Surgeon-designed patient-specific instrumentation improves glenoid component screw placement for reverse total shoulder arthroplasty in a population with small glenoid dimensions.

Autor: Yung CS; Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professional Block, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong., Fang C; Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professional Block, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong. fangcx@gmail.com., Fang E; Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professional Block, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong., Siu YC; Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, Hong Kong., Yee DKH; Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong., Wong KK; Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong., Poon KC; Department of Prosthetics and Orthotics, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong., Leung MMF; Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professional Block, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong., Wan J; Department of Prosthetics and Orthotics, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong., Lau TW; Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professional Block, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong., Leung F; Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professional Block, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong.
Jazyk: angličtina
Zdroj: International orthopaedics [Int Orthop] 2023 May; Vol. 47 (5), pp. 1267-1275. Date of Electronic Publication: 2023 Feb 10.
DOI: 10.1007/s00264-023-05706-z
Abstrakt: Purpose: Glenoid component loosening is a potential complication of reverse total shoulder arthroplasty (rTSA), occurring in part due to lack of adequate screw purchase in quality scapular bone stock. This study was to determine the efficacy of a surgeon-designed, 3D-printed patient-specific instrumentation (PSI) compared to conventional instrumentation (CI) in achieving longer superior and inferior screw lengths for glenoid component fixation.
Methods: A multi-centre retrospective analysis of patients who underwent rTSA between 2015 and 2020. Lengths of the superior and inferior locking screws inserted for fixation of the glenoid baseplate component were recorded and compared according to whether patients received PSI or CI. Secondary outcomes included operative duration and incidence of complications requiring revision surgery.
Results: Seventy-three patients (31 PSI vs. 42 CI) were analysed. Average glenoid diameter was 24.5 mm (SD: 3.1) and 81% of patients had smaller glenoid dimensions compared to the baseplate itself. PSI produced significantly longer superior (44.7 vs. 30.7 mm; P < 0.001) and inferior (43.0 vs. 31 mm; P < 0.001) mean screw lengths, as compared to CI. A greater proportion of maximal screw lengths for the given rTSA construct (48 mm) were observed in the PSI group (71.9% vs. 11.9% superior, 59.4% vs. 11.9% inferior). Operative duration was not statistically significantly different between the PSI and CI groups (150 min vs. 169 min, respectively; P = 0.229). No patients had radiographic loosening of the glenoid component with an average of 2-year follow-up.
Conclusion: PSI facilitates longer superior and inferior screw placement in the fixation of the glenoid component for rTSA. With sufficient training, PSI can be designed and implemented by surgeons themselves.
(© 2023. The Author(s).)
Databáze: MEDLINE
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