Levi Morse
- Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia
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Berhouet J, Samargandi R, Favard L, Turbillon C, Jacquot A, Gauci MO. The Real Post-Operative Range of Motion Differs from the Virtual Pre-Operative Planned Range of Motion in Reverse Shoulder Arthroplasty. J Pers Med 2023; 13:jpm13050765. [PMID: 37240935 DOI: 10.3390/jpm13050765] [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: 03/28/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION The purpose of this study was to analyze the real range of motion (RoM) measured in patients operated on for reverse shoulder arthroplasty (RSA) and compare it to the virtual RoM provided by the preoperative planning software. HYPOTHESIS There was a difference between virtual and real RoM, which can be explained by different factors, specifically the scapula-thoracic (ST) joint. METHODS Twenty patients with RSA were assessed at a minimum follow-up of 18 months. Passive RoM in forward elevation abduction, without and with manually locking the ST joint, and in external rotation with arm at side were recorded. The humerus, scapula, and implants were manually segmented on post-operative CTs. Post-operative bony structures were registered to preoperative bony elements. From this registration, a post-operative plan corresponding to the real post-operative implant positioning was generated and the corresponding virtual RoM analysis was recorded. On the post-operative anteroposterior X-rays and 2D-CT coronal planning view, the glenoid horizontal line angle (GH), the metaphyseal horizontal line angle (MH), and the gleno-metaphyseal angle (GMA) were measured to assess the extrinsic glenoid inclination, as well as the relative position of the humeral and glenoid components. RESULTS There were some significant differences between virtual and post-operative passive abduction and forward elevation, with (55° and 50°, p < 0.0001) or without ST joint participation (15° and 27°, p < 0.002). For external rotation with arm at side, there was no significant difference between planning (24° ± 26°) and post-operative clinical observation (19° ± 12°) (p = 0.38). For the angle measurements, the GMA was significantly higher (42.8° ± 15.2° vs. 29.1°± 18.2°, p < 0.0001), and the GH angle, significantly lower on the virtual planning (85.2° ± 8.8° vs. 99.5° ± 12.5°, p < 0.0001), while the MH was not different (p = 0.33). CONCLUSIONS The virtual RoM given by the planning software used in this study differs from the real post-operative passive RoM, except for external rotation. This can be explained by the lack of ST joint and soft tissues simulation. However, in focusing on the virtual GH participation, the simulation looks informative. Some modifications between the glenoid and humerus starting positions before running the motion analysis could be provided for making it more realistic and predictive of the RSA functional results. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Julien Berhouet
- CHRU Trousseau Service d'Orthopédie Traumatologie, Faculté de Médecine de Tours, Université de Tours, 1C Avenue de la République, 37170 Tours, France
- Equipe Reconnaissance de Forme et Analyse de l'Image, Laboratoire d'Informatique Fondamentale et Appliquée de Tours EA6300, Ecole d'Ingénieurs Polytechnique Universitaire de Tours, Université de Tours, 64 Avenue Portalis, 37200 Tours, France
| | - Ramy Samargandi
- CHRU Trousseau Service d'Orthopédie Traumatologie, Faculté de Médecine de Tours, Université de Tours, 1C Avenue de la République, 37170 Tours, France
- Department of Orthopedic Surgery, Faculty of Medicine, University of Jeddah, Jeddah 23218, Saudi Arabia
| | - Luc Favard
- CHRU Trousseau Service d'Orthopédie Traumatologie, Faculté de Médecine de Tours, Université de Tours, 1C Avenue de la République, 37170 Tours, France
| | - Céline Turbillon
- CHRU Trousseau Service d'Orthopédie Traumatologie, Faculté de Médecine de Tours, Université de Tours, 1C Avenue de la République, 37170 Tours, France
| | - Adrien Jacquot
- Centre for Chirurgie des Articulations et du Sport (ARTICS), 24 rue du XXIème Régiment d'Aviation, 54000 Nancy, France
| | - Marc-Olivier Gauci
- Institut Locomoteur et du Sport, Hôpital Pasteur 2, 30 Voie Romaine, 06000 Nice, France
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Hall T, Wong JRY, Dirckx M, Rajesparan K, Rashid A. Pre-operative arthritic glenoid assessment: 3D automated planning software versus manual multiplanar measurements of version and inclination. J Orthop 2023; 36:24-28. [PMID: 36582547 PMCID: PMC9793237 DOI: 10.1016/j.jor.2022.12.005] [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: 09/07/2022] [Revised: 11/26/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Background Preoperative CT-based planning is established in shoulder arthroplasty surgery. Automated planning software has become available to assist the surgeon and may increase reliability and efficiency. This study aims to evaluate the reliability of an automated 3-dimensional (3D) planning software package (Blueprint™ v2.1.5, Wright Medical Ltd) in the assessment of the arthritic shoulder against manual multiplanar measurement (MM). Methods 74 CT studies acquired for preoperative shoulder arthroplasty planning were reviewed on two occasions by four different evaluators, taking manual measurement (MM) of glenoid version and inclination adjusted with multiplanar reformation and adhering to modified Freidman and Maurier methods. 15 scans were not processed by Blueprint due to incompatible scanning protocols or severe scapular dysmorphia. 59 Blueprint measures were compared with the manual data. Results Version: Intra-observer reliability of glenoid version MM was excellent (mean ICC 0.92). Inter-observer reliability between all four readers was good (ICC 0.89). A Bland-Altman analysis of Blueprint versus MM for version measurements demonstrated a mean pair difference of -5.77 (95% CI -7.25 to 4.29). Inclination: Intra-rater and inter-rater reliabilities were good (ICC 0.85 and 0.80 respectively). Blueprint and MM values for inclination followed a more convergent pattern than for version. Bland-Altman analysis for inclination did not show substantial bias, with a mean pair difference of 1.4 (95% CI -0.1 to 2.9). Conclusion Manual preoperative planning for shoulder arthroplasty is time consuming and requires experience. Automated 3D planning offers a consistent tool to assist the surgeon, notwithstanding intra-operative anatomical and technical variation, and margin of error. Surgeons should as ever be mindful of the specifics of a given automated program and our data quantified a bias for retroversion which may be important for measures close to the thresholds for augmentation or customised implants.
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Affiliation(s)
- Tim Hall
- Department of Radiology, University Hospital Lewisham (Lewisham and Greenwich NHS Trust), Lewisham High Street, London, SE13 6LH, United Kingdom
| | | | - Margo Dirckx
- Department of Trauma and Orthopaedic Surgery, Epsom and St Helier University Hospitals NHS Trust, Dorking Rd, Epsom, KT18 7EG, United Kingdom
| | - Kannan Rajesparan
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, 235 Euston Rd, London, NW1 2BU, United Kingdom
| | - Abbas Rashid
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, 235 Euston Rd, London, NW1 2BU, United Kingdom
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Accuracy of Blueprint software in predicting range of motion 1 year after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:1088-1094. [PMID: 36690174 DOI: 10.1016/j.jse.2022.12.009] [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: 09/02/2022] [Revised: 11/16/2022] [Accepted: 12/11/2022] [Indexed: 01/22/2023]
Abstract
HYPOTHESIS AND BACKGROUND Blueprint 3-dimensional computed tomography software has a functionality that predicts impingement-free range of motion (ROM) with determination of the limits of ROM at which bone and/or prosthetic impingement occurs. To our knowledge, only 1 previously published study has assessed the ability of Blueprint software to predict actual postoperative ROM after reverse total shoulder arthroplasty (RTSA). The hypotheses of this study were that (1) mean Blueprint-predicted impingement-free ROM would be statistically similar to the mean actual ROM 1 year after RTSA and (2) there would be a correlation between Blueprint-predicted impingement-free ROM and the actual ROM 1 year after RTSA. MATERIALS AND METHODS A retrospective review of patients who underwent Blueprint planning prior to undergoing RTSA from March 2017 through May 2021 was performed. At 1-year follow-up, flexion, external rotation at the side, abduction, external rotation in the abducted position, internal rotation in the abducted position, and internal rotation behind the back were measured. The preoperatively predicted flexion, extension, abduction, external rotation, and internal rotation were recorded using Blueprint software. The group 1 analysis examined the predicted vs. actual ROM of all 127 patients regardless of whether intraoperative component modifications were made. The group 2 analysis examined the predicted vs. actual ROM of only the patients who did not undergo intraoperative changes that would affect the preoperative ROM prediction (n = 97). The group 3 analysis examined the predicted vs. actual ROM of group 2 combined with the 30 patients who underwent post hoc Blueprint planning modifications to account for the changes made intraoperatively (combined sample size of 127). RESULTS Of the 141 patients, 127 (90%) were available for 1-year follow-up. When the mean values of all 3 groups were examined, the actual ROM and predicted ROM were statistically significantly different (P < .0001) for flexion, external rotation, abduction, abduction-external rotation, and abduction-internal rotation. In group 1, a very weak or poor correlation was found between predicted internal rotation and actual abducted internal rotation (r = 0.19, P = .04). For all other ROM metrics in groups 1, 2, and 3, there were no correlations between predicted and actual ROM (P ≥ .07). CONCLUSIONS In its current state, preoperative Blueprint 3-dimensional computed tomography planning software is unable to accurately predict ROM 1 year after RTSA.
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Portnoy Y, Koren J, Khoury A, Factor S, Dadia S, Ran Y, Benady A. Three-dimensional technologies in presurgical planning of bone surgeries: current evidence and future perspectives. Int J Surg 2023; 109:3-10. [PMID: 36799780 PMCID: PMC10389328 DOI: 10.1097/js9.0000000000000201] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/20/2022] [Indexed: 02/18/2023]
Abstract
BACKGROUND The recent development of three-dimensional (3D) technologies introduces a novel set of opportunities to the medical field in general, and specifically to surgery. The preoperative phase has proven to be a critical factor in surgical success. Utilization of 3D technologies has the potential to improve preoperative planning and overall surgical outcomes. In this narrative review article, the authors describe existing clinical data pertaining to the current use of 3D printing, virtual reality, and augmented reality in the preoperative phase of bone surgery. METHODS The methodology included keyword-based literature search in PubMed and Google Scholar for original articles published between 2014 and 2022. After excluding studies performed in nonbone surgery disciplines, data from 61 studies of five different surgical disciplines were processed to be included in this narrative review. RESULTS Among the mentioned technologies, 3D printing is currently the most advanced in terms of clinical use, predominantly creating anatomical models and patient-specific instruments that provide high-quality operative preparation. Virtual reality allows to set a surgical plan and to further simulate the procedure via a 2D screen or head mounted display. Augmented reality is found to be useful for surgical simulation upon 3D printed anatomical models or virtual phantoms. CONCLUSIONS Overall, 3D technologies are gradually becoming an integral part of a surgeon's preoperative toolbox, allowing for increased surgical accuracy and reduction of operation time, mainly in complex and unique surgical cases. This may eventually lead to improved surgical outcomes, thereby optimizing the personalized surgical approach.
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Affiliation(s)
- Yotam Portnoy
- First Faculty of Medicine, Charles University in Prague, Prague, Czechia
| | - Jonathan Koren
- First Faculty of Medicine, Charles University in Prague, Prague, Czechia
| | - Amal Khoury
- Sackler School of Medicine, Tel Aviv University
- Division of Orthopaedic Surgery
| | - Shai Factor
- Sackler School of Medicine, Tel Aviv University
- Division of Orthopaedic Surgery
| | - Solomon Dadia
- Sackler School of Medicine, Tel Aviv University
- Levin Center of 3D Printing and Surgical Innovation
- National Unit of Orthopedic Oncology
| | - Yuval Ran
- Sackler School of Medicine, Tel Aviv University
- Office of the Deputy Medical Manager, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Amit Benady
- Sackler School of Medicine, Tel Aviv University
- Division of Orthopaedic Surgery
- Levin Center of 3D Printing and Surgical Innovation
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de Marinis R, Contreras JJ, Vidal C, Palma C, Angulo M, Valenzuela A, Jaña R, Calvo C, Liendo R, Soza F. The Reverse Shoulder Arthroplasty Angle in MRI: Impact of the Articular Cartilage in the Estimated Inclination of the Inferior Glenoid. J Shoulder Elb Arthroplast 2023; 7:24715492231167110. [PMID: 37008200 PMCID: PMC10064160 DOI: 10.1177/24715492231167110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
Purpose To describe the reverse shoulder arthroplasty angle (RSA angle) in magnetic resonance imaging (MRI) and compare the angle formed using bony landmarks (Bony RSA angle or B-RSA angle) with another angle formed using the cartilage margin as reference (Cartilage RSA angle or C-RSA angle). Methods Adult patients with a shoulder MRI obtained in our hospital between July 2020 and July 2021 were included. The C-RSA angle and B-RSA angle were measured. All images were independently assessed by 4 evaluators. Intraclass correlation coefficient (ICC) was determined for the B-RSA and C-RSA to evaluate interobserver agreement. Results A total of 61 patients were included with a median age of 59 years (17-77). C-RSA angle was significantly higher than B-RSA (25.4° ± 0.7 vs 19.5° ± 0.7, respectively) with a P-value <.001. The overall agreement was considered “good” for C-RSA (ICC = 0.74 [95% CI 0.61-0.83]) and “excellent” for B-RSA angle (ICC = 0.76 [95% CI 0.65-0.85]). Conclusions C-RSA angle is significantly higher than B-RSA angle. In cases without significant glenoid wear neglecting to account for the remaining articular cartilage at the inferior glenoid margin may result in superior inclination of standard surgical guides.
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Affiliation(s)
- Rodrigo de Marinis
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Shoulder and Elbow Unit, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
- Rodrigo de Marinis, Diagonal Paraguay 362, 3er piso, Región Metropolitana, Santiago, Chile.
| | - Julio J. Contreras
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catalina Vidal
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristóbal Palma
- Radiology Department, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Manuela Angulo
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alfonso Valenzuela
- Shoulder and Elbow Unit, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Ricardo Jaña
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudio Calvo
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Liendo
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Soza
- Department of Orthopedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Kida H, Urita A, Momma D, Matsui Y, Endo T, Kawamura D, Taneichi H, Iwasaki N. Implications of navigation system use for glenoid component placement in reverse shoulder arthroplasty. Sci Rep 2022; 12:21190. [PMID: 36477208 PMCID: PMC9729232 DOI: 10.1038/s41598-022-25833-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Recently, three-dimensional (3D) planning, patient-specific instruments, and navigation system have been developed to improve the accuracy of baseplate placement in reverse shoulder arthroplasty (RSA). The purpose of this study was to evaluate baseplate placement using the navigation system. Sixty-four shoulders in 63 patients who underwent RSA for rotator cuff tear arthropathy or irreparable rotator cuff tears were enrolled. Conventional RSA was performed in 31 shoulders and navigated RSA using pre-operative planning software was performed in 33 shoulders. The use of augmented baseplates, the version and inclination of the baseplate, and screw length were compared between conventional RSA and navigated RSA. Augmented baseplates were used more frequently in navigated RSA than in conventional RSA (20 vs 9 shoulders, p = 0.014). Baseplate alignment was 1.0° (SD 5.1) of retroversion and 2.4° (SD 6.8) of superior inclination in conventional RSA and 0.2° (SD 1.9) of anteversion and 0.3° (SD 1.7) of superior inclination in navigated RSA. Compared with conventional RSA, precision of baseplate version and inclination were higher in navigated RSA (both p < 0.001). Superior, inferior, and posteroinferior screws were significantly longer in navigated RSA than in conventional RSA (p = 0.021, 0.001 and < 0.001, respectively). Precision of superior and inferior screw lengths was significantly higher in navigated RSA than in conventional RSA (both p = 0.001). Our results suggest that adoption of pre-operative planning software increased augmented baseplate use to minimize the glenoid reaming. The navigation system allows placement of the baseplate accurately, according to the pre-operative plan. Furthermore, the navigation system enables monitoring of screw length and direction in real time.
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Affiliation(s)
- Hiroaki Kida
- grid.39158.360000 0001 2173 7691Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Atsushi Urita
- grid.255137.70000 0001 0702 8004Department of Orthopaedic Surgery, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi 321-0293 Japan
| | - Daisuke Momma
- grid.412167.70000 0004 0378 6088Center of Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Yuki Matsui
- grid.39158.360000 0001 2173 7691Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takeshi Endo
- grid.39158.360000 0001 2173 7691Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Kawamura
- grid.39158.360000 0001 2173 7691Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Taneichi
- grid.255137.70000 0001 0702 8004Department of Orthopaedic Surgery, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi 321-0293 Japan
| | - Norimasa Iwasaki
- grid.39158.360000 0001 2173 7691Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Hao KA, Dean EW, Hones KM, King JJ, Schoch BS, Dean NE, Farmer KW, Struk AM, Wright TW. Influence of humeral lengthening on clinical outcomes in reverse shoulder arthroplasty. Orthop Traumatol Surg Res 2022; 109:103502. [PMID: 36470370 DOI: 10.1016/j.otsr.2022.103502] [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: 07/04/2022] [Revised: 08/28/2022] [Accepted: 09/07/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Deltoid tensioning secondary to humeral lengthening after reverse shoulder arthroplasty (RSA) is commonly theorized to be crucial to improving range of motion (ROM) but may predispose patients to acromial/scapular spine fractures and neurologic injury. Clinical evidence linking patient outcomes to humeral lengthening is limited. This study assesses the relationship between humeral lengthening and clinical outcomes after RSA. METHODS A single institution review of 284 RSAs performed in 265 patients was performed. Humeral lengthening was defined as the difference in the subacromial height preoperatively to postoperatively as measured on Grashey radiographs. The subacromial height was measured as the vertical difference between the most inferolateral aspect of the acromion and the most superior aspect of the greater tuberosity. The relationship between humeral lengthening and clinical outcomes was assessed on a continuous basis. Secondarily, clinical outcomes were assessed using a dichotomous definition of humeral lengthening (≤25 vs. >25mm) based on prior clinical and biomechanical work purporting a correlation with clinical outcomes. Improvement exceeding the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for ROM and outcome scores after RSA were also compared. RESULTS Humeral lengthening demonstrated a nonlinear relationship with postoperative ROM, clinical outcome scores, and shoulder strength and their improvement preoperatively to postoperatively. Furthermore, there were minimal differences in ROM measures, outcome scores, and shoulder strength when stratified using the dichotomous definition of humeral lengthening. No difference in the proportion of patients exceeding the MCID or SCB when stratified by humeral lengthening ≤25 vs. >25mm was found. There was no difference in humeral lengthening in patients with versus without complications. CONCLUSION No clear relationship between humeral lengthening and clinical outcomes was identified. The previously purported 25mm threshold for humeral lengthening did not predict improved patient outcomes. Outcomes after RSA are multifactorial; the relationship between humeral lengthening and outcomes is likely confounded by other patient and surgical factors. LEVEL OF EVIDENCE IV; Case Series.
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Affiliation(s)
- Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ethan W Dean
- Piedmont Orthopedics
- OrthoAtlanta, Atlanta, GA, USA
| | - Keegan M Hones
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Bradley S Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Natalie E Dean
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kevin W Farmer
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Aimee M Struk
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA.
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Hsu CP, Wu CT, Chen CY, Lin SC, Hsu KY. Difference analysis of the glenoid centerline between 3D preoperative planning and 3D printed prosthesis manipulation in total shoulder arthroplasty. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04688-8. [PMID: 36445496 DOI: 10.1007/s00402-022-04688-8] [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: 07/01/2022] [Accepted: 10/30/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Excessive version and inclination of the glenoid component during total shoulder arthroplasty can lead to glenohumeral instability, early loosening, and even failure. The orientation and position of the central pin determine the version and inclination of the glenoid component. The purpose of this study was to compare the differences in centerline position and orientation obtained using "3D preoperative planning based on the best-fit method for glenoid elements" and the surgeon's manipulation. MATERIALS AND METHODS Twenty-nine CT images of glenohumeral osteoarthritis of the shoulder were reconstructed into a 3D model, and a 3D printer was used to create an in vitro model for the surgeon to drill the center pin. The 3D shoulder model was also used for 3D preoperative planning (3DPP) using the best-fit method for glenoid elements. The in vitro model was scanned and the version, inclination and center position were measured to compare with the 3DPP results. RESULTS The respective mean inclinations (versions) of the surgeon and 3DPP were -2.63° ± 6.60 (2.87° ± 5.97) and -1.96° ± 4.24 (-3.21° ± 4.00), respectively. There was no significant difference in the inclination and version of the surgeon and 3DPP. For surgeons, the probability of the inclination and version being greater than 10° was 13.8% (4/29) and 10.3% (3/29), respectively. Compared to the 3DPP results, the surgeon's center position was shifted down an average of 1.63 mm. There was a significant difference in the center position of the surgeon and 3DPP (p < 0.05). CONCLUSION The central pin drilled by surgeons using general instruments was significantly lower than those defined using 3D preoperative planning and standard central definitions. 3D preoperative planning prevents the version and inclination of the centerline from exceeding safe values (± 10°).
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Affiliation(s)
- Chi-Pin Hsu
- High Speed 3D Printing Research Center, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Chen-Te Wu
- Department of Medical Imaging and Intervention Radiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Yu Chen
- Department of Orthopaedic Surgery Division of Sports Medicine and Musculoskeletal Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Shang-Chih Lin
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Kuo-Yao Hsu
- Department of Orthopaedic Surgery Division of Sports Medicine and Musculoskeletal Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Preoperative Planning for Anatomic Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2022; 30:e1207-e1216. [PMID: 36135930 DOI: 10.5435/jaaos-d-21-01119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/08/2022] [Indexed: 02/01/2023] Open
Abstract
The success of total shoulder arthroplasty is dependent on both proper patient selection and restoration of the native anatomy. After proper patient selection, preoperative planning is essential to select implants that will allow the surgeon to properly restore soft-tissue tension and correct for deformity. Although it is possible to template implants with plain radiographs, these do not allow accurate measurements of the complex three-dimensional anatomy of the glenohumeral joint. CT can be used to further examine version of the glenoid and humerus, as well as humeral head subluxation. Three-dimensional reconstructions also allow for virtual implantation, resulting in a more reliable prediction of implant appearance. Commercial software is available that calculates parameters such as version; however, these have been shown to have variability when compared with measurements obtained by surgeons. Patient-specific instrumentation can also be obtained based on preoperative measurements; however, although it allowed for improved measurements when compared with two-dimensional imaging, there has been no difference in version error, inclination error, or positional offset of the glenoid implant when comparing patient-specific instrumentation with standard instrumentation. Intraoperative navigation can also be used to give real-time feedback on implant positioning; however, additional studies are needed to fully evaluate its benefit.
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Concordance of Preoperative 3D Templating in Stemless Anatomic Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2022; 30:e1269-e1278. [PMID: 36027052 DOI: 10.5435/jaaos-d-22-00309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/11/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Recent advances in preoperative 3D templating software allow surgeons to plan implant size and position for stemless total shoulder arthroplasty (TSA). Whether these preoperative plans accurately reflect intraoperative decisions is yet unknown, and the purpose of this study was to evaluate concordance between planned and actual implant sizes in a series of patients undergoing stemless TSA. METHODS A retrospective cohort of consecutive, anatomic, stemless TSA cases performed by two surgeons between September 2019 and February 2021 was examined. Preoperative templated plans were collected using 3D planning software, and the sizes of planned glenoid, humeral head, and nucleus "stem" implants and other procedural data were recorded, along with sociodemographic information. These predicted parameters were compared with the implant sizes, and the concordance of these templated plans was quantified by direct comparison and bootstrapped simulations. RESULTS Fifty cases met inclusion criteria, among which perfect concordance across all three implants was observed in 11 cases (22%). The glenoid implant had the highest concordance (80%) relative to the humeral head and nucleus implants (38% and 60%, respectively), which was statistically significant ( P < 0.001). Planned humeral head implants were more often oversized relative to their actual implanted size. However, 84% of the planned humeral heads were within 1 diameter size; in addition, 98% of the planned glenoid implants were within one size and all were within 10 mm of the implanted glenoid backside radius. All nucleus implants were within one size. DISCUSSION Final implant sizes demonstrated variable concordance relative to preoperative plans, with glenoid implants having the highest accuracy and humeral heads having the highest variability. Multiple factors contributed to the varying concordances for the different implants, suggesting possible areas of improvement in this technology. These results may have implications for logistics, intraoperative efficiency, and overall cost and underscore the potential value of this technology. LEVEL OF EVIDENCE Level III.
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The Effect of Glenoid Version on Glenohumeral Instability. J Am Acad Orthop Surg 2022; 30:e1165-e1178. [PMID: 36166388 DOI: 10.5435/jaaos-d-22-00148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023] Open
Abstract
In recent years, an appreciation for the dynamic relationship between glenoid and humeral-sided bone loss and its importance to the pathomechanics of glenohumeral instability has substantially affected modern treatment algorithms. However, comparatively less attention has been paid to the influence of glenoid version on glenohumeral instability. Limited biomechanical data suggest that alterations in glenoid version may affect the forces necessary to destabilize the glenohumeral joint. However, this phenomenon has not been consistently corroborated by the results of clinical studies. Although increased glenoid retroversion may represent an independent risk factor for posterior glenohumeral instability, this relationship has not been reliably observed in the setting of anterior glenohumeral instability. Similarly, the effect of glenoid version on the failure rates of surgical stabilization procedures remains poorly understood.
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Prevalence and Clinical Impact of Incidental Findings on Preoperative 3D Planning Computed Tomography for Total Shoulder Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202208000-00003. [PMID: 35944103 PMCID: PMC9359811 DOI: 10.5435/jaaosglobal-d-21-00291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 06/16/2022] [Indexed: 11/24/2022]
Abstract
Introduction: 3D planning software for shoulder arthroplasty recently emerged for aiding in intraoperative determination of native glenoid. These protocols often require increased scan resolution, however, raising the question of an increased prevalence and clinical impact of incidental findings (IFs) from preoperative imaging. Methods: A retrospective review of preoperative shoulder CT reports was conducted for 333 consecutive patients planning anatomic or reverse total shoulder arthroplasties. Patients with thin-sliced CT scans (1.25 mm) were compared with those with standard CT scans (2.5 mm). Poisson regression was performed with baseline characteristics and potentially pathologic IFs (PPIFs). Results: IFs were present in 131 of the 333 scans (39.3%), and 38 of the 333 scans (11.4%) included PPIFs. Only 8 of the 333 scans (2.4%) required workup, with 2 of the 333 (0.6%) leading to new cancer diagnoses. Thin-sliced CT scans detected a higher mean number of IFs (1.12 versus 0.22, P < 0.001) while the mean number of PPIFs remained similar (0.13 versus 0.10, P = 0.43). Conclusion: IFs are frequent; however, only 0.6% scans led to new cancer diagnoses. Comparison of thin-sliced with standard CT scans revealed a higher frequency of IFs but similar PPIFs, indicating increased burden of IFs without the benefit of identifying additional malignancies. As demand rises for shoulder arthroplasties, surgeons should consider the potential hidden costs of IFs when using 3D planning programs.
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Werner BC, Denard PJ, Tokish JM, Bedi A, Donegan RP, Metcalfe N, Dines JS. The addition of preoperative three-dimensional analysis alters implant choice in shoulder arthroplasty. Shoulder Elbow 2022; 14:378-384. [PMID: 35846399 PMCID: PMC9284305 DOI: 10.1177/1758573221989306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/05/2020] [Accepted: 01/04/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The primary objective of the present study was to investigate how preoperative imaging modalities including 3D computed tomography (CT) scans with preoperative planning software affect implant choice for shoulder arthroplasty. METHODS X-ray, uncorrected 2D CT scans, and 3D CT scans from 21 patients undergoing primary arthroplasty were reviewed by five shoulder surgeons. Each surgeon measured glenoid version, inclination and humeral head subluxation, and then selected an anatomic or reverse shoulder arthroplasty implant based only on these imaging parameters. Each surgeon virtually positioned the implant. Agreement between surgeons and changes in plan for individual surgeons between imaging modalities were assessed. RESULTS Average measurements of native version, inclination, and subluxation were similar across all imaging modalities with very good interobserver reliability. Overall, there was a high rate of variability in choice of implant depending on imaging modality. Agreement on implant selection between surgeons improved from 68.6% using x-ray to 80.0% with 3D CT. Introducing age added significant variability, reducing agreement on implant choice to 61.0% with 3D CT. CONCLUSIONS The use of preoperative 3D planning changes implant choice in nearly one-third of cases compared to plain radiographs and improves surgeon agreement on implant choice compared to x-ray and 2D CT.Level of evidence: III.
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Affiliation(s)
- Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
- Brian C Werner, Department of Orthopaedic
Surgery, University of Virginia Health System, PO Box 800159, Charlottesville,
VA, USA.
| | | | | | - Asheesh Bedi
- Department of Orthopaedic Surgery,
University of Michigan, Ann Arbor, MI, USA
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Nascimento LGP, Ikemoto RY, Wright T. Navegação em cirurgia de artroplastia de ombro. Rev Bras Ortop 2022; 57:540-545. [PMID: 35966424 PMCID: PMC9365459 DOI: 10.1055/s-0040-1712989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/10/2020] [Indexed: 11/10/2022] Open
Abstract
The indication of shoulder arthroplasties has increased progressively. Accurate positioning of the components may have significant implications for clinical results. The navigation used to aid in the performance of anatomical and reverse total arthroplasties has provided greater precision in implant placement, especially on the glenoid. The development of the technique, material, and prosthesis design have shown encouraging results and led to a trend toward its expansion. In this way, we estimate a higher survival of the arthroplasties resulting from lower rates of dislocation and early loosening. We aim to describe the current technique and to present the results of the literature with navigation. However, comparative clinical studies with long term follow-up are necessary to prove the efficacy in the final results of total shoulder arthroplasties.
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Affiliation(s)
| | - Roberto Yukio Ikemoto
- Divisão de ombro e cotovelo, Faculdade de Medicina do ABC, Santo André, SP, Brasil
- Departamento de Ortopedia, Hospital Ipiranga, São Paulo, SP, Brasil
| | - Thomas Wright
- Centro de treinamento e pesquisa musculoesquelética, University of Florida, Gainesville, Florida, United States
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Freehill MT, Weick JW, Ponce BA, Bedi A, Haas D, Ruffino B, Robbins C, Prete AM, Costouros JG, Warner JJP. Anatomic Total Shoulder Arthroplasty: Component Size Prediction with 3-Dimensional Pre-Operative Digital Planning. J Shoulder Elb Arthroplast 2022; 6:24715492221098818. [PMID: 35669622 PMCID: PMC9163733 DOI: 10.1177/24715492221098818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/03/2022] [Accepted: 03/12/2022] [Indexed: 11/15/2022] Open
Abstract
Background The rate, complexity, and cost of total shoulder arthroplasty (TSA) continues to grow. Technology has advanced pre-operative templating. Reducing cost of TSA has positive impact for the patient, manufacturer, and hospital. The aim of this study was to evaluate the accuracy of implant size selection based on 3-D templating. Our hypothesis was that pre-operative templating would enable accurate implant prediction within one size. Methods Multicenter retrospective study of anatomic TSAs templated utilizing 3-D virtual planning technology. This program uses computed tomography (CT) scans allowing the surgeon to predict component sizes of the glenoid and humeral head and stem. Pre-operative templated implant size were compared to actual implant size at the time of surgery. Primary data analysis utilized unweighted Cohen's Kappa test. Results 111 TSAs were analyzed from five surgeons. Pre-operative templated glenoid sizes were within one size of actual implant in 99% and exactly matched in 89%. For patients requiring a posterior glenoid augment (n = 14), 100% of implants were within one size of the template and 93% matched exactly. For stemless humeral components (n = 87) implanted, 98% matched the pre-operative template within one size with 79% exactly matched. For stemmed components (n = 24), 88% of cases were within one size of the preoperative plan and exactly matching in 83%. Humeral head diameter matched within one size of the pre-operative template in 84% of cases and exactly matched in 72%. Conclusion Pre-operative 3-D templating for TSAs can accurately predict glenoid and humeral component size. This study sets the groundwork for utilization of pre-operative 3-D templating as a potential method to reduce overall TSA costs by managing cost of implants, reducing inventory needs, and improving surgical efficiency.
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Affiliation(s)
| | - Jack W. Weick
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Brent A. Ponce
- Department of Orthopaedic Surgery, University of Alabama Birmingham, Birmingham, AL, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Bethany Ruffino
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Chris Robbins
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Alexander M. Prete
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Jon JP Warner
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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Variability and reliability of 2-dimensional vs. 3-dimensional glenoid version measurements with 3-dimensional preoperative planning software. J Shoulder Elbow Surg 2022; 31:302-309. [PMID: 34411724 DOI: 10.1016/j.jse.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/07/2021] [Accepted: 07/11/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preoperative planning for total shoulder arthroplasty (TSA) may change according to the measured degree of glenoid version. Both 2-dimensional (2D) and 3-dimensional (3D) computed tomographic (CT) scans are used to measure glenoid version, with no consensus on which method is more accurate. However, it is generally accepted that 3D measurements are more reliable, yet most 3D reconstruction software currently in clinical use have never been directly compared to 2D. The purpose of this study is to directly compare 2D and 3D glenoid version measurements and determine the differences between the two. METHODS CT scans were performed preoperatively on 315 shoulders undergoing either anatomic or reverse TSA. 2D measurements of glenoid version were obtained manually using the Friedman method, whereas 3D measurements were obtained using the Equinoxe Planning Application (Exactech Inc.) 3D-reconstruction software. Negative version values indicate retroversion, whereas positive values indicate anteversion. Two observers collected the 2D measurements 2 separate times, and intra- and interobserver measurements were calculated. Groups were compared for variability using intraclass correlation coefficients (ICCs), and for differences in sample means using Student t tests. Additionally, samples were stratified by version value in order to better understand the potential sources of error between measurement techniques. RESULTS For the 2D measurements, intraobserver variability indicated excellent reproducibility for both observer 1 (ICC = 0.928, 95% confidence interval [CI] 0.911-0.942) and observer 2 (ICC = 0.964, 95% CI 0.955-0.971). Interobserver variability measurements also indicated excellent reproducibility (ICC = 0.915, 95% CI 0.778-0.956). The overall 2D version measurement average (-4.9° ± 10.3°) was significantly less retroverted than the 3D measurement average (-8.4° ± 9.1°) (P < .001), with 3D measurements yielding a more retroverted value 73% of the time. When stratified on the basis of version value with outliers excluded, there was no significant difference in the distribution of high-error samples within the data. DISCUSSION There was excellent reproducibility between the 2 observers in terms of both intra- and interobserver variability. The 3D measurement techniques were significantly more likely to return a more retroverted measurement, and high-error samples were evenly distributed throughout the data, indicating that there were no discernable trends in the degree of error observed. Shoulder surgeons should be aware that different glenoid version measurement strategies can yield different version measurements, as these can affect preoperative planning and surgeon decision making.
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Sheth B, Lavin AC, Martinez C, Sabesan VJ. The Use of Preoperative Planning to Decrease Costs and Increase Efficiency in the OR. JSES Int 2022; 6:454-458. [PMID: 35572445 PMCID: PMC9091925 DOI: 10.1016/j.jseint.2022.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Shoulder arthroplasty (SA) incurs up to $1.8B per year in societal costs. With the increasing demand for SA and the steady decrease of annual reimbursements for orthopedic procedures, it has become crucial to control costs. In SA, there has been an interest in using preoperative planning software to improve accuracy in positioning and implant selection, ultimately optimizing outcomes. However, the use of preoperative planning to increase efficiency has not been studied. The purpose of this study was to determine if preoperative planning could increase efficiency and decrease costs in the operating room. Methods This retrospective review included 94 patients who underwent shoulder arthroplasty and had a CT scan with a preoperative plan by a single orthopedic surgeon between 2017 and 2020. The patients were divided based on the use of the preoperative plan during surgery. Group 1 included 65 patients with a preoperative plan used during surgery, and group 2 included 29 patients without a preoperative plan utilized during surgery. Average preparation time, surgical time, time in the operating room, the number of trays sterilized, and postoperative outcomes were analyzed between the two groups. Subanalysis was done to find a statistical difference in the cost of sterilization for both groups. Results The cohort had 55% males, with an average age of 71 years and an average BMI of 29.9. There were no significant differences between the groups for age, BMI, or ASA class. There was no significant difference between groups in preparation time (group 1: 53.3 min, group 2: 53.1 min P = .924), surgical time (group 1: 119.7 min, group 2: 111.9 min; P = .25), or time in the OR (group 1: 183.2 min, group 2: 173.2 min; P = .156). There was a statistical difference in the number of trays (5 vs. 8; P < .01) and cost of sterilization between groups ($487.30 vs. $842.86; P < .01). No correlation between the number of trays and preparation time (group 1: −0.05, group 2: −0.28) or trays and surgical time was found for either group (group 1: r = −0.31, group 2: r = −0.22). There were no significant differences in postoperative outcomes between the groups. Conclusion While preoperative planning did not reduce time in the OR for shoulder arthroplasty, it was correlated to a significant reduction in the number and cost of sterilized trays with comparable postoperative outcomes.
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Waltz CDRRA, Peebles AM, Ernat JJ, Eble SK, Denard PJ, Romeo AA, Golijanin P, Liegel SM, Provencher MT. Commercial 3-D Imaging Programs Are Not Created Equal: Version and Inclination Measurement Positions Vary Among Preoperative Planning Software. JSES Int 2022; 6:413-420. [PMID: 35572452 PMCID: PMC9091744 DOI: 10.1016/j.jseint.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
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The Accuracy of Three-Dimensional CT Scan Software in Predicting Prosthetic Utilization in Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2022; 30:e223-e232. [PMID: 34613949 DOI: 10.5435/jaaos-d-21-00641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/03/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Recent innovations in shoulder arthroplasty include three-dimensional (3D) CT software imaging that can be used to predict which prosthetic implants will be used intraoperatively. Correct prediction of the implants may optimize supply chain logistics for the surgeon, hospital, ambulatory surgery center, and the implant company. The purpose of this study was to examine a single surgeon's experience with this software to determine its predictive accuracy in determining which implants would be used intraoperatively. METHODS A retrospective review of patients undergoing total shoulder arthroplasty (TSA) performed by a single surgeon was performed. Inclusion criteria were patients undergoing anatomic (aTSA) or reverse (rTSA) TSA examined preoperatively with the 3D CT planning software. A chart review was performed to compare the accuracy of the preoperative plan in predicting the actual prostheses implanted at surgery. RESULTS Two hundred seventy-eight shoulders from 260 patients were included. One hundred fifty-one shoulders underwent aTSA, and 127 shoulders underwent rTSA. The surgeon was able to predict the type of arthroplasty (anatomic versus reverse) implanted in 269 of 278 (97%) shoulders. Using the 3D CT software, the surgeon was able to predict all the implants implanted in 68 shoulders (24%). For aTSA, 3D CT imaging successfully predicted all implants implanted in 43 shoulders (28%), glenoid implants implanted in 120 of 148 shoulders (81%), and humeral implants implanted in 54 shoulders (36%). For rTSA, 3D CT imaging successfully predicted all implants implanted in 26 shoulders (20%), glenoid implants implanted in 106 shoulders (83%), and humeral implants implanted in 39 shoulders (31%). CONCLUSIONS The 3D CT software combined with surgeon's judgment provided a high accuracy (97%) in determining the type of arthroplasty, a moderately high accuracy in determining the glenoid implants (81% to 83%), a low accuracy in determining humeral implants (31% to 36%), and a low accuracy in determining all prostheses used for each surgery (20% to 28%). LEVEL OF EVIDENCE LOE IV-Diagnostic Case Series.
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Hao KA, Sutton CD, Wright TW, Schoch BS, Wright JO, Struk AM, Haupt ET, Leonor T, King JJ. Influence of glenoid wear pattern on glenoid component placement accuracy in shoulder arthroplasty. JSES Int 2022; 6:200-208. [PMID: 35252914 PMCID: PMC8888204 DOI: 10.1016/j.jseint.2021.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Accurate glenoid component placement in shoulder arthroplasty is often difficult even with the use of preoperative planning. Computer navigation and patient-specific guides increase component placement accuracy, but which patients benefit most is unknown. Our purpose was to assess surgeons' accuracy in placing a glenoid component in vivo using 3-dimensional preoperative planning and standard instruments among various glenoid wear patterns. Methods We conducted a retrospective review of 170 primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) performed at a single institution. Commercially available preoperative planning software was used in all arthroplasties with multiplanar 2-dimensional computed tomography and a 3-dimensional implant overlay. After registration of intraoperative bony landmarks to the navigation system, participating surgeons with knowledge of the preoperative plan were blinded to the computer screen and attempted to implement their preoperative plan by simulating placement of a central-axis glenoid guide pin. Two hundred thirty-three screenshots of surgeon's simulated guide pin placement were included. Glenoid displacement, error in version and inclination, and overall malposition from the preoperatively planned target point were stratified by posterior wear status (with [Walch B2 or B3] or without [A1, A2, or B1]) and Walch classification (A1, A2, B1, B2, or B3). The glenoid component was considered malpositioned when version or inclination errors exceeded 10° or the starting point displacement exceeded 4 mm. Results For rTSA, errors in version were greater for glenoids with posterior wear compared with those without (8.1° ± 5.6° vs. 4.7° ± 4.0°; P < .001). On post hoc analysis, B2 glenoids had greater version error than A1, A2, and B1 glenoids. A greater proportion of glenoids undergoing rTSA that possessed posterior wear had an error in version >10° compared with those without (31% vs. 8%; P < .001). Consequently, glenoids undergoing rTSA with posterior wear were malpositioned at a greater rate compared with those without (73% vs. 53%). In contrast, glenoids undergoing aTSA with and without posterior wear did not differ based on displacement error, version error, inclination error, or malposition occurrence. Conclusions Posterior glenoid bone loss more commonly resulted in glenoid version errors exceeding 10 degrees and component malposition in rTSA, but not for aTSA. Malposition was still relatively high in patients without significant posterior wear for both aTSA (36%) and rTSA (53%). Surgeons should consider alternate techniques beyond preoperative planning and standard instrumentation when performing shoulder arthroplasty in patients with posteriorly worn glenoids.
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Levins JG, Kukreja M, Paxton ES, Green A. Computer-Assisted Preoperative Planning and Patient-Specific Instrumentation for Glenoid Implants in Shoulder Arthroplasty. JBJS Rev 2021; 9:01874474-202109000-00006. [PMID: 35417437 DOI: 10.2106/jbjs.rvw.20.00236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Glenoid component positioning affects implant survival after total shoulder arthroplasty, and accurate glenoid-component positioning is an important technical aspect. » The use of virtual planning and patient-specific instrumentation has been shown to produce reliable implant placement in the laboratory and in some clinical studies. » Currently available preoperative planning software programs employ different techniques to generate 3-dimensional models and produce anatomic measurements potentially affecting clinical decisions. » There are no published data, to our knowledge, on the effect of preoperative computer planning and patient-specific instrumentation on long-term clinical outcomes.
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Affiliation(s)
- James G Levins
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, Brown University Warren Alpert School of Medicine, Providence, Rhode Island
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Cancienne JM, Dempsey IJ, Garrigues GE, Cole BJ, Brockmeier SF, Werner BC. Trends and impact of three-dimensional preoperative imaging for anatomic total shoulder arthroplasty. Shoulder Elbow 2021; 13:380-387. [PMID: 34394735 PMCID: PMC8355644 DOI: 10.1177/1758573220908865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/29/2019] [Accepted: 01/29/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The goals of this study were to determine the incidence in the United States of preoperative three-dimensional imaging prior to anatomic total shoulder arthroplasty for osteoarthritis and to determine if preoperative imaging is associated with decreased complication rates. METHODS Using a Medicare insurance database, we identified all patients who underwent computed tomography (n = 9380) and/or magnetic resonance imaging (n = 15,653) prior to anatomic total shoulder arthroplasty for a diagnosis of osteoarthritis from 2005 to 2014. The incidence of imaging over time was analyzed and complication rates compared between patients with imaging to matched controls. RESULTS The incidence of preoperative three-dimensional imaging significantly increased over time, with computed tomography increasing more than magnetic resonance imaging. Compared to controls, patients with preoperative computed tomography imaging had significantly lower revision rates at two years (odds ratio 0.72 (0.64-0.82), p = 0.008). There were no other significant differences in the other complications studied. CONCLUSIONS The use of preoperative three-dimensional imaging for anatomic total shoulder arthroplasty for a diagnosis of osteoarthritis has increased dramatically, with the use of computed tomography increasing the most. Patients who underwent preoperative computed tomography imaging experienced lower revision rates at two years postoperatively compared to matched controls without such imaging. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
| | - Ian J Dempsey
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, USA
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, USA
| | - Stephen F Brockmeier
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, USA
- Brian C Werner, Department of Orthopaedic
Surgery, University of Virginia Health System, PO Box 800159, Charlottesville,
VA, USA.
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Shah SS, Sahota S, Denard PJ, Provencher MT, Parsons BO, Hartzler RU, Dines JS. Variability in total shoulder arthroplasty planning software compared to a control CT-derived 3D printed scapula. Shoulder Elbow 2021; 13:268-275. [PMID: 34659466 PMCID: PMC8513001 DOI: 10.1177/1758573219888821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/08/2019] [Accepted: 10/21/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Two techniques exist from which all 3D preoperative planning software for total shoulder arthroplasty are based. One technique is based on measurements constructed on the mid-glenoid and scapular landmarks (Landmark). The second is an automated system using a best-fit sphere technique (Automated). The purpose was to compare glenoid measurements from the two techniques against a control computed tomography-derived 3D printed scapula. METHODS Computed tomography scans of osteoarthritic shoulders of 20 patients undergoing primary total shoulder arthroplasty were analyzed with both 3D planning software techniques. Measurements from a 3D printed scapula (Scapula) from the true 3D computed tomography scan served as controls. Glenoid version and inclination measurements from each group were blinded and reviewed. RESULTS In 65% (Automated) and 45% (Landmark) of cases, either inclination or version varied by 5° or more versus 3D printed scapula. Significant variability in version differences compared to the scapula group existed (p = 0.007). Glenoid version from the Scapula = 13.0° ± 10.6°, Automated = 15.0° ± 13.9°, and Landmark = 12.2° ± 7.8°. Inclination from Scapula = 5.4° ± 7.9°, Automated = 6.1° ± 12.6°, and Landmark = 6.2° ± 9.1°. DISCUSSION A high percentage of cases showed discrepancies in glenoid inclination and version values from both techniques. Surgeons should be aware that regardless of software technique, there is variability compared to measurements from a control 3D computed tomography printed scapula.
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Affiliation(s)
| | | | | | | | - Bradford O Parsons
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Hurst SA, Merlini L, Hansen U, Gregory J, Emery R, Gregory T. The Glenoid Vault Outer Cortex a new more accurate radiological reference for shoulder arthroplasty. SICOT J 2021; 7:32. [PMID: 34009116 PMCID: PMC8132599 DOI: 10.1051/sicotj/2021030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/13/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Correct positioning of the glenoid component is an important determinant of outcome in shoulder arthroplasty. We describe and assess a new radiological plane of reference for improving the accuracy of glenoid preparation prior to component implantation – the Glenoid Vault Outer Cortex (GvOC) plane. Methods: One hundred and five CT scans of normal scapulae were obtained. Forty six females and 59 males aged between 22 and 30 years. The accuracy of the GvOC plane was then compared against the current “gold standard” – the scapular border (SB). Measurements of glenoid inclination, version, rotation, and offset were obtained using both the GvOC and SB planes. These were then compared to actual values. Results: The mean difference between version obtained using the GvOC plane and the actual value was 1.8° (−2 to 5, SD 1.6) as compared to 6.7° (−2 to 17, SD 4.3) when the SB plane was used, (p < 0.001). The mean difference between estimates of inclination obtained using the GvOC plane and the actual were 1.9° (−4 to 6, SD 1.6) as compared to 11.2° (−4 to 25, SD 6.1) when the SB plane was used, (p < 0.001). Conclusions: The GvOC plane produced estimates of glenoid version and inclination closer to actual values with lower variance than when the SB plane was used. The GvOC may be a more accurate and reproducible radiological method for surgeons to use when defining glenoid anatomy prior to arthroplasty surgery.
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Affiliation(s)
- Simon A Hurst
- Avicenne Teaching Hospital, 125 rue Stalingrad, Bobigny, 93000 Paris, France - Université Paris Sorbonne Nord, Campus de Bobigny, 1, rue de Chablis, Bobigny, 93000 Paris, France - Imperial College, St Mary's Hospital Campus, Queen Elizabeth Queen Mother Building, Praed Street, W2 1NY London, UK
| | - Lorenzo Merlini
- Avicenne Teaching Hospital, 125 rue Stalingrad, Bobigny, 93000 Paris, France - University Sorbonne-Paris-Nord, Equip Projet MOVEO, LaMSN, 99 Avenue Jean Baptiste, Clement, 93430 Villetaneuse, France
| | - Ulrich Hansen
- Imperial College, Department of Mechanical Engineering, South Kensington Campus, SW7 2AZ London, UK
| | - Jules Gregory
- Department of Radiology, Beaujon Hospital, Paris Nord Val de Seine Hospitals, APHP, 100 Avenue du General Leclerc, 92110 Clichy, France
| | - Roger Emery
- Imperial College, St Mary's Hospital Campus, Queen Elizabeth Queen Mother Building, Praed Street, W2 1NY London, UK
| | - Thomas Gregory
- Avicenne Teaching Hospital, 125 rue Stalingrad, Bobigny, 93000 Paris, France - University Sorbonne-Paris-Nord, Equip Projet MOVEO, LaMSN, 99 Avenue Jean Baptiste, Clement, 93430 Villetaneuse, France
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Harding GT, Bois AJ, Bouliane MJ. A novel method for localization of the maximum glenoid bone defect during reverse shoulder arthroplasty. JSES Int 2021; 5:667-672. [PMID: 34223413 PMCID: PMC8245994 DOI: 10.1016/j.jseint.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Management of glenoid bone defects during reverse shoulder arthroplasty remains a challenge. The aim of our study was to preoperatively localize the maximal depth of glenoid bone defects in relation to glenoid reaming. Methods Thirty preoperative shoulder computed tomography scans were collected. Three assessors created standardized surgical plans, using 3-dimensional (3D) computed tomography–based Blueprint planning software in which the reaming axis was held constant at zero degrees of version and inclination. Each plan resulted in a 2-dimensional (2D) image of the reamer’s contact on the glenoid and a corresponding 3D representation of the glenoid bone defect. The position of the maximum glenoid defect was localized on both the 2D and 3D images. Descriptive statistics were calculated. The correlation between angles from 2D and 3D images was assessed, and intraclass correlation was used to assess inter-rater and intrarater reliability. Results Twenty-eight patients were included. The overall mean difference between 2D and 3D angles was 5.4° (standard deviation 5.2°). The correlation between 2D and 3D angles was almost perfect. Intraclass correlation results demonstrated near-perfect agreement. The maximal glenoid defect was within 5% of a circle (or +/- 9°) from perpendicular to the high-side ream line in 85.1% of comparisons and was within 10% of a circle in 97.6% of comparisons. Conclusion Using Blueprint planning software, we have demonstrated with almost perfect agreement among 3 assessors that when the reaming axis is held constant, the maximum glenoid bone defect is reliably located perpendicular to the glenoid ream line.
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Affiliation(s)
- Graeme T. Harding
- Division of Orthopaedic Surgery, University of Alberta, Edmonton, Alberta, Canada
- Corresponding author: Graeme T. Harding, MASc, MD, FRCSC, CORe Main Office, 6-110 Clinical Sciences Building, Edmonton, Alberta T6G 2G3, Canada.
| | - Aaron J. Bois
- Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Martin J. Bouliane
- Division of Orthopaedic Surgery, University of Alberta, Edmonton, Alberta, Canada
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The study of 2-dimensional computed tomography scans of the glenoid anatomy in relation to reverse shoulder arthroplasty in the Southern Chinese population. JSES Int 2021; 5:714-721. [PMID: 34223420 PMCID: PMC8246002 DOI: 10.1016/j.jseint.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Reverse shoulder arthroplasty is becoming an increasingly common surgical procedure in Hong Kong, as well as in many other countries worldwide. The aim of this study is to describe the glenoid anatomy in the Southern Chinese population. We are interested to know whether commercially available glenoid implants are suitable for this population and whether there are any steps or precautions we can take during surgery to optimize the clinical outcome for these patients. Method A total of 244 shoulders of Southern Chinese patients were analyzed using 2-dimensional computed tomography, formatted to align along the scapular axis. The anatomic parameters analyzed included the shape, axial configuration, maximum width, maximum height, version, and presence of bone defect. Results In our study, 76.6% of glenoids were pear-shaped, 23.0% were elliptical, and only 0.4% were inverted pear in shape. Of all glenoids, 95.1% of glenoids had posterior-prominent axial configuration, whereas 4.9% had neutral axial configuration. The mean maximum glenoid height for both genders was 33.8 mm, whereas the mean maximum glenoid height was 32.2 mm for women and 36.6 mm for men. The mean maximum glenoid width for both genders was 25.8 mm, whereas the mean maximum glenoid width was 24.8 mm for women and 27.3 mm for men. The differences in measurements between genders were statistically significant. Of all glenoids, 46.3% of the glenoids were retroverted, whereas 53.7% of the glenoids were anteverted. The mean version for both genders was 0.77 degrees anteversion. The mean version was 1.16 degrees anteversion for women and 0.10 degrees anteversion for men. Of the 244 glenoids, 4 had bone defects. In our study, 39.8% of patients had mean maximum glenoid widths that were less than 25 mm, which is the smallest size available for most conventional glenoid baseplates. Conclusion A significant portion of the Southern Chinese population has glenoid widths that are smaller than the smallest commercially available glenoid baseplates. Understanding the glenoid anatomy is crucial in the case of reverse shoulder arthroplasty, as it has significant implications in implant design, operative planning, and surgical outcomes.
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Matache BA, Alnusif N, Chaoui J, Walch G, Athwal GS. Humeral head subluxation in Walch type B shoulders varies across imaging modalities. JSES Int 2021; 5:98-101. [PMID: 33554173 PMCID: PMC7846694 DOI: 10.1016/j.jseint.2020.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background The Walch type B pattern of glenohumeral osteoarthritis is characterized by posterior humeral head subluxation (PHHS). At present, it is unknown whether the percentage of subluxation measured on axillary radiographs is consistent with measurements on 2-dimensional (2D) axial or 3-dimensional (3D) volumetric computed tomography (CT). The purpose of this study was to evaluate PHHS across imaging modalities (radiographs, 2D CT, and 3D CT). Methods A cohort of 30 patients with Walch type B shoulders underwent radiography and standardized CT scans. The cohort comprised 10 type B1, 10 type B2, and 10 type B3 glenoids. PHHS was measured using the scapulohumeral subluxation method on axillary radiographs and 2D CT. On 3D CT, PHHS was measured volumetrically. PHHS was statistically compared between imaging modalities, with P ≤ .05 considered significant. Results The mean PHHS value for the entire group was 69% ± 24% on radiographs, 65% ± 23% with 2D CT, and 74% ± 24% with 3D volumetric CT. PHHS as measured on complete axillary radiographs was not significantly different than that measured on 2D CT (P = .941). Additionally, PHHS on 3D volumetric CT was 9.5% greater than that on 2D CT (P < .001). There were no significant differences in PHHS between the type B1, B2, and B3 groups with 2D or 3D CT measurement techniques (P > .102). Conclusion Significant differences in PHHS were found between measurement techniques (P < .035). A 9.5% difference in PHHS between 2D and 3D CT can be mostly accounted for by the linear (2D) vs. volumetric (3D) measurement techniques (a linear 80% PHHS value is mathematically equivalent to a volumetric PHHS value of 89.6%). Surgeons should be aware that subluxation values and therefore thresholds vary across different imaging modalities and measurement techniques.
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Affiliation(s)
| | - Naser Alnusif
- Roth
- McFarlane Hand & Upper Limb Centre, St. Joseph's Healthcare London, London, ON, Canada
| | | | | | - George S Athwal
- Roth
- McFarlane Hand & Upper Limb Centre, St. Joseph's Healthcare London, London, ON, Canada
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Erickson BJ, Chalmers PN, Denard P, Lederman E, Horneff G, Werner BC, Provencher MT, Romeo AA. Does commercially available shoulder arthroplasty preoperative planning software agree with surgeon measurements of version, inclination, and subluxation? J Shoulder Elbow Surg 2021; 30:413-420. [PMID: 32544424 DOI: 10.1016/j.jse.2020.05.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preoperative planning with commercially available imaging software in shoulder arthroplasty may allow for improved decision-making and more accurate placement of the glenoid component. METHODS A total of 81 consecutive shoulder computed tomography scans obtained for preoperative planning purposes for shoulder arthroplasty were analyzed by commercially available software from 4 companies (Blueprint: Wright Medical, Memphis, TN, USA; GPS: Exactech, Gainesville, FL, USA; Materialise: DJO, Vista, CA, USA; and VIP: Arthrex, Naples, FL, USA) and by 5 fellowship-trained sports medicine/shoulder surgeons. Inclination, version, and subluxation of the humerus were measured in a blinded fashion on axial and coronal sequences at the mid-glenoid. Surgeon measurements were analyzed for agreement and were compared with the 4 commercial programs. RESULTS Surgeon reliability was acceptable for version (intraclass correlation coefficient [ICC]: 0.876), inclination (ICC: 0.84), and subluxation (ICC: 0.523). Significant differences were found between surgeon and commercial software measurements in version (P = .03), inclination (P = .023), and subluxation (P < .001). Software measurements tended to be more superiorly inclined (average -2° to 2° greater), more retroverted (average 2°-5° greater), and more posteriorly subluxed (average 7°-10° greater) than surgeon measurements. In comparing imaging software measurements, only Blueprint was found to produce significantly different version measurements than surgeon measurements (P = .02). CONCLUSION Preoperative planning software for shoulder arthroplasty has limited agreement in measures of version, inclination, and subluxation measurements, whereas surgeons have high inter-reliability. Surgeons should be cautious when using commercial software planning systems and when comparing publications that use different planning systems to determine preoperative glenoid deformity measurements.
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Affiliation(s)
- Brandon J Erickson
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, New York, NY, USA.
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Patrick Denard
- Department of Orthopaedic Surgery, Southern Oregon Orthopaedics, Medford, OR, USA
| | - Evan Lederman
- Department of Orthopaedic Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Gabriel Horneff
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Chalfont, PA, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | | | - Anthony A Romeo
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, New York, NY, USA
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Computer-Assisted Surgery in Reverse Shoulder Arthroplasty: Early Experience. Indian J Orthop 2021; 55:1003-1008. [PMID: 34194658 PMCID: PMC8192603 DOI: 10.1007/s43465-020-00344-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/30/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND In the last decade, new technologies have been applied to shoulder arthroplasty. The aim of this work was to show that navigated RSA allows the surgeon to reach the planned version/inclination in all cases. In this article are shown preliminary data, advantages, disadvantages and limits of the technique. METHODS Eighteen computer-assisted reverse shoulder arthroplasty were performed. Preoperative glenoid version and inclination were evaluated with preoperative CT scan using Orthoblue® (Exactech, Gainesville, FL,USA) software, as well as baseplate type, planned glenoid component seating, planned postoperative version, planned postoperative inclination, intraoperative glenoid version/inclination, screw length and surgical time. A senior shoulder surgeon has analyzed the advantages, disadvantages and limitation of this kind of surgery. RESULTS Mean surgical time of the primary implants was 92 ± 12 min (min 75-max 110). Mean preoperative inclination was + 2.6° ± 6.4, mean preoperative version was - 7.6° ± 8.4. Mean planned postoperative inclination was - 2.7° ± 2.3, mean planned postoperative version was - 1.6° ± 2.9 and mean planned glenoid seating was 89% ± 8%. Planned settings were reached in all cases during surgery. Baseplate implanted were in nine cases 8° posterior augmented, in six cases standard and in three cases 10° superior augmented. Mean screw length was 33.5 mm ± 4.2 mm. No GPS system failure has been recorded. One coracoid fracture occurred during the first case. DISCUSSION Intraoperative navigation system is a reliable and user-friendly technology that allows the surgeon to reach planned glenoid positioning during surgery. Furthermore, this technology will allow the surgeon to compare clinical outcomes to component positioning data. The lack of humeral implant navigation is the main limit of this technique.
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Prevalence and Treatment of Osteoporosis Prior to Elective Shoulder Arthroplasty. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00204. [PMID: 33986217 PMCID: PMC7722598 DOI: 10.5435/jaaosglobal-d-20-00204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/18/2022]
Abstract
Introduction: The rate of preoperative osteoporosis in lower extremity arthroplasty is 33%. The prevalence of osteoporosis in shoulder arthroplasty patients is inadequately studied. The purpose of this study was to (1) determine the prevalence of osteoporosis in patients undergoing elective shoulder arthroplasty, (2) report the percentage of patients having dual-energy x-ray absorptiometry (DEXA) testing before surgery, and (3) determine the percentage of patients who have been prescribed osteoporosis medications within 6 months before or after surgery. Methods: This retrospective case series included all adults aged 50 years and older who underwent elective shoulder arthroplasty at a single tertiary care center over an 8-year period. National Osteoporosis Foundation (NOF) criteria for screening and treatment were applied. Results: Two hundred fifty-one patients met the inclusion criteria; 171 (68%) met the criteria for DEXA testing, but only 31 (12%) had this testing within 2 years preoperatively. Eighty patients (32%) met the NOF criteria for receipt of pharmacologic osteoporosis treatment, and 17/80 (21%) received a prescription for pharmacotherapy. Discussion: Two-thirds of elective shoulder arthroplasty patients meet the criteria to have bone mineral density measurement done, but less than 20% have this done. One in three elective shoulder arthroplasty patients meet the criteria to receive osteoporosis medications, but only 20% of these patients receive therapy.
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