Thomas W Throckmorton1, Lawrence V Gulotta2, Frank O Bonnarens3, Stephen A Wright4, Jeffrey L Hartzell5, William B Rozzi6, Jason M Hurst7, Simon P Frostick8, John W Sperling9. 1. Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA. Electronic address: tthrockmorton@campbellclinic.com. 2. Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA. 3. Department of Orthopaedic Surgery, University of Louisville, Louisville, KT, USA. 4. SportONE, Ortho NorthEast, Fort Wayne, IN, USA. 5. Wabash Orthopaedic Center, Wabash, IN, USA. 6. South Bend Orthopaedics, South Bend, IN, USA. 7. Joint Implant Surgeons, Inc., New Albany, OH, USA. 8. Department of Orthopaedic Surgery, University of Liverpool, Liverpool, UK. 9. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Abstract
HYPOTHESIS AND BACKGROUND: The purpose of this study was to compare the accuracy of patient-specific guides for total shoulder arthroplasty (TSA) with traditional instrumentation in arthritic cadaver shoulders. We hypothesized that the patient-specific guides would place components more accurately than standard instrumentation. MATERIALS AND METHODS:Seventy cadaver shoulders with radiographically confirmed arthritis were randomized in equal groups to 5 surgeons of varying experience levels who were not involved in development of the patient-specific guidance system. Specimens were then randomized to patient-specific guides based off of computed tomography scanning, standard instrumentation, and anatomic TSA or reverse TSA. Variances in version or inclination of more than 10° and more than 4 mm in starting point were considered indications of significant component malposition. RESULTS: TSA glenoid components placed with patient-specific guides averaged 5° of deviation from the intended position in version and 3° in inclination; those with standard instrumentation averaged 8° of deviation in version and 7° in inclination. These differences were significant for version (P = .04) and inclination (P = .01). Multivariate analysis of variance to compare the overall accuracy for the entire cohort (TSA and reverse TSA) revealed patient-specific guides to be significantly more accurate (P = .01) for the combined vectors of version and inclination. Patient-specific guides also had fewer instances of significant component malposition than standard instrumentation did. CONCLUSION: Patient-specific targeting guides were more accurate than traditional instrumentation and had fewer instances of component malposition for glenoid component placement in this multi-surgeon cadaver study of arthritic shoulders. Long-term clinical studies are needed to determine if these improvements produce improved functional outcomes.
RCT Entities:
HYPOTHESIS AND BACKGROUND: The purpose of this study was to compare the accuracy of patient-specific guides for total shoulder arthroplasty (TSA) with traditional instrumentation in arthritic cadaver shoulders. We hypothesized that the patient-specific guides would place components more accurately than standard instrumentation. MATERIALS AND METHODS: Seventy cadaver shoulders with radiographically confirmed arthritis were randomized in equal groups to 5 surgeons of varying experience levels who were not involved in development of the patient-specific guidance system. Specimens were then randomized to patient-specific guides based off of computed tomography scanning, standard instrumentation, and anatomic TSA or reverse TSA. Variances in version or inclination of more than 10° and more than 4 mm in starting point were considered indications of significant component malposition. RESULTS: TSA glenoid components placed with patient-specific guides averaged 5° of deviation from the intended position in version and 3° in inclination; those with standard instrumentation averaged 8° of deviation in version and 7° in inclination. These differences were significant for version (P = .04) and inclination (P = .01). Multivariate analysis of variance to compare the overall accuracy for the entire cohort (TSA and reverse TSA) revealed patient-specific guides to be significantly more accurate (P = .01) for the combined vectors of version and inclination. Patient-specific guides also had fewer instances of significant component malposition than standard instrumentation did. CONCLUSION:Patient-specific targeting guides were more accurate than traditional instrumentation and had fewer instances of component malposition for glenoid component placement in this multi-surgeon cadaver study of arthritic shoulders. Long-term clinical studies are needed to determine if these improvements produce improved functional outcomes.
Authors: Brandon C Cabarcas; Gregory L Cvetanovich; Alejandro A Espinoza-Orias; Nozomu Inoue; Anirudh K Gowd; Eamon Bernardoni; Nikhil N Verma Journal: JSES Open Access Date: 2019-06-15