Tuesday, September 20, 2016

Intraoperative Manufacturing of Patient-Specific Instrumentation for Shoulder Arthroplasty

Intraoperative Manufacturing of Patient-Specific Instrumentation for Shoulder Arthroplasty: A Novel Mechatronic Approach

These authors propose a technology for the intraoperative production of patient-specific instrumentation, employing a table side machine, bespoke software and a disposable element comprising a region of standard geometry and a body of moldable material. 

They collected anatomical data from computed tomography scans of 10 human scapulae. For each the optimal glenoid guidewire position was digitally planned and recorded.

The technology was successfully able to produce sterile, patient-specific guides according to a pre-operative plan in 5 min.

The average guide wire placement accuracy was 1:58mm and 6.82 in the manual group, and 0:55mm and 1:76 in the guided group.

The readers may be interested in some of the steps

Comment: It is of interest to see the enthusiasm with which patient-specific instrumentation (PSI) is being pursued. In this in vitro laboratory example, intraoperative manufacturing of patient-specific instrumentation improved the guide wire placement by several millimeters. The clinical cost-effectiveness and practicality of such a system and its effect on clinical outcomes remain to be demonstrated.

Our approach to total shoulder arthroplasty does not involve PSI or a guide wire, but rather uses a nubbed reamer
to conservatively shape the face of the glenoid bone to match the back of the glenoid component without a specific attempt to change glenoid version.

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