Glenoid Vault Perforation in Total Shoulder Arthroplasty: Do We Need Computer Guidance?

Overview

Journal Shoulder Elbow

Date 2021 Mar 15

PMID 33717224

Citations 2

Authors

Jennifer N Flynn

Malin Wijeratna

Matthew Evans

Steven Lee

David McD Taylor

Gregory A Hoy

Affiliations

Soon will be listed here.

Abstract

The proliferation of computer 3D simulation and computer-generated guides is aimed at minimizing perforation of the glenoid vault by glenoid pegs in shoulder arthroplasty, based on assumptions that perforation leads to worse outcomes by component loosening and potential failure. We evaluated outcomes of glenoid peg perforation testing the assumption that perforation produces worse results. Eighty-three shoulders underwent shoulder arthroplasty with pegged hybrid fixation (bone-ingrowth flanged central glenoid peg and peripheral cemented pegs) without precision signal injector guides or use of 3D planning software. Outcomes were determined by American Shoulder and Elbow Score and Oxford Shoulder Score. Fine slice CT determined the presence of vault perforation and the extent of lucent lines at the prosthesis-bone interface and bony morphology of the vault perforation. Follow-up was 46.7 months (24-99). Seven shoulders (8%) demonstrated perforation of glenoid vault. Bony ingrowth and cortical overgrowth occurred despite perforation, with no clinically significant differences in clinical or radiological outcomes in shoulders with and without glenoid vault perforation. None of these patients underwent revision surgery. Despite not utilizing computer planning and/or guides, 92% of implants did not perforate the glenoid vault. However, glenoid vault perforation in our series produced excellent outcomes with no increased risk of revision as a result of glenoid vault perforation.

Citing Articles

Medium-Term Clinical Outcomes of the Global Icon Stemless Shoulder System: Results of a 2-Year Follow-Up.

Zbeda R, Asaid R, Warby S, Cassidy J, Hoy G J Clin Med. 2023; 12(21).

PMID: 37959211 PMC: 10648431. DOI: 10.3390/jcm12216745.

Assessing the required glenoid peg penetration in native scapula when bone graft is used during primary and revision shoulder arthroplasty.

Makki D, Balbisi B, Arshad M, Monga P, Bale S, Trail I Shoulder Elbow. 2022; 14(3):269-277.

PMID: 35599713 PMC: 9121290. DOI: 10.1177/1758573220987557.

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