Thursday, October 22, 2015

Patient-specific instrument guidance - is it of value in shoulder arthroplasty?

Patient-specific instrument guidance of glenoid component implantation reduces inclination variability in total and reverse shoulder arthroplasty

These authors assessed the influence of 3-dimensional preoperative planning and patient-specific instrument (PSI) guidance of glenoid component positioning on its inclination in total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA).
Thirty-six shoulder arthroplasties (12 TSAs, 24 RSAs) were analyzed, of which 18 procedures (6 TSAs, 12 RSAs) were executed using preoperative 3D planning and patient-specific guides to position the central guide pin for glenoid component implantation.

The inclination of the glenoid component was measured by 2 observers, using the angle between the glenoid baseplate and the floor of the supraspinatus fossa (angle β) on postoperative radiographs.

The results are shown in the table below.

Comment: As is the case for almost all articles describing the use of 3D planning software and patient-specific instrumentation, this report does not provide data on the cost, time or training needed for these complex technologies. As the table above and figure below comparing a non PSI reverse on the left to a PSI reverse on the right show, the apparent benefit of PSI can be subtle.

We find that the optimal position of the glenoid component depends in large part on the arthritic anatomy and the quality of the bone available to support the prosthesis. To us this seems a higher priority than trying to align the prosthesis with a line drawn through the floor of the supraspinus fossa


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