Comparison of Patient-Specific Instruments with Standard Surgical Instruments in Determining Glenoid Component Position: A Randomized Prospective Clinical Trial JBJS

Comparison of Patient-Specific Instruments with Standard Surgical Instruments in Determining Glenoid Component Position: A Randomized Prospective Clinical Trial JBJS

This study compared surgeons' ability to achieve a preoperatively determined glenoid position with either (1) novel three-dimensional computed tomographic scan planning software combined with patient-specific instrumentation* (the glenoid positioning system group), or (2) conventional computed tomographic scan, preoperative planning, and surgical technique, utilizing instruments provided by the implant manufacturer (the standard surgical group).  Postoperatively, a second computed tomographic scan was used to define and compare the actual implant location with the preoperative plan.

The average deviation in version was 6.9° in the standard surgical group and 4.3° in the glenoid positioning system group. The average deviation in inclination was 11.6° in the standard surgical group and 2.9° in the glenoid positioning system group.

Once again we come to the value equation: what was the incremental benefit and what was the incremental cost? With respect to the former (benefit), while the results between the two methods were statistically different, it is difficult to know if these differences are of clinical significance in that clinical outcomes are not available for the two groups. With respect to the latter (cost), the data are not provided. The 'Novel simulator' requires reformatting of CT images to produce new two-dimensional images.

The question is 'did the patients having arthroplasty with the patient-specific instruments achieve better clinical results than those with standard instruments?

Our practice is to use standardized two-dimensional images in the form of plain radiographs, saving the costs (and radiation) of CT scans, the proprietary software, the processing costs, and the production of patient-specific instruments.

*ArthroPlan (invented by one of the authors of this paper)

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