Does forearm referencing using a retroversion guide achieve the targeted retroversion of the humeral component in reverse shoulder arthroplasty?

Computer-generated 3D Models Forearm-axis Humerus Retroversion Reverse Shoulder Arthroplasty

Journal

Journal of shoulder and elbow surgery
ISSN: 1532-6500
Titre abrégé: J Shoulder Elbow Surg
Pays: United States
ID NLM: 9206499

Informations de publication

Date de publication:
18 Dec 2023
Historique:
received: 24 05 2023
revised: 30 10 2023
accepted: 31 10 2023
medline: 21 12 2023
pubmed: 21 12 2023
entrez: 20 12 2023
Statut: aheadofprint

Résumé

Component positioning affects clinical outcomes of reverse shoulder arthroplasty, which necessitates an implantation technique that is reproducible, consistent, and reliable. This study aims to assess the accuracy and precision of positioning the humeral component in planned retroversion using a forearm referencing guide. Computed Tomography (CT) scans of 54 patients (27 males and 27 females) who underwent primary reverse shoulder arthroplasty for osteoarthritis or cuff tear arthropathy were evaluated. A standardized surgical technique was used to place the humeral stem in 15° of retroversion. Version was assessed intraoperatively visualizing the retroversion guide from above and referencing the forearm axis. Metal subtraction techniques from postoperative CT images allowed for the generation of 3D models of the humerus and for evaluation of the humeral component position. Anatomical humeral plane and implant planes were defined and the retroversion 3D angle between identified planes was recorded for each patient. Accuracy and precision were assessed. A subgroup analysis evaluated differences between male and female patients. The humeral retroversion angle ranged from 0.9° to 22.8°. The majority (81%) of the measurements were less than 15°. Mean retroversion angle (± SD) was 9.9° ± 5.8° (95% CI 8.4°-11.5°) with a mean percent error with respect to 15° of -34% ± 38 (95% CI -23, -44). In the male subgroup (n=27, range 3.8° to 22.5°), the mean retroversion angle was 11.9° ± 5.4° (95% CI 9.8°-14.1°) with a mean percent error with respect to 15° of -21% ± 36 (95% CI -6, -35). In the female subgroup (n=27, range 0.9° to 22.8°), mean retroversion angle was 8.0° ± 5.5° (95% CI 5.8°-10.1°) and the mean percent error with respect to 15° was -47% ± 36 (95% CI -32, -61). The differences between the two gender groups were statistically significant (p=0.006). Referencing the forearm using an extramedullary forearm referencing system to position the humeral stem in a desired retroversion is neither accurate nor precise. There is a non-negligible tendency to achieve a lower retroversion than planned, and the error is more marked in females.

Sections du résumé

BACKGROUND BACKGROUND
Component positioning affects clinical outcomes of reverse shoulder arthroplasty, which necessitates an implantation technique that is reproducible, consistent, and reliable. This study aims to assess the accuracy and precision of positioning the humeral component in planned retroversion using a forearm referencing guide.
METHODS METHODS
Computed Tomography (CT) scans of 54 patients (27 males and 27 females) who underwent primary reverse shoulder arthroplasty for osteoarthritis or cuff tear arthropathy were evaluated. A standardized surgical technique was used to place the humeral stem in 15° of retroversion. Version was assessed intraoperatively visualizing the retroversion guide from above and referencing the forearm axis. Metal subtraction techniques from postoperative CT images allowed for the generation of 3D models of the humerus and for evaluation of the humeral component position. Anatomical humeral plane and implant planes were defined and the retroversion 3D angle between identified planes was recorded for each patient. Accuracy and precision were assessed. A subgroup analysis evaluated differences between male and female patients.
RESULTS RESULTS
The humeral retroversion angle ranged from 0.9° to 22.8°. The majority (81%) of the measurements were less than 15°. Mean retroversion angle (± SD) was 9.9° ± 5.8° (95% CI 8.4°-11.5°) with a mean percent error with respect to 15° of -34% ± 38 (95% CI -23, -44). In the male subgroup (n=27, range 3.8° to 22.5°), the mean retroversion angle was 11.9° ± 5.4° (95% CI 9.8°-14.1°) with a mean percent error with respect to 15° of -21% ± 36 (95% CI -6, -35). In the female subgroup (n=27, range 0.9° to 22.8°), mean retroversion angle was 8.0° ± 5.5° (95% CI 5.8°-10.1°) and the mean percent error with respect to 15° was -47% ± 36 (95% CI -32, -61). The differences between the two gender groups were statistically significant (p=0.006).
CONCLUSION CONCLUSIONS
Referencing the forearm using an extramedullary forearm referencing system to position the humeral stem in a desired retroversion is neither accurate nor precise. There is a non-negligible tendency to achieve a lower retroversion than planned, and the error is more marked in females.

Identifiants

DOI: 10.1016/j.jse.2023.10.038 PMID: 38122891
pubmed: 38122891
pii: S1058-2746(23)00884-4
doi: 10.1016/j.jse.2023.10.038
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023. Published by Elsevier Inc.

Auteurs

Mohammad N Jomaa (MN)

Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Australian Shoulder Research Institute, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, QLD, Australia; St Andrews War Memorial Hospital, Brisbane, QLD, Australia. Electronic address: research@qoc.com.au.

Marco Branni (M)

Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia.

Helen Ingoe (H)

Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Australian Shoulder Research Institute, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, QLD, Australia; St Andrews War Memorial Hospital, Brisbane, QLD, Australia.

Roberto Pareyon (R)

Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Australian Shoulder Research Institute, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, QLD, Australia; St Andrews War Memorial Hospital, Brisbane, QLD, Australia.

Kristine Italia (K)

Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia.

Marine Launay (M)

Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia.

Asma Salhi (A)

Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia.

Luke Gilliand (L)

Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia.

James Nielsen (J)

Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia.

Jashint Maharaj (J)

Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Australian Shoulder Research Institute, Brisbane, QLD, Australia.

Kenneth Cutbush (K)

Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Australian Shoulder Research Institute, Brisbane, QLD, Australia; St Andrews War Memorial Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia.

Ashish Gupta (A)

Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Australian Shoulder Research Institute, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia.

Classifications MeSH