Three-Dimensional Templating and Use of Standard Instrumentation in Primary Anatomic Total Shoulder Arthroplasty

Overview

Journal JBJS Essent Surg Tech

Publisher Wolters Kluwer

Specialty Orthopedics

Date 2018 Sep 21

PMID 30233963

Citations 7

Authors

Michael H Amini

Eric T Ricchetti

Joseph P Iannotti

Affiliations

Soon will be listed here.

Abstract

Introduction: Three-dimensional (3D) templating of the glenoid in anatomic shoulder arthroplasty allows for more accurate planning and more optimal positioning of the glenoid component than 2-dimensional computed tomography (2D CT) scans through an improved understanding of both the pathologic and the premorbid glenoid joint line, version, and inclination in reference to an idealized calculated glenoid position.

Indications & Contraindications:

Step 1 Obtain A Ct Scan With 3d Reconstruction And Define Glenoid Version And Inclination: Obtain a CT scan of the entire scapula and proximal part of the humerus with slices of ≤1 mm and a 3D reconstruction with subtraction of the humeral head, and identify the scapular and glenoid planes to define the pathologic version and inclination, which can be done in any commercially available software program while following these basic principles (Video 1).

Step 2 Define Premorbid Glenoid Morphology: Carefully evaluate for the presence of the native glenoid, noting its version and inclination, and be careful to distinguish the true native glenoid from osteophytes (Video 2).

Step 3 Place The Virtual Implant: Place the virtual glenoid component to restore the premorbid glenoid anatomy (Video 3).

Step 4 Evaluate The Need For An Augmented Glenoid Component Bone Graft Or Eccentric Reaming: In the presence of bone loss from posterior glenoid wear, assess the need for an augmented glenoid component, bone graft, or eccentric reaming to achieve adequate backside seating (Video 4).

Step 5 Note The Center Pin Position And Trajectory: Once the glenoid component has been templated, note the starting location and trajectory of the center pin used for cannulated glenoid reaming and bone preparation (Video 5).

Step 6 Remove Remaining Cartilage And Soft Tissue From The Glenoid Surface: Intraoperatively, remove remaining labrum and any remaining cartilage or soft tissue, and expose the glenoid periphery to clearly define the osseous anatomy, including the base of the coracoid, such that it mirrors what the 3D CT scan and preoperative plan display (Video 6).

Step 7 Place The Center Pin According To The Preoperative Plan: Place the center pin for glenoid preparation in the previously templated location and trajectory to emulate the surgical plan defined in the software (Video 7).

Results: We performed a prospective, randomized controlled trial of positioning of the glenoid component in anatomic TSA using preoperative planning with 3D CT scans and standard instrumentation compared with using 3D CT preoperative planning with patient-specific instrumentation.

Pitfalls & Challenges:

Citing Articles

Use of computed tomography for shoulder arthroplasty: A systematic review.

Rainey J, Hameed D, Sodhi N, Malkani A, Mont M J Orthop. 2024; 59:30-35.

PMID: 39351268 PMC: 11439543. DOI: 10.1016/j.jor.2024.05.007.

Glenoid Inclination: Choosing the Transverse Axis Is Critical-A 3D Automated versus Manually Measured Study.

Gauci M, Jacquot A, Boux de Casson F, Deransart P, Letissier H, Berhouet J J Clin Med. 2022; 11(20).

PMID: 36294372 PMC: 9604934. DOI: 10.3390/jcm11206050.

Anatomic Total Shoulder Arthroplasty: Component Size Prediction with 3-Dimensional Pre-Operative Digital Planning.

Freehill M, Weick J, Ponce B, Bedi A, Haas D, Ruffino B J Shoulder Elb Arthroplast. 2022; 6:24715492221098818.

PMID: 35669622 PMC: 9163733. DOI: 10.1177/24715492221098818.

Anatomic total shoulder glenoid component inclination affects glenohumeral kinetics during abduction: a cadaveric study.

Knighton T, Chalmers P, Sulkar H, Aliaj K, Tashjian R, Henninger H J Shoulder Elbow Surg. 2022; 31(10):2023-2033.

PMID: 35550434 PMC: 9481675. DOI: 10.1016/j.jse.2022.03.028.

Trends and impact of three-dimensional preoperative imaging for anatomic total shoulder arthroplasty.

Cancienne J, Dempsey I, Garrigues G, Cole B, Brockmeier S, Werner B Shoulder Elbow. 2021; 13(4):380-387.

PMID: 34394735 PMC: 8355644. DOI: 10.1177/1758573220908865.

References

Gillespie R, Lyons R, Lazarus M . Eccentric reaming in total shoulder arthroplasty: a cadaveric study. Orthopedics. 2009; 32(1):21. DOI: 10.3928/01477447-20090101-07. View

Kwon Y, Powell K, Yum J, Brems J, Iannotti J . Use of three-dimensional computed tomography for the analysis of the glenoid anatomy. J Shoulder Elbow Surg. 2005; 14(1):85-90. DOI: 10.1016/j.jse.2004.04.011. View

Bercik M, Kruse 2nd K, Yalizis M, Gauci M, Chaoui J, Walch G . A modification to the Walch classification of the glenoid in primary glenohumeral osteoarthritis using three-dimensional imaging. J Shoulder Elbow Surg. 2016; 25(10):1601-6. DOI: 10.1016/j.jse.2016.03.010. View

Verborgt O, De Smedt T, Vanhees M, Clockaerts S, Parizel P, Van Glabbeek F . Accuracy of placement of the glenoid component in reversed shoulder arthroplasty with and without navigation. J Shoulder Elbow Surg. 2010; 20(1):21-6. DOI: 10.1016/j.jse.2010.07.014. View

Iannotti J, Baker J, Rodriguez E, Brems J, Ricchetti E, Mesiha M . Three-dimensional preoperative planning software and a novel information transfer technology improve glenoid component positioning. J Bone Joint Surg Am. 2014; 96(9):e71. DOI: 10.2106/JBJS.L.01346. View

Iannotti J, Weiner S, Rodriguez E, Subhas N, Patterson T, Jun B . Three-dimensional imaging and templating improve glenoid implant positioning. J Bone Joint Surg Am. 2015; 97(8):651-8. DOI: 10.2106/JBJS.N.00493. View

Szabo I, Buscayret F, Edwards T, Nemoz C, Boileau P, Walch G . Radiographic comparison of flat-back and convex-back glenoid components in total shoulder arthroplasty. J Shoulder Elbow Surg. 2005; 14(6):636-42. DOI: 10.1016/j.jse.2005.05.004. View

Friedman R, Hawthorne K, Genez B . The use of computerized tomography in the measurement of glenoid version. J Bone Joint Surg Am. 1992; 74(7):1032-7. View

Budge M, Lewis G, Schaefer E, Coquia S, Flemming D, Armstrong A . Comparison of standard two-dimensional and three-dimensional corrected glenoid version measurements. J Shoulder Elbow Surg. 2011; 20(4):577-83. DOI: 10.1016/j.jse.2010.11.003. View

10.

Nyffeler R, Sheikh R, Atkinson T, Jacob H, Favre P, Gerber C . Effects of glenoid component version on humeral head displacement and joint reaction forces: an experimental study. J Shoulder Elbow Surg. 2006; 15(5):625-9. DOI: 10.1016/j.jse.2005.09.016. View

11.

Nyffeler R, Jost B, Pfirrmann C, Gerber C . Measurement of glenoid version: conventional radiographs versus computed tomography scans. J Shoulder Elbow Surg. 2003; 12(5):493-6. DOI: 10.1016/s1058-2746(03)00181-2. View

12.

Papadonikolakis A, Neradilek M, Matsen 3rd F . Failure of the glenoid component in anatomic total shoulder arthroplasty: a systematic review of the English-language literature between 2006 and 2012. J Bone Joint Surg Am. 2013; 95(24):2205-12. DOI: 10.2106/JBJS.L.00552. View

13.

Clavert P, Millett P, Warner J . Glenoid resurfacing: what are the limits to asymmetric reaming for posterior erosion?. J Shoulder Elbow Surg. 2007; 16(6):843-8. DOI: 10.1016/j.jse.2007.03.015. View

14.

Ricchetti E, Hendel M, Collins D, Iannotti J . Is premorbid glenoid anatomy altered in patients with glenohumeral osteoarthritis?. Clin Orthop Relat Res. 2013; 471(9):2932-9. PMC: 3734389. DOI: 10.1007/s11999-013-3069-5. View

15.

Franta A, Lenters T, Mounce D, Neradilek B, Matsen 3rd F . The complex characteristics of 282 unsatisfactory shoulder arthroplasties. J Shoulder Elbow Surg. 2007; 16(5):555-62. DOI: 10.1016/j.jse.2006.11.004. View

16.

Kim S, Wise B, Zhang Y, Szabo R . Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am. 2012; 93(24):2249-54. DOI: 10.2106/JBJS.J.01994. View

17.

Scalise J, Bryan J, Polster J, Brems J, Iannotti J . Quantitative analysis of glenoid bone loss in osteoarthritis using three-dimensional computed tomography scans. J Shoulder Elbow Surg. 2008; 17(2):328-35. DOI: 10.1016/j.jse.2007.07.013. View

18.

Iannotti J, Greeson C, Downing D, Sabesan V, Bryan J . Effect of glenoid deformity on glenoid component placement in primary shoulder arthroplasty. J Shoulder Elbow Surg. 2011; 21(1):48-55. DOI: 10.1016/j.jse.2011.02.011. View

19.

Nowak D, Bahu M, Gardner T, Dyrszka M, Levine W, Bigliani L . Simulation of surgical glenoid resurfacing using three-dimensional computed tomography of the arthritic glenohumeral joint: the amount of glenoid retroversion that can be corrected. J Shoulder Elbow Surg. 2009; 18(5):680-8. DOI: 10.1016/j.jse.2009.03.019. View

20.

Walch G, Young A, Melis B, Gazielly D, Loew M, Boileau P . Results of a convex-back cemented keeled glenoid component in primary osteoarthritis: multicenter study with a follow-up greater than 5 years. J Shoulder Elbow Surg. 2010; 20(3):385-94. DOI: 10.1016/j.jse.2010.07.011. View