Saturday, January 9, 2016

Glenoid targeting guides in shoulder arthroplasty - are they useful?

Is a generic targeting guide useful for glenoid component placement in shoulder arthroplasty?

These authors conducted a retrospective study comparing postoperative glenoid component version using a generic glenoid targeting guide to that with traditional instrumentation used in historical controls.

Average mean ± SD deviation in component version for the traditional technique group was 10° ± 7° compared with 9° ± 6° for the targeting guide group.

Comment: Instead of prioritizing 'correction' of glenoid version with a targeting system and guide wire  (as shown in the upper figure copyrighted by Steve Lippitt ), we use a nubbed reamer that allows us to adjust the angle of the reamer to minimize the bone removal in conservatively reaming the glenoid to a single concavity (lower figure).

Below is an example of a two year followup of a ream and run procedure in which the glenoid was reamed conservatively without specific attempt to change version.

An anteriorly eccentric humeral head was used to achieve centering in the reamed glenoid as shown below.

We've found that this approach is simple, effective and flexible, avoiding the need for preoperative CT scans, special instruments, or extended surgical time.


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