These authors point out that fixation of the glenoid baseplate in reverse total shoulder arthroplasty (rTSA) is an important factor in the success of the procedure. They state that although aseptic loosening comprises 1.1%to 5% of the postoperative complications for rTSA it accounts for 18.2% of revisions.
They sought to determine whether computed tomography–based computer navigation improved the glenoid base plate fixation of the Exactech baseplate that uses an ingrowth central peg and angled peripheral screws.
Patients undergoing rTSAs using navigation (NAV, N = 27) and manual technique (MAN, N= 23) from January 2014 to July 2017 were analyzed in a case-control design. Screw purchase length and central cage perforation were assessed using multiplanar computed tomography. Central cage perforation was defined as a breach in the scapular wall in any plane.
Median screw purchase length was significantly longer in the NAV group for both anterior (20 mm vs. 15 mm, P <.01) and posterior screws (20 mm vs. 13 mm, P <.01), but not for the superior and inferior screws.
The NAV group displayed significantly reduced incidence of central cage perforation (17.7% vs. 52.4%, P . .04).
The authors concluded that for the Exactech baseplate, the use of computer-assisted navigated rTSA contributes to significant alterations in screw purchase length, screw angulation, and central cage perforation of the glenoid baseplate compared with non-navigated methods.
Comment: This is an interesting retrospective investigation that applies specifically to the prosthesis system studied. Some additional data would be helpful in assessing the value of the "NAV" system: (1) what is the incremental cost of implementing and using the NAV?, (2) has it been demonstrated that even a small amount of scapular penetration by the central peg affects the stability of the Equinoxe baseplate?, (3) how much is the fixation of the baseplate compromised by the observed changes in screw length and angulation" (4) are the clinical results different for those shoulders in which NAV is used?
The authors concluded that for the Exactech baseplate, the use of computer-assisted navigated rTSA contributes to significant alterations in screw purchase length, screw angulation, and central cage perforation of the glenoid baseplate compared with non-navigated methods.
Comment: This is an interesting retrospective investigation that applies specifically to the prosthesis system studied. Some additional data would be helpful in assessing the value of the "NAV" system: (1) what is the incremental cost of implementing and using the NAV?, (2) has it been demonstrated that even a small amount of scapular penetration by the central peg affects the stability of the Equinoxe baseplate?, (3) how much is the fixation of the baseplate compromised by the observed changes in screw length and angulation" (4) are the clinical results different for those shoulders in which NAV is used?
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