Friday, January 8, 2016

Patient specific instrumentation for a custom reversed glenoid - a cadaver study

A patient-specific guide for optimizing custom-made glenoid implantation in cases of severe glenoid defects: an in vitro study.

These authors created glenoid defects in 10 cadaveric shoulders and then planned a reversed shoulder arthroplasty with patient-specific glenoid components.

A patient-specific positioning guide was used for 5 specimens. 


The remaining 5 specimens had implantation without the guide. They found that their patient-specific positioning guide improved the position and fixation of their custom-made glenoid component in cases of severe glenoid defects.

Comment: While this is an interesting display of expensive and complex technology, its clinical value is unproven.

In our practice, custom implants and patient specific instruments are unnecessary in that the fixation of the reversed glenoid component (whether or not there are glenoid defects) depends on the availability of reasonable glenoid bone between the glenoid surface and the base of the subscapularis fossa as shown by the green line in the CT scan below

The quality of the bone for fixation of the glenoid baseplate can be assessed intraopratively by the security of the bite achieved with the glenoid tap

Here are a couple of our cases from this week showing our management of glenoid defects with standard implants and without patient specific instrumentation.



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