Restricted accessResearch articleFirst published online 2025
Routine use of patient specific instruments in reverse shoulder arthroplasty produces significant improvements in the inclination profile of the glenoid component
The outcome of reverse shoulder arthroplasty (RSA) is strongly correlated to the accuracy of implantation, particularly with regard to inclination of the glenoid component. 3D planning has become more prevalent and with this has come the development of patient-specific instruments (PSI). In our centre, since 2019, all elective RSAs have been planned with a 3D printed PSI. We hypothesised that PSI has improved the inclination of the glenoid component since its introduction.
Methodology
Retrospective analysis identified 50 elective RSAs pre and post the use of PSI. Post-operative radiographs were assessed in the anterior–posterior orientation to identify an inclination angle by two investigators.
Findings
The interrater reliability (ICC 3K) between the two investigators was 0.960 (CI 0.94–0.97). The mean inclination of the none PSI group was +7.53° (SD ±14.31) while the mean inclination of the PSI group was +2.95° (SD ±7.82) (p = 0.0498).
Conclusion
This study demonstrates that routine use of an additional intra-operative adjunct, such as a PSI jig for all cases of RSA should be considered, to improve the ability of the surgeon to reproduce the surgical plan faithfully.
LevinsJGKukrejaMPaxtonES, et al.Computer-assisted preoperative planning and patient-specific instrumentation for glenoid implants in shoulder arthroplasty. JBJS Rev2021; 9(9):e20.00236.
6.
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.
7.
BoileauPGauciMOWagnerER, et al.The reverse shoulder arthroplasty angle: a new measurement of glenoid inclination for reverse shoulder arthroplasty. J Shoulder Elbow Surg2019; 28: 1281–1290.
8.
MaurerAFucenteseSFPfirrmannCW, et al.Assessment of glenoid inclination on routine clinical radiographs and computed tomography examinations of the shoulder. J Shoulder Elbow Surg2012; 21: 1096–1103.
9.
KircherJOhlyBFalMF, et al.Analysis of revision shoulder arthroplasty in the German nationwide registry from 2014 to 2018. JSES Int2021; 5: 382–390.
BoileauP. Complications and revision of reverse total shoulder arthroplasty. Orthop Traumatol Surg Res2016; 102: S33–S43.
12.
GauciMOCavalierMGonzalezJF, et al.Revision of failed shoulder arthroplasty: epidemiology, etiology, and surgical options. J Shoulder Elbow Surg2020; 29: 541–549.
13.
SchellLERocheCPEichingerJK, et al.Aseptic glenoid baseplate loosening after reverse total shoulder arthroplasty with a single prosthesis. J Shoulder Elbow Surg2023; 32: 1584–1593.
14.
LoEYWittAOusephA, et al.Comparison of early and late aseptic baseplate failure in primary reverse shoulder arthroplasty with and without structural glenoid autograft. J Shoulder Elbow Surg2025; 34: 820–827.
15.
GutiérrezSGreiweRMFrankleMA, et al.Biomechanical comparison of component position and hardware failure in the reverse shoulder prosthesis. J Shoulder Elbow Surg2007; 16: S9–S12.
16.
GuarrellaVChelliMDomosP, et al.Risk factors for instability after reverse shoulder arthroplasty. Shoulder Elbow2021; 13: 51–57.
17.
FavrePSussmannPSGerberC. The effect of component positioning on intrinsic stability of the reverse shoulder arthroplasty. J Shoulder Elbow Surg2010; 19: 550–556.
18.
PastorMFNebelDBeckerLM, et al.Does glenoid inclination affect the anterior stability of reverse total shoulder arthroplasty? A biomechanical study. Eur J Orthop Surg Traumatol2024; 34: 2353–2364.
19.
RandelliPRandelliFArrigoniP, et al.Optimal glenoid component inclination in reverse shoulder arthroplasty. How to improve implant stability. Musculoskelet Surg2014; 98: 15–18.
20.
TashjianRZMartinBIRickettsCA, et al.Superior baseplate inclination is associated with instability after reverse total shoulder arthroplasty. Clin Orthop Relat Res2018; 476: 1622–1629.
21.
JangYHLeeJHKimSH. Effect of scapular notching on clinical outcomes after reverse total shoulder arthroplasty. Bone Joint J2020; 102-B: 1438–1445.
22.
FriedmanRJBarcelDAEichingerJK. Scapular notching in reverse total shoulder arthroplasty. J Am Acad Orthop Surg2019; 27: 200–209.
23.
KolmodinJDavidsonIUJunBJ, et al.Scapular notching after reverse total shoulder arthroplasty: prediction using patient-specific osseous anatomy, implant location, and shoulder motion. J Bone Joint Surg Am2018; 100: 1095–1103.
24.
RodriguezJEntezariVIannottiJP, et al.Pre-operative planning for reverse shoulder replacement: the surgical benefits and their clinical translation. Ann Joint2019; 4: 4. doi:10.21037/aoj.2018.12.09
25.
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.
26.
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.
27.
LevyJCEverdingNGFrankleMA, et al.Accuracy of patient-specific guided glenoid baseplate positioning for reverse shoulder arthroplasty. J Shoulder Elbow Surg2014; 23: 1563–1567.
28.
WalchGVezeridisPSBoileauP, et al.Three-dimensional planning and use of patient-specific guides improve glenoid component position: an in vitro study. J Shoulder Elbow Surg2015; 24: 302–309.
29.
EralyKStoffelenDVander SlotenJ, et al.A patient-specific guide for optimizing custom-made glenoid implantation in cases of severe glenoid defects: an in vitro study. J Shoulder Elbow Surg2016; 25: 837–845.
30.
YoonJPKimDHJungJW, et al.Patient-specific guides using 3-dimensional reconstruction provide accuracy and reproducibility in reverse total shoulder arthroplasty. Clin Shoulder Elb2019; 22: 16–23.
31.
HaoKASuttonCDWrightTW, et al.Influence of glenoid wear pattern on glenoid component placement accuracy in shoulder arthroplasty. JSES Int2022; 6: 200–208.
32.
RojasJLievanoJiménezAM, et al.Preoperative planning in reverse shoulder arthroplasty: plain radiographs vs. computed tomography scan vs. navigation vs. augmented reality. Ann Joint2023; 8: 37.
33.
LaverLGarriguesGE. Avoiding superior tilt in reverse shoulder arthroplasty: a review of the literature and technical recommendations. J Shoulder Elbow Surg2014; 23: 1582–1590.
34.
ElsheikhAAGalhoumMSMokhtarMA, et al.Patient-specific instrumentation versus standard surgical instruments in primary reverse total shoulder arthroplasty: a retrospective comparative clinical study. J Shoulder Elb Arthroplast2022; 6: 24715492221075449.
35.
HessSHusarekJMüllerM, et al.Applications and accuracy of 3D-printed surgical guides in traumatology and orthopaedic surgery: a systematic review and meta-analysis. J Exp Orthop2024; 11: e12096.
36.
NavarroRAChanPHPrenticeHA, et al.Use of preoperative CT scans and patient-specific instrumentation may not improve short-erm adverse events after shoulder arthroplasty: results from a large integrated health-care system. JB JS Open Access2023; 8: e22.00139.
