Article

Patient-Specific Guides/Instrumentation in Shoulder Arthroplasty

Publish date: February 26, 2018

TAKE-HOME POINTS

Optimal outcomes following TSA and RSA are dependent on proper implant position.
Patient-specific guides/instrumentation result in improved accuracy of implant positioning compared to traditional methods.
Currently, there are no clinical studies demonstrating superiority of patient-specific guide/instrumentation use on patient outcomes.
At this time there are 3 commercially available single use patient-specific instrumentation systems (DJO Global, Wright Medical Group, and Zimmer Biomet) and 1 commercially available reusable patient-specific instrumentation system (Arthrex).
Limited research is available comparing the accuracy of different commercially available 3-D planning systems.

References

1. Churchill RS, Brems JJ, Kotschi H. Glenoid size, inclination, and version: an anatomic study. J Shoulder Elbow Surg. 2001;10(4):327-332. doi:10.1067/mse.2001.115269.

2. Norris TR, Iannotti JP. Functional outcome after shoulder arthroplasty for primary osteoarthritis: a multicenter study. J Shoulder Elbow Surg. 2002;11(2):130-135. doi:10.1067/mse.2002.121146.

3. Mullaji AB, Beddow FH, Lamb GH. CT measurement of glenoid erosion in arthritis. J Bone Joint Surg Br. 1994;76(3):384-388.

4. Walch G, Badet R, Boulahia A, Khoury A. Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty. 1999;14(6):756-760.

5. RJ Friedman, KB Hawthorne, BM Genez. The use of computerized tomography in the measurement of glenoid version. J Bone Joint Surg. 1992;74(7):1032-1037. doi:10.2106/00004623-199274070-00009.

6. Yian EH, Werner CM, Nyffeler RW, et al. Radiographic and computed tomography analysis of cemented pegged polyethylene glenoid components in total shoulder replacement. J Bone Joint Surg. 2005;87(9):1928-1936. doi:10.2106/00004623-200509000-00004.

7. Hasan SS, Leith JM, Campbell B, Kapil R, Smith KL, Matsen FA. Characteristics of unsatisfactory shoulder arthroplasties. J Shoulder Elbow Surg. 2002;11(5):431-441.

8. Hopkins AR, Hansen UN, Amis AA, Emery R. The effects of glenoid component alignment variations on cement mantle stresses in total shoulder arthroplasty. J Shoulder Elbow Surg. 2004;13(6):668-675. doi:10.1016/S1058274604001399.

9. Iannotti JP, Greeson C, Downing D, Sabesan V, Bryan JA. Effect of glenoid deformity on glenoid component placement in primary shoulder arthroplasty. J Shoulder Elbow Surg. 2012;21(1):48-55. doi:10.1016/j.jse.2011.02.011.

10. Nyffeler RW, Jost B, Pfirrmann CWA, Gerber C. Measurement of glenoid version: conventional radiographs versus computed tomography scans. J Shoulder Elbow Surg. 2003;12(5):493-496. doi:10.1016/S1058274603001812.

11. Hoenecke HR, Hermida JC, Flores-Hernandez C, D'Lima DD. Accuracy of CT-based measurements of glenoid version for total shoulder arthroplasty. J Shoulder Elbow Surg. 2010;19(2):166-171. doi:10.1016/j.jse.2009.08.009.

12. Wall B, Nové-Josserand L, O'Connor DP, Edwards TB, Walch G. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am. 2007;89(7):1476-1485. doi:10.2106/JBJS.F.00666.

13. Gutiérrez S, Comiskey 4, Charles A, Luo Z, Pupello DR, Frankle MA. Range of impingement-free abduction and adduction deficit after reverse shoulder arthroplasty. hierarchy of surgical and implant-design-related factors. J Bone Joint Surg Am. 2008;90(12):2606-2615. doi:10.2106/JBJS.H.00012.

14. Roche CP, Marczuk Y, Wright TW, et al. Scapular notching and osteophyte formation after reverse shoulder replacement: Radiological analysis of implant position in male and female patients. Bone Joint J. 2013;95-B(4):530-535. doi:10.1302/0301-620X.95B4.30442.

15. Poon PC, Chou J, Young SW, Astley T. A comparison of concentric and eccentric glenospheres in reverse shoulder arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2014;96(16):e138. doi:10.2106/JBJS.M.00941.

16. Nyffeler RW, Werner CML, Gerber C. Biomechanical relevance of glenoid component positioning in the reverse delta III total shoulder prosthesis. J Shoulder Elbow Surg. 2005;14(5):524-528. doi:10.1016/j.jse.2004.09.010.

17. Li X, Knutson Z, Choi D, et al. Effects of glenosphere positioning on impingement-free internal and external rotation after reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2013;22(6):807-813. doi:10.1016/j.jse.2012.07.013.

18. Lévigne C, Boileau P, Favard L, et al. Scapular notching in reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2008;17(6):925-935. doi:10.1016/j.jse.2008.02.010.

19. Gutiérrez S, Walker M, Willis M, Pupello DR, Frankle MA. Effects of tilt and glenosphere eccentricity on baseplate/bone interface forces in a computational model, validated by a mechanical model, of reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2011;20(5):732-739. doi:10.1016/j.jse.2010.10.035.

20. Verborgt O, De Smedt T, Vanhees M, Clockaerts S, Parizel PM, Van Glabbeek F. Accuracy of placement of the glenoid component in reversed shoulder arthroplasty with and without navigation. J Shoulder Elbow Surg. 2011;20(1):21-26. doi:10.1016/j.jse.2010.07.014.

21. Throckmorton TW, Gulotta LV, Bonnarens FO, et al. Patient-specific targeting guides compared with traditional instrumentation for glenoid component placement in shoulder arthroplasty: A multi-surgeon study in 70 arthritic cadaver specimens. J Shoulder Elbow Surg. 2015;24(6):965-971. doi:10.1016/j.jse.2014.10.013.

22. Kircher J, Wiedemann M, Magosch P, Lichtenberg S, Habermeyer P. Improved accuracy of glenoid positioning in total shoulder arthroplasty with intraoperative navigation: a prospective-randomized clinical study. J Shoulder Elbow Surg. 2009;18(4):515-520. doi:10.1016/j.jse.2009.03.014.

23. Levy JC, Everding NG, Frankle MA, Keppler LJ. Accuracy of patient-specific guided glenoid baseplate positioning for reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2014;23(10):1563-1567. doi:10.1016/j.jse.2014.01.051.

24. Walch G, Vezeridis PS, Boileau P, Deransart P, Chaoui J. Three-dimensional planning and use of patient-specific guides improve glenoid component position: an in vitro study. J Shoulder Elbow Surg. 2015;24(2):302-309. doi:10.1016/j.jse.2014.05.029.

25. Eraly K, Stoffelen D, Vander Sloten J, Jonkers I, Debeer P. A patient-specific guide for optimizing custom-made glenoid implantation in cases of severe glenoid defects: an in vitro study. J Shoulder Elbow Surg. 2016;25(5):837-845. doi:10.1016/j.jse.2015.09.034.

26. Gauci MO, Boileau P, Baba M, Chaoui J, Walch G. Patient-specific glenoid guides provide accuracy and reproducibility in total shoulder arthroplasty. Bone Joint J. 2016;98-B(8):1080-1085. doi:10.1302/0301-620X.98B8.37257.

27. Dallalana RJ, McMahon RA, East B, Geraghty L. Accuracy of patient-specific instrumentation in anatomic and reverse total shoulder arthroplasty. Int J Shoulder Surg. 2016;10(2):59-66. doi:10.4103/09736042.180717.

28. Hendel MD, Bryan JA, Barsoum WK, et al. Comparison of patient-specific instruments with standard surgical instruments in determining glenoid component position: a randomized prospective clinical trial. J Bone Joint Surg. 2012;94(23):2167-2175. doi:10.2106/JBJS.K.01209.

29. Iannotti JP, Weiner S, Rodriguez E, et al. Three-dimensional imaging and templating improve glenoid implant positioning. J Bone Joint Surg. 2015;97(8):651-658. doi:10.2106/JBJS.N.00493.

30. Denard PJ, Provencher MT, Lädermann A, Romeo AA, Dines JS. Version and inclination obtained with 3D planning in total shoulder arthroplasty: do different programs produce the same results? SECEC-ESSSE Congress, Berlin 2017. 2017.