Saturday, February 9, 2013

CT navigation for reverse total shoulder

Intraoperative CT navigation for glenoid component fixation in reverse shoulder arthroplasty

Patients having a reverse total shoulder often represent the nexus of (1) altered shoulder anatomy, (2) poor bone quality, (3) increased loading of the arthroplasty and (4) increased fall risk. For these reasons, fixation of the glenoid component must be optimized. 

In our practice we find that good glenoid exposure allows us to optimize component and screw placement while minimizing the removal of bone and properly orienting the glenoid component, as shown in this recent case on the shoulder of a gentleman from southern California.

The authors of this article present a process that includes the extra steps of placing a positioning pin with infrared markers for intraoperative navigation. Registration was done using an intra operative CT scan. Data were fed to a "navigation suite to facilitate glenoid component fixation". CT images in three planes were used to assess the position of the central peg before reaming. CT images were also used to achieve the best desired screw position.

We agree with the authors that optimizing positioning and screw placement while minimizing the risk of scapular fractures is important, we are yet to be convinced that the cost and increased OR time associated with CT navigation is justified in terms of improved patient outcomes.

Our preoperative planning is based on preoperative high quality plain films and our surgical technique is based on good glenoid exposure.


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