Pre-operative Planning for Total Shoulder Arthroplasty and Component Size Predictive Validation: Implications for Inventory Management

The use of three-dimensional (3D) computer simulations for pre-operative planning of total shoulder arthroplasty (TSA) has greatly increased in the past decade [1,2]. These studies have primarily focused on optimizing glenoid resurfacing to elucidate the factors involved in glenoid loosening, the most common cause of TSA failure [3,4]. While finite element analyses have investigated the effects of glenoid resurfacing parameters such as implant placement and depth of reaming on the stresses associated with the glenoid/cement/implant construct, none have determined if their method for simulating glenoid surface preparation is physically representative or accurate. In TSA, the first step in glenoid resurfacing is reaming the glenoid surface in preparation for the placement of the glenoid implant. The purpose of this study was to validate the volume removed as determined by computer simulated reaming against the volume removed by ream of cadaveric scapulae.

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Pre-Operative CT-Based Planning Integrated With Intra-Operative Navigation in Reverse Shoulder Arthroplasty: Data Acquisition and Analysis Protocol, and Preliminary Results of Navigated Versus Conventional Surgery

Dose-Response ◽

10.1177/1559325820970832 ◽

2020 ◽

Vol 18 (4) ◽

pp. 155932582097083

Author(s):

Fabio Moreschini ◽

Giovanni Battista Colasanti ◽

Carlo Cataldi ◽

Lorenzo Mannelli ◽

Nicola Mondanelli ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Conventional Technique ◽

Shoulder Function ◽

Glenoid Component ◽

Navigation Group ◽

Screw Length ◽

Operative Planning ◽

Glenoid Baseplate

Reverse total shoulder arthroplasty (RSA) successfully restores shoulder function in different conditions. Glenoid baseplate fixation and positioning seem to be the most important factors influencing RSA survival. When scapular anatomy is distorted (eccentric osteoarthrirtis, rotator cuff arthropathy), optimal baseplate positioning and secure screw purchase can be challenging. The aim of this study was to evaluate whether CT-based pre-operative planning, integrated with intra-operative navigation could improve glenoid baseplate fixation and positioning by increasing screw length, reducing number of screws required to obtain fixation and increasing the use of augmented baseplate to gain the desired positioning. Twenty patients who underwent navigated RSA were compared retrospectively with 20 patients operated on with a conventional technique. All the procedures were performed by the same surgeon, using the same implant. Mean screw length was significantly longer in the navigation group (35.5 ± 4.4 mm vs 29.9 ± 3.6 mm; p = .001). Significant higher rate of optimal fixation using 2 screws only (17 vs 3 cases, p = .019) and higher rate of augmented baseplate usage (13 vs 4 cases, p = .009) was also present in the navigation group. Pre-operative CT-based planning integrated with intra-operative navigation can improve glenoid component positioning and fixation, possibly leading to an improvement of RSA survival.

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Trends in operative duration of total shoulder arthroplasty from 2008 to 2018: a national database study

Shoulder & Elbow ◽

10.1177/17585732211008900 ◽

2021 ◽

pp. 175857322110089

Author(s):

Edward J Testa ◽

Nicholas J Lemme ◽

Lambert T Li ◽

Steven DeFroda

Keyword(s):

Shoulder Arthroplasty ◽

Operative Time ◽

Outpatient Surgery ◽

Total Shoulder Arthroplasty ◽

International Normalized Ratio ◽

National Database ◽

Improvement Program ◽

Factors Affecting ◽

Operative Duration ◽

Operative Planning

Background As total shoulder arthroplasty has emerged as the fastest growing joint replacement performed, optimizing surgical efficiency and patient outcomes is essential. The goals of the current study were to identify trends and factors affecting the operative time of total shoulder arthroplasty over a 10-year period. Methods The National Surgical Quality Improvement Program database was analyzed to determine the operative time and 30-day complications of total shoulder arthroplasty from 2008 to 2018. Factors affecting total shoulder arthroplasty operative time were also assessed. Multivariable linear regression was used to analyze operative time over years studied while controlling for patient demographics and comorbidities. Results A total of 20,587 total shoulder arthroplasty cases from 2008 to 2018 were included. Mean operative time in 2008 was 139.0 min, while in 2018, mean operative time decreased to 105.6 min (P < .001). Male sex, outpatient surgery, increased body mass index, and low preoperative hematocrit were associated with longer operative times, while elevated international normalized ratio, resident involvement, and elective surgeries were associated with decreased operative duration. Discussion Operative time for total shoulder arthroplasty has decreased from 2008 to 2018. Patient factors and comorbidities are associated with operative time, and such factors are important to consider in operative planning to ensure appropriate patient and surgeon expectations.

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The effect of glenoid component size on the stability of total shoulder arthroplasty

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2006.03.012 ◽

2007 ◽

Vol 16 (3) ◽

pp. S102-S106 ◽

Cited By ~ 16

Author(s):

Nattapol Tammachote ◽

John W. Sperling ◽

Lawrence J. Berglund ◽

Scott P. Steinmann ◽

Robert H. Cofield ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Glenoid Component ◽

Component Size ◽

The Stability

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Shoulder Arthroplasty Imaging: What’s New

The Open Orthopaedics Journal ◽

10.2174/1874325001711011126 ◽

2017 ◽

Vol 11 (1) ◽

pp. 1126-1132 ◽

Cited By ~ 3

Author(s):

T.M Gregory ◽

J. Gregory ◽

E. Nicolas ◽

J. Pierrart ◽

E. Masmejean

Keyword(s):

Shoulder Arthroplasty ◽

Imaging System ◽

Radiolucent Line ◽

Total Shoulder Arthroplasty ◽

Surgical Techniques ◽

Operative Planning ◽

Shoulder Imaging ◽

Component Loosening ◽

Shoulder Arthroplasties ◽

Reverse Total Shoulder

Background:Shoulder arthroplasty, in its different forms (hemiarthroplasty, total shoulder arthroplasty and reverse total shoulder arthroplasty) has transformed the clinical outcomes of shoulder disorders. Improvement of general clinical outcome is the result of stronger adequacy of the treatment to the diagnosis, enhanced surgical techniques, specific implanted materials, and more accurate follow up. Imaging is an important tool in each step of these processes.Method:This article is a review article declining recent imaging processes for shoulder arthroplasty.Results:Shoulder imaging is important for shoulder arthroplasty pre-operative planning but also for post-operative monitoring of the prosthesis and this article has a focus on the validity of plain radiographs for detecting radiolucent line and on new Computed Tomography scan method established to eliminate the prosthesis metallic artefacts that obscure the component fixation visualisation.Conclusion:Number of shoulder arthroplasties implanted have grown up rapidly for the past decade, leading to an increase in the number of complications. In parallel, new imaging system have been established to monitor these complications, especially component loosening

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Technical note: subscapularis-sparing approach to perform anatomic total shoulder arthroplasty using a multiplanar humeral osteotomy and angled glenoid instruments

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02900-w ◽

2022 ◽

Vol 17 (1) ◽

Author(s):

Sohil S. Desai ◽

Ryan A. Nelson ◽

Kayla C. Korbel ◽

William N. Levine ◽

Steven S. Goldberg

Keyword(s):

Shoulder Arthroplasty ◽

Glenohumeral Joint ◽

Total Shoulder Arthroplasty ◽

Technical Note ◽

Lesser Tuberosity ◽

Component Size ◽

Functional Deficits ◽

Humeral Component ◽

Patient Reported ◽

Deltopectoral Approach

Abstract Background Anatomic total shoulder arthroplasty is typically performed through the deltopectoral approach followed by either a subscapularis tenotomy, tendon peel, or lesser tuberosity osteotomy to provide adequate exposure. These subscapularis-takedown methods have been associated with incomplete subscapularis healing, however, and as a result often lead to functional deficits and complications. Subscapularis-sparing approaches have been introduced to mitigate these complications, but thus far have either been limited to hemiarthroplasty or resulted in residual inferior humeral head osteophytes and humeral component size mismatch. The present technique demonstrates the possibility for surgeons to capitalize on the improved patient outcomes that are afforded by subscapularis-sparing approaches, while still utilizing the deltopectoral interval to perform a total glenohumeral joint arthroplasty. Methods This article describes in detail the placement of a stemless anatomic TSA with the use of angled glenoid instruments through a subscapularis-sparing deltopectoral approach. Postoperatively, patients are placed in a sling but are instructed to remove as tolerated, as early as the 1st postoperative week. Physical therapy is started at week 1 with a 4-phase progression. Conclusions This technique using a TSA system with a polyaxial glenoid reamer and angled pegs on the backside of the glenoid allows the potential for maintenance of the strong postoperative radiographic and patient-reported outcomes that are achieved using traditional TSA approaches, with the advantage of accelerated rehabilitation protocols and decreased risk of subscapularis insufficiency that result from the use of subscapularis-sparing approaches.

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