Novel robotic technology for the rapid intraoperative manufacture of patient specific instrumentation allowing for improved glenoid component accuracy in shoulder arthroplasty – A cadaveric study

Aims Patient-specific instrumentation has been shown to increase a surgeon’s precision and accuracy in placing the glenoid component in shoulder arthroplasty. There is, however, little available information about the use of patient-specific planning (PSP) tools for this operation. It is not known how these tools alter the decision-making patterns of shoulder surgeons. The aim of this study was to investigate whether PSP, when compared with the use of plain radiographs or select static CT images, influences the understanding of glenoid pathology and surgical planning. Methods A case-based survey presented surgeons with a patient’s history, physical examination, and, sequentially, radiographs, select static CT images, and PSP with a 3D imaging program. For each imaging modality, the surgeons were asked to identify the Walch classification of the glenoid and to propose the surgical treatment. The participating surgeons were grouped according to the annual volume of shoulder arthroplasties that they undertook, and responses were compared with the recommendations of two experts. Results A total of 59 surgeons completed the survey. For all surgeons, the use of the PSP significantly increased agreement with the experts in glenoid classification (x2 = 8.54; p = 0.014) and surgical planning (x2 = 37.91; p < 0.001). The additional information provided by the PSP also showed a significantly higher impact on surgical decision-making for surgeons who undertake fewer than ten shoulder arthroplasties annually (p = 0.017). Conclusions The information provided by PSP has the greatest impact on the surgical decision-making of low volume surgeons (those who perform fewer than ten shoulder arthroplasties annually), and PSP brings all surgeons in to closer agreement with the recommendations of experts for glenoid classification and surgical planning. Cite this article: Bone Joint J 2020;102-B(3):365–370

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

JSES Open Access ◽

10.1016/j.jses.2019.04.001 ◽

2019 ◽

Vol 3 (2) ◽

pp. 83-92 ◽

Cited By ~ 1

Author(s):

Brandon C. Cabarcas ◽

Gregory L. Cvetanovich ◽

Alejandro A. Espinoza Orías ◽

Nozomu Inoue ◽

Anirudh K. Gowd ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Cadaveric Study ◽

Patient Specific

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Journey of the glenoid in anatomic total shoulder replacement

Shoulder & Elbow ◽

10.1177/1758573218790119 ◽

2018 ◽

Vol 11 (2) ◽

pp. 140-148 ◽

Cited By ~ 4

Author(s):

Alessandro Castagna ◽

Raffaele Garofalo

Keyword(s):

Shoulder Arthroplasty ◽

Current Practice ◽

Total Shoulder Arthroplasty ◽

Shoulder Function ◽

Patient Specific ◽

Glenoid Component ◽

Shoulder Replacement ◽

Final Destination ◽

Component Loosening

Anatomic total shoulder arthroplasty (TSR) has been shown to generate good to excellent results for patients with osteoarthritis and a functioning rotator cuff. Many studies have reported that the glenoid component loosening and failure remain the most common long-term complication of total shoulder arthroplasty. The approach to glenoid component is critical because a surgeon should consider patient-specific anatomy, preserving bone stock and joint line restoration, for a good and durable shoulder function. Over the years, different glenoid design and materials have been tried in various configurations. These include cemented polyethylene, uncemented metal-backed and hybrid implants. Although advances in biomechanics, design and tribology have improved our understanding of the glenoid, the journey of the glenoid component in anatomic total shoulder arthroplasty has not yet reached its final destination. This article attempts to describe the evolution of the glenoid component in anatomic TSR and current practice.

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Accuracy of Patient-specific Jigs for Glenoid Component Positioning in Total Shoulder Arthroplasty

Techniques in Shoulder & Elbow Surgery ◽

10.1097/bte.0000000000000126 ◽

2018 ◽

Vol 19 (1) ◽

pp. 24-28

Author(s):

Luke P. Wheeler ◽

Grant Booth ◽

Sven Delport

Keyword(s):

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Patient Specific ◽

Glenoid Component

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

Shoulder & Elbow ◽

10.1177/1758573220908903 ◽

2020 ◽

pp. 175857322090890

Author(s):

Robert Z Tashjian ◽

Lindsay Beck ◽

Irene Stertz ◽

Peter N Chalmers

Keyword(s):

Shoulder Arthroplasty ◽

Bone Grafting ◽

Total Shoulder Arthroplasty ◽

Three Dimensional ◽

Reverse Total Shoulder Arthroplasty ◽

Patient Specific ◽

Computer Assisted ◽

Patient Specific Instrumentation ◽

Reverse Total Shoulder ◽

Glenoid Erosion

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

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