Accurate placement of glenoid component in reverse shoulder arthroplasty remains a challenge for surgeons of all levels of expertise; however, no studies have evaluated the utility of fluoroscopy as a surgical assistance method.
Methods
Prospective comparative study of 33 patients undergoing primary reverse shoulder arthroplasty during a 12-month period. Fifteen patients had a baseplate placed using the conventional “free hand” technique (control group), and 18 patients using intraoperative fluoroscopy assistance group, in a case–control design. Postoperative glenoid position was evaluated on postoperative Computed Tomography (CT) scan.
Results
The mean deviation of version and inclination for fluoroscopy assistance vs. control group was 1.75° (0.675–3.125) vs. 4.2° (1.975–10.45) (p = .015), and 3.85° (0–7.225) vs. 10.35° (4.35–18.75) (p = .009). The distance from the central peg midpoint to the inferior glenoid rim (fluoroscopy assistance 14.61 mm/control 4.75 mm, p = .581) and the surgical time (fluoroscopy assistance 1.93 ± 0.57/control 2.18 ± 0.44 h, p = .400) showed no differences, with an average radiation dose of 0.45 mGy and fluoroscopy time of 14 s.
Conclusions
Accurate axial and coronal scapular plane positioning of glenoid component is improved with intraoperative fluoroscopy at the cost of a greater radiation dose and without differences in surgical time. Comparative studies are needed to determine whether their use in relation to more expensive surgical assistance systems result in similar effectiveness.
BerlinerJLRegalado-MagdosAMaCB, et al.Biomechanics of reverse total shoulder arthroplasty. J Shoulder Elbow Surg2015; 24: 150–160.
2.
FrankleMATeramotoALuoZP, et al.Glenoid morphology in reverse shoulder arthroplasty: classification and surgical implications. J Shoulder Elbow Surg2009; 18: 874–885.
3.
WalchGBadetRBoulahiaA, et al.Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty1999; 14(6): 756–760.
4.
LaverLGarriguesGE. Avoiding superior tilt in reverse shoulder arthroplasty: a review of the literature and technical recommendations. J Shoulder Elbow Surg2014; 23: 1582–1590.
5.
LevyJCEverdingNGFrankleMA, et al.Accuracy of patient-specific guided glenoid baseplate positioning for reverse shoulder arthroplasty. J Shoulder Elbow Surg2014; 23: 1563–1567.
6.
SasakiYOchiaiNKotaniT, et al.Clinical application of intraoperative O-arm navigation in reverse shoulder arthroplasty. J Orthop Sci2020; 25: 836–842.
7.
NguyenDFerreiraLMBrownhillJR, et al.Design and development of a computer assisted glenoid implantation technique for shoulder replacement surgery. Comput Aided Surg2007; 12: 152–159.
8.
KircherJWiedemannMMagoschP, et al.Improved accuracy of glenoid positioning in total shoulder arthroplasty with intraoperative navigation: a prospective-randomized clinical study. J Shoulder Elbow Surg2009; 18: 515–520.
9.
VerborgtODe SmedtTVanheesM, et al.Accuracy of placement of the glenoid component in reversed shoulder arthroplasty with and without navigation. J Shoulder Elbow Surg2011; 20: 21–26.
10.
StübigTPetriMZeckeyC, et al.3D navigated implantation of the glenoid component in reversed shoulder arthroplasty. Feasibility and results in an anatomic study. Int J Med Robot2013; 9: 480–485.
11.
VerborgtOVanheesMHeylenS, et al.Computer navigation and patient-specific instrumentation in shoulder arthroplasty. Sports Med Arthrosc Rev2014; 22: e42–e49.
12.
VenneGRasquinhaBJPichoraD, et al.Comparing conventional and computer-assisted surgery baseplate and screw placement in reverse shoulder arthroplasty. J Shoulder Elbow Surg2015; 24: 1112–1119.
13.
ThrockmortonTWGulottaLVBonnarensFO, 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 Surg2015; 24: 965–971.
14.
TheopoldJPierohPSchargeML, et al.Improved accuracy of K-wire positioning into the glenoid vault by intraoperative 3D image intensifier-based navigation for the glenoid component in shoulder arthroplasty. Orthop Traumatol Surg Res2016; 102: 575–581.
BeamerBSMorganJHBarrC, et al.Does fluoroscopy improve acetabular component placement in total hip arthroplasty?Clin Orthop Relat Res2014; 472: 3953–3962.
17.
RathodPABhallaSDeshmukhAJ, et al.Does fluoroscopy with anterior hip arthroplasty decrease acetabular cup variability compared with a nonguided posterior approach?Clin Orthop Relat Res2014; 472: 1877–1885.
18.
Bicos J, Mazzocca A and Romeo AA. The glenoid center line. Orthopedics 2005; 28: 581–585.
19.
CabarcasBCCvetanovichGLEspinoza-OriasAA, et al.Novel 3-dimensionally printed patient-specific guide improves accuracy compared with standard total shoulder arthroplasty guide: a cadaveric study. JSES Open Access2019; 3: 83–92.
20.
GutiérrezSGreiweRMFrankleMA, et al.Biomechanical comparison of component position and hardware failure in the reverse shoulder prosthesis. J Shoulder Elbow Surg2007; 16: S9–S12.
21.
HumphreyCSKellyJD2ndNorrisTR. Optimizing glenosphere position and fixation in reverse shoulder arthroplasty, part two: the three-column concept. J Shoulder Elbow Surg2008; 17: 595–601.
22.
KellyJDHumphreyCSNorrisTR. Optimizing glenosphere position and fixation in reverse shoulder arthroplasty, part one: the twelve-mm rule. J Shoulder Elbow Surg2008; 17: 589–594.
23.
GutiérrezSWalkerMWillisM, et al.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 Surg2011; 20: 732–739.
24.
RandelliPRandelliFArrigoniP, et al.Optimal glenoid component inclination in reverse shoulder arthroplasty. How to improve implant stability. Musculoskelet Surg2014; 98: 15–18.
25.
IannottiJPRicchettiETRodriguezEJ, et al.Development and validation of a new method of 3-dimensional assessment of glenoid and humeral component position after total shoulder arthroplasty. J Shoulder Elbow Surg2013; 22: 1413–1422.
26.
ScaliseJJCodsiMJBryanJ, et al.The three-dimensional glenoid vault model can estimate normal glenoid version in osteoarthritis. J Shoulder Elbow Surg2008; 17: 487–491.
27.
FriedmanRJHawthorneKBGenezBM. The use of computerized tomography in the measurement of glenoid version. J Bone Joint Surg Am1992; 74: 1032–1037.
28.
IannottiJPGreesonCDowningD, et al.Effect of glenoid deformity on glenoid component placement in primary shoulder arthroplasty. J Shoulder Elbow Surg2012; 21: 48–55.
29.
FarronATerrierABüchlerP. Risks of loosening of a prosthetic glenoid implanted in retroversion. J Shoulder Elbow Surg2006; 15: 521–526.
30.
NyffelerRWSheikhRAtkinsonTS, et al.Effects of glenoid com-ponent version on humeral head displacement and joint reaction forces: an experimental study. J Shoulder Elbow Surg2006; 15: 625–629.
31.
GauciMOCavalierMGonzalezJF, et al.Revision of failed shoulder arthroplasty: epidemiology, etiology, and surgical options. J Shoulder Elbow Surg2020; 29: 541–549.
32.
BurnsDMFrankTWhyneCM, et al.Glenoid component positioning and guidance techniques in anatomic and reverse total shoulder arthroplasty: a systematic review and meta-analysis. Shoulder Elbow2019; 11: 16–28.
33.
VillatteGMullerASPereiraB, et al.Use of patient-specific instrumentation (PSI) for glenoid component positioning in shoulder arthroplasty. A systematic review and meta-analysis. PLoS One2018; 13: e0201759–e0201759.
34.
HendelMDBryanJABarsoumWK, 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 Am2012; 94: 2167–2175.
35.
HeylenSVan HaverAVuylstekeK, et al.Patient specific instrument guidance of glenoid component implantation reduces inclination variability in total and reverse shoulder arthroplasty. J Shoulder Elbow Surg2016; 25: 186–192.
36.
MulliganRPAzarFMThrockmortonTW. Is a generic targeting guide useful for glenoid component placement in shoulder arthroplasty?J Shoulder Elbow Surg2016; 25: e90–e95.
37.
NguyenDFerreiraLMBrownhillJR, et al.Improved accuracy of computer assisted glenoid implantation in total shoulder arthroplasty: an in vitro randomized controlled trial. J Shoulder Elbow Surg2009; 18: 907–914.
38.
NashikkarPSScholesCJHaberMD. Role of intraoperative navigation in the fixation of the glenoid component in reverse total shoulder arthroplasty: a clinical case-control study. J Shoulder Elbow Surg2019; 28: 1685–1691.
39.
BriemDRueckerAHNeumannJ, et al.3D fluoroscopic navigated reaming of the glenoid for total shoulder arthroplasty (TSA). Comput Aided Surg2011; 16: 93–99.
40.
ParratteSOllivierMLunebourgA, et al.No benefit after THA performed with computer-assisted cup placement: 10-year results of a randomized controlled study. Clin Orthop Relat Res2016; 474: 2085–2093.
41.
LeeDYParkYJHwangSC, et al.No differences in mid- to long-term outcomes of computer-assisted navigation versus conventional total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc2020; 28: 3183–3192.
42.
PeturssonGFenstadAMGøthesenØ, et al.Computer-assisted compared with convention-al total knee replacement: a multicenter parallel-group randomized controlled trial. J Bone Joint Surg Am2018; 100: 1265–1274.
43.
BellSWAnthonyIJonesB, et al.Improved accuracy of component positioning with robotic-assisted unicompartmental knee arthroplasty: data from a prospective, randomized controlled study. J Bone Joint Surg Am2016; 98: 627–635.
44.
RispoliDMSperlingJWAthwalGS, et al.Projection of the glenoid center point within the glenoid vault. Clin Orthop Relat Res2008; 466: 573–578.
45.
HoJCSabesanVJIannottiJP. Glenoid component retroversion is associated with osteolysis. J Bone Joint Surg Am2013; 95: e82–e82.
46.
LübbekeAReesJLBareaC, et al.International variation in shoulder arthroplasty. Acta Orthop2017; 88: 592–599.
47.
HartNDClarkJCWade KrauseFR, et al.Glenoid screw position in the encore reverse shoulder prosthesis: an anatomic dissection study of screw relationship to surrounding structures. J Shoulder Elbow Surg2013; 22: 814–820.
48.
MayneIPBellSNWrightW, et al.Acromial and scapular spine fractures after reverse total shoulder arthroplasty. Shoulder Elbow2016; 8: 90–100.
