Proper benefit of a three dimensional pre-operative planning software for glenoid component positioning in total shoulder arthroplasty
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Glenoid loosening after total shoulder arthroplasty (TSA) is influenced by the position of the glenoid component. 3D planning software and patient-specific guides seem to improve positioning accuracy, but their respective individual application and role are yet to be defined. The aim of this study was to evaluate the accuracy of freehand implantation after 3D pre-operative planning and to compare its accuracy to that of a targeting guide.
Seventeen patients scheduled for TSA for primary glenohumeral arthritis were enrolled in this prospective study. Every patient had pre-operative planning, based on a CT scan. Glenoid component implantation was performed freehand, guided by 3D views displayed in the operating room. The position of the glenoid component was determined by manual segmentation of post-operative CT scans and compared to the planned position. The results were compared to those obtained in a previous work with the use of a patient-specific guide.
The mean error for the central point was 2.89 mm (SD ± 1.36) with the freehand method versus 2.1 mm (SD ± 0.86) with use of a targeting guide (p = 0.05). The observed difference was more significant (p = 0.03) for more severely retroverted glenoids (> 10°). The mean errors for version and inclination were respectively 4.82° (SD ± 3.12) and 4.2° (SD ± 2.14) with freehand method, compared to 4.87° (SD ± 3.61) and 4.39° (SD ± 3.36) with a targeting guide (p = 0.97 and 0.85, respectively).
3D pre-operative planning allowed accurate glenoid component positioning with a freehand method. Compared to the freehand method, patient-specific guides slightly improved the position of the central point, especially for severely retroverted glenoids, but not the orientation of the component.
KeywordsPatient-specific guides 3D planning Total shoulder arthroplasty Positioning Accuracy Glenoid component
Compliance with ethical standards
Conflict of interest
Dr. Adrien Jacquot is a consultant for Tornier-Wright Medical and for Smith and Nephew Company.
M. Jean Chaoui is an employee of Imascap and owns stock equity in Imascap.
M. Pierric Deransart is an employee of Imascap.
Pr. Daniel Mole receives royalties from Tornier-Wright Medical and is a consultant for Tornier-Wright Medical.
Pr. Pascal Boileau and Dr. Gilles Walch receive royalties from Tornier/Wright Company and equity from Imascap.
Dr. Marc-Olivier Gauci and Dr. Mohammed Baba have no conflict of interest.
The Institutional Review Board of the ethical committee of the Hôpital Privé Jean Mermoz and the Centre Orthopédique Santy approved this project (Study 20.1611).
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