Use of Patient-Specific Instrumentation (PSI) for glenoid component positioning in shoulder arthroplasty. A systematic review and meta-analysis

Abstract BackgroundAnatomical Total Shoulder Arthroplasty (TSA) is an effective treatment adopted in patients with glenohumeral osteoarthritis. The glenoid component failure is the main risk that occurs in this therapeutic choice; however, doubts remain, regarding the selection of the best implant in order to avoid such complication.MethodsA systematic review of randomized clinical trials (RCTs) or quasi will be carried out, applying the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocols, comparing polyethylene (keeled and pegged) versus metal back implants in adult patients with glenohumeral osteoarthritis.Our search strategy will be carried out in the MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science. Data management and extraction will be performed using a data withdrawal form and by analyzing study method characteristics, participant characteristics, intervention characteristics, results, methodological domains. The summaries of research evidence will be accessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Shoulder function through functional scores such as Constant-Murley (CM) and American Shoulder and Elbow Surgeons (ASES), pain (Visual Analogue Scale), infection, procedure failure, radiograph radiolucency and loosening, are the selected outcomes. Another analysis such as subgroup, heterogeneity, sensitivity and statistical are going to be performed whenever possible.DiscussionThis systematic review aims to analyze how glenoidal implants behave in Total Shoulder Arthroplasties and therefore provide evidence concerning the best clinical practice to avoid complication. Systematic review registrationPROSPERO, CRD 42018079537.

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Patient-specific planning in shoulder arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.102b3.bjj-2019-1153.r1 ◽

2020 ◽

Vol 102-B (3) ◽

pp. 365-370

Author(s):

Kyong S. Min ◽

Henry M. Fox ◽

Asheesh Bedi ◽

Gilles Walch ◽

Jon J. P. Warner

Keyword(s):

Decision Making ◽

Shoulder Arthroplasty ◽

Surgical Planning ◽

Ct Images ◽

Patient Specific ◽

Glenoid Component ◽

Surgical Decision ◽

Patient Specific Instrumentation ◽

Shoulder Arthroplasties ◽

Surgical Decision Making

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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Glenoid failure after total shoulder arthroplasty with cemented all-polyethylene versus metal-backed implants: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2020-043449 ◽

2020 ◽

Vol 10 (12) ◽

pp. e043449

Author(s):

Renato Aroca Aroca Zan ◽

Rafael Fuchs Lazarini ◽

Fabio Teruo Matsunaga ◽

Nicola Archetti Netto ◽

João Carlos Belloti ◽

...

Keyword(s):

Systematic Review ◽

Shoulder Arthroplasty ◽

Meta Analysis ◽

Total Shoulder Arthroplasty ◽

Shoulder Function ◽

Sensitivity Analyses ◽

Glenoid Component ◽

Cochrane Central Register ◽

Functional Scores ◽

Selection Of

IntroductionAnatomical total shoulder arthroplasty (TSA) is an effective treatment adopted for patients with glenohumeral osteoarthritis (OA). The glenoid component failure is the main risk that occurs in this therapeutic choice; however, doubts remain regarding the selection of the best implant for avoiding complication. This systematic review aims to evaluate the glenoid component in TSA by comparing the complications of different types of implants.Methods and analysisA systematic review of randomised clinical trials or quasi-randomised trials will be performed by applying the Preferred Reporting Items for Systematic Review and Meta-Analysis protocols and comparing polyethylene (keeled and pegged) versus metal-backed implants in adult patients with glenohumeral OA. Our search strategy will be performed using MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, EMBASE and Web of Science. Data management and extraction will be performed using a data withdrawal form and by analysing study method characteristics, participant characteristics, intervention characteristics, results and methodological domains. The database search will be performed by February 2021. The Grading of Recommendations Assessment, Development and Evaluation will be used for assessing the quality of evidence of each study selected; however, some critical and important outcomes were determined such as the shoulder function through functional scores (Constant-Murley and American Shoulder and Elbow Surgeons), complications represented by pain (Visual Analogue Scale), surgical revision, radiograph radiolucency and loosening. The confidence in estimated effects for these outcomes will be applied as the overall confidence. The outcomes will be defined as early or late, according to the postoperative follow-up of less than or greater than 1 year, respectively, for complications and radiographs. For the shoulder function, follow-ups will be divided into 6, 12 and 24 months. Heterogeneity is expected in systematic reviews; therefore, the selection of outcomes, as well as the sample size, and specific statistical analysis can lead to meta-analysis; however, if it fails, narrative evidence synthesis will be conducted. Other analyses such as descriptive, subgroup and sensitivity analyses will be performed whenever possible. This systematic review will, therefore, provide evidence concerning the best clinical practice for avoiding complications.Ethics and disseminationThis study has been approved by the Institutional Review Board of Universidade Federal de São Paulo (protocols 0725/2017, 2.157.415 and 70473017.5.0000.5505), and the findings will be disseminated through peer-reviewed publication and conference presentations.PROSPERO registration numberCRD42018079537.

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