1
|
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.
Collapse
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
| | | | | | | |
Collapse
|
2
|
Paul AV, Udoh I, Bharadwaj A, Bokshan S, Owens BD, Levine WN, Garrigues GE, Abrams JS, McMahon PJ, Miniaci A, Nagda S, Braman JP, MacDonald P, Riboh JC, Kaar S, Lau B. Preoperative planning with three-dimensional CT vs. three-dimensional magnetic resonance imaging does not change surgical management for shoulder instability. JSES Int 2024; 8:243-249. [PMID: 38464444 PMCID: PMC10920129 DOI: 10.1016/j.jseint.2023.08.005] [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: 03/12/2024] Open
Abstract
Background This study aims to determine the effect of time and imaging modality (three-dimensional (3D) CT vs. 3D magnetic resonance imaging (MRI)) on the surgical procedure indicated for shoulder instability. The hypothesis is there will be no clinical difference in procedure selection between time and imaging modality. Methods Eleven shoulder surgeons were surveyed with the same ten shoulder instability clinical scenarios at three time points. All time points included history of present illness, musculoskeletal exam, radiographs, and standard two-dimensional MRI. To assess the effect of imaging modality, survey 1 included 3D MRI while survey 2 included a two-dimensional and 3D CT scan. To assess the effect of time, a retest was performed with survey 3 which was identical to survey 2. The outcome measured was whether surgeons made a "major" or "minor" surgical change between surveys. Results The average major change rate was 14.1% (standard deviation: 7.6%). The average minor change rate was 12.6% (standard deviation: 7.5%). Between survey 1 to the survey 2, the major change rate was 15.2%, compared to 13.1% when going from the second to the third survey (P = .68). The minior change rate between the first and second surveys was 12.1% and between the second to third interview was 13.1% (P = .8). Discussion The findings suggest that the major factor related to procedural changes was time between reviewing patient information. Furthermore, this study demonstrates that there remains significant intrasurgeon variability in selecting surgical procedures for shoulder instability. Lastly, the findings in this study suggest that 3D MRI is clinically equivalent to 3D CT in guiding shoulder instability surgical management. Conclusion This study demonstrates that there is significant variability in surgical procedure selection driven by time alone in shoulder instability. Surgical decision making with 3D MRI was similar to 3D CT scans and may be used by surgeons for preoperative planning.
Collapse
Affiliation(s)
- Alexandra V. Paul
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Imoh Udoh
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Ananyaa Bharadwaj
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Steven Bokshan
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brett D. Owens
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - William N. Levine
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Grant E. Garrigues
- Midwest Orthopaedics at RUSH, Rush University Medical Center, Chicago, IL, USA
| | | | | | - Anthony Miniaci
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Jonathan P. Braman
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Peter MacDonald
- Orthopaedic Surgery, Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada
| | | | - Scott Kaar
- Department of Orthopaedic Surgery, Saint Louis University, St. Louis, MO, USA
| | - Brian Lau
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
3
|
Rajabzadeh-Oghaz H, Kumar V, Berry DB, Singh A, Schoch BS, Aibinder WR, Gobbato B, Polakovic S, Elwell J, Roche CP. Impact of Deltoid Computer Tomography Image Data on the Accuracy of Machine Learning Predictions of Clinical Outcomes after Anatomic and Reverse Total Shoulder Arthroplasty. J Clin Med 2024; 13:1273. [PMID: 38592118 PMCID: PMC10931952 DOI: 10.3390/jcm13051273] [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: 01/19/2024] [Revised: 02/05/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Despite the importance of the deltoid to shoulder biomechanics, very few studies have quantified the three-dimensional shape, size, or quality of the deltoid muscle, and no studies have correlated these measurements to clinical outcomes after anatomic (aTSA) and/or reverse (rTSA) total shoulder arthroplasty in any statistically/scientifically relevant manner. Methods: Preoperative computer tomography (CT) images from 1057 patients (585 female, 469 male; 799 primary rTSA and 258 primary aTSA) of a single platform shoulder arthroplasty prosthesis (Equinoxe; Exactech, Inc., Gainesville, FL) were analyzed in this study. A machine learning (ML) framework was used to segment the deltoid muscle for 1057 patients and quantify 15 different muscle characteristics, including volumetric (size, shape, etc.) and intensity-based Hounsfield (HU) measurements. These deltoid measurements were correlated to postoperative clinical outcomes and utilized as inputs to train/test ML algorithms used to predict postoperative outcomes at multiple postoperative timepoints (1 year, 2-3 years, and 3-5 years) for aTSA and rTSA. Results: Numerous deltoid muscle measurements were demonstrated to significantly vary with age, gender, prosthesis type, and CT image kernel; notably, normalized deltoid volume and deltoid fatty infiltration were demonstrated to be relevant to preoperative and postoperative clinical outcomes after aTSA and rTSA. Incorporating deltoid image data into the ML models improved clinical outcome prediction accuracy relative to ML algorithms without image data, particularly for the prediction of abduction and forward elevation after aTSA and rTSA. Analyzing ML feature importance facilitated rank-ordering of the deltoid image measurements relevant to aTSA and rTSA clinical outcomes. Specifically, we identified that deltoid shape flatness, normalized deltoid volume, deltoid voxel skewness, and deltoid shape sphericity were the most predictive image-based features used to predict clinical outcomes after aTSA and rTSA. Many of these deltoid measurements were found to be more predictive of aTSA and rTSA postoperative outcomes than patient demographic data, comorbidity data, and diagnosis data. Conclusions: While future work is required to further refine the ML models, which include additional shoulder muscles, like the rotator cuff, our results show promise that the developed ML framework can be used to evolve traditional CT-based preoperative planning software into an evidence-based ML clinical decision support tool.
Collapse
Affiliation(s)
| | - Vikas Kumar
- Exactech, Inc., Gainesville, FL 32653, USA; (H.R.-O.); (V.K.); (S.P.); (J.E.)
| | - David B. Berry
- Department of Orthopedic Surgery, University of California San Diego, San Diego, CA 92093, USA; (D.B.B.); (A.S.)
| | - Anshu Singh
- Department of Orthopedic Surgery, University of California San Diego, San Diego, CA 92093, USA; (D.B.B.); (A.S.)
| | | | - William R. Aibinder
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Bruno Gobbato
- R. José Emmendoerfer, 1449—Nova Brasília, Jaraguá do Sul 89252-278, SC, Brazil;
| | - Sandrine Polakovic
- Exactech, Inc., Gainesville, FL 32653, USA; (H.R.-O.); (V.K.); (S.P.); (J.E.)
| | - Josie Elwell
- Exactech, Inc., Gainesville, FL 32653, USA; (H.R.-O.); (V.K.); (S.P.); (J.E.)
| | | |
Collapse
|
4
|
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.
Collapse
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
| | | | | |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
|
7
|
Elmallah R, Swanson D, Le K, Kirsch J, Jawa A. Baseplate retroversion does not affect postoperative outcomes after reverse shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:2082-2088. [PMID: 35429631 DOI: 10.1016/j.jse.2022.02.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is concern that excessive glenoid component retroversion leads to altered biomechanics and baseplate failure in reverse shoulder arthroplasty (RSA). However, much of this has been rooted in the total shoulder arthroplasty experience. In the current literature, it is not well defined whether glenoid baseplate positioning in reverse arthroplasty affects functional outcomes. Our practice has been to preserve glenoid bone stock without aiming for a certain degree of retroversion. We aimed to evaluate the correlation between pre- and postoperative retroversion in a cohort of RSAs and determine the effect of glenoid retroversion on functional outcomes, range of motion, and postoperative complications. METHODS A retrospective review of patients who had an RSA between 2017 and 2019 was performed. Preoperative computed tomography scans were used to assess preoperative retroversion, and axillary radiographs were used for postoperative retroversion. Outcome measures included American Shoulder and Elbow Surgeons score, visual analog scale for pain score, Single Assessment Numeric Evaluation score, range of motion, radiographic lucency, and complications. RESULTS A total of 271 patients were eligible for the study. There was a 76.9% 2-year follow-up rate. In total 161 patients had postoperative retroversion ≤15° (group A), and 110 patients had retroversion >15° (group B). There were no significant differences in American Shoulder and Elbow Surgeons, visual analog scale, or Single Assessment Numeric Evaluation scores. There were also no significant differences in postoperative range of motion. There was 1 baseplate failure in each group, and there was 1 patient in group B with asymptomatic radiographic loosening (baseplate at risk). The mean change in pre- to postoperative retroversion was 1° and 4° in groups A and B, respectively. CONCLUSION There was no significant difference in postoperative functional outcomes, range of motion, or complications between patients who had baseplate retroversion ≤15° vs. those who had retroversion >15°.
Collapse
Affiliation(s)
- Randa Elmallah
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Kiet Le
- Boston Sports and Shoulder Center, Waltham, MA, USA; Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Jacob Kirsch
- Boston Sports and Shoulder Center, Waltham, MA, USA; Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Andrew Jawa
- Boston Sports and Shoulder Center, Waltham, MA, USA; Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA.
| |
Collapse
|
8
|
LiBrizzi CL, Rao SS, Wang KY, Levin AS, Morris CD. Survey of sarcoma surgery principles among orthopaedic oncologists. Surg Oncol 2022; 42:101782. [DOI: 10.1016/j.suronc.2022.101782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/26/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
|
9
|
Li H, Xu J, Zhang D, He Y, Chen X. Automatic surgical planning based on bone density assessment and path integral in cone space for reverse shoulder arthroplasty. Int J Comput Assist Radiol Surg 2022; 17:1017-1027. [PMID: 35489006 DOI: 10.1007/s11548-022-02633-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Reverse shoulder arthroplasty (RSA) is an effective surgery for severe shoulder joint diseases. Traditionally, the preoperative planning procedure of RSA is manually conducted by experienced surgeons, resulting in prolonged operating time and unreliable drilling paths of the prosthetic fixation screws. In this study, an automatic surgical planning algorithm for RSA was proposed to compute the optimal path of screw implantation. METHODS Firstly, a cone-shaped space containing alternative paths for each screw is generated using geometric parameters. Then, the volume constraint is applied to automatically remove inappropriate paths outside the bone boundary. Subsequently, the integral of grayscale value of the CT is used to evaluate the bone density and to compute the optimal solution. An automatic surgical planning software for RSA was also developed with the aforementioned algorithms. RESULTS Twenty-four clinical cases were used for preoperative planning to evaluate the accuracy and efficiency of the system. Results demonstrated that the angles among the prosthetic fixation screws were all within constraint angle(45°), and the stability rate of the planned prosthesis was 94.92%. The average time for the automatic planning algorithm was 4.39 s, and 83.96 s for the whole procedure. Repetitive experiments were also conducted to demonstrate the robustness of our system, and the variance of the stability coefficient was 0.027%. CONCLUSIONS In contrast to the cumbersome manual planning of the existing methods for RSA, our method requires only simple interaction operations. It enables efficient and precise automatic preoperative planning to simulate the ideal placement of the long prosthetic screws for the long-term stability of the prosthesis. In the future, it will have great clinical application prospects in RSA.
Collapse
Affiliation(s)
- Haitao Li
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Room A-925, Dongchuan Road 800, Minhang District, Shanghai, 200240, China
| | - Jiangchang Xu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Room A-925, Dongchuan Road 800, Minhang District, Shanghai, 200240, China
| | - Dingzhong Zhang
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Room A-925, Dongchuan Road 800, Minhang District, Shanghai, 200240, China
| | - Yaohua He
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China. .,Department of Orthopaedics, Jinshan Branch of Shanghai Sixth People's Hospital Affiliated to Shanghai University of Medicine & Health Sciences, 147 Jiankang Road, Shanghai, 201503, China.
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Room A-925, Dongchuan Road 800, Minhang District, Shanghai, 200240, China. .,Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China.
| |
Collapse
|
10
|
Sprowls GR, Wilson CD, Stewart W, Hammonds KA, Baruch NH, Ward RA, Robin BN. Intraoperative navigation and preoperative templating software are associated with increased glenoid baseplate screw length and use of augmented baseplates in reverse total shoulder arthroplasty. JSES Int 2020; 5:102-108. [PMID: 33554174 PMCID: PMC7846692 DOI: 10.1016/j.jseint.2020.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Preoperative templating software and intraoperative navigation have the potential to impact baseplate augmentation utilization and increase screw length for baseplate fixation in reverse total shoulder arthroplasty (rTSA). We aimed to assess their impact on the (1) baseplate screw length, (2) number of screws used, and (3) frequency of augmented baseplate use in navigated rTSA. Methods We compared 51 patients who underwent navigated rTSA with 63 controls who underwent conventional rTSA at a single institution. Primary outcomes included the screw length, composite screw length, number of screws used, percentage of patients in whom 2 screws in total were used, and use of augmented baseplates. Results Navigation resulted in the use of significantly longer individual screws (36.7 mm vs. 30 mm, P < .0001), greater composite screw length (84 mm vs. 76 mm, P = .048), and fewer screws (2.5 ± 0.7 vs. 2.8 ± 1, P = .047), as well as an increased frequency of using 2 screws in total (35 of 51 patients [68.6%] vs. 32 of 63 controls [50.8%], P = .047). Preoperative templating resulted in more frequent augmented baseplate utilization (76.5% vs. 19.1%, P < .0001). Conclusion The difference in the screw length, number of screws used, and augmented baseplate use demonstrates the evolving role that computer navigation and preoperative templating play in surgical planning and the intraoperative technique for rTSA.
Collapse
Affiliation(s)
- Gregory R. Sprowls
- Department of Orthopaedic Surgery, Baylor Scott & White Health, Temple, TX, USA
- College of Medicine, Texas A&M University, Temple, TX, USA
- Corresponding author: Gregory R. Sprowls, MD, 3108 Mea Ct, Temple, TX 76502, USA.
| | - Charlie D. Wilson
- Department of Orthopaedic Surgery, Baylor Scott & White Health, Temple, TX, USA
- College of Medicine, Texas A&M University, Temple, TX, USA
| | - Wells Stewart
- Department of Orthopaedic Surgery, Baylor Scott & White Health, Temple, TX, USA
- College of Medicine, Texas A&M University, Temple, TX, USA
| | | | | | - Russell A. Ward
- Department of Orthopaedic Surgery, Baylor Scott & White Health, Temple, TX, USA
- College of Medicine, Texas A&M University, Temple, TX, USA
| | - Brett N. Robin
- Department of Orthopaedic Surgery, Baylor Scott & White Health, Temple, TX, USA
- College of Medicine, Texas A&M University, Temple, TX, USA
| |
Collapse
|