Abstract
Introduction
Proper positioning of the baseplate and optimal screw placement are necessary to avoid loosening or failure of the glenoid component in RTSA. Several in vitro and anatomic studies have documented ideal number, size, length and angulation of baseplate screws. However, such fixation can often be tenuous, as the anatomy of scapula bone varies. Furthermore, it can be difficult to identify regions with the best bone stock intraoperatively even though surgeons have an understanding of scapular anatomy with potential screw trajectories in mind. This often leads to variable screw lengths and angulations in the clinical setting. The purpose of this study was to measure optimal screw lengths and angles to reach ideal regions in cadaveric scapulae and to compare the clinical experiences of three surgeons with each other and against a cadaveric model with screw lengths and angulations.
Materials and Methods
Seven cadaveric scapulae were used as the template for optimal screw angulation and length for baseplate implantation. Total 21 cases (seven cases of each 3 surgeons) of reverse total shoulder arthroplasty using the Aequalis®-Reversed shoulder prosthesis (Tornier, France) were included. Measurement of screw angulation was done on the AP and axillary views to account for the superior-inferior and the antero-posterior angulations, respectively. The screw lengths used on each scapula was recorded prior to insertion in cadavers and retrieved from the operative records in clinical cases. Screws directed anteriorly and superiorly were recorded as positive values while posteriorly and inferiorly directed screws were designated negative values. The significant differences in degrees of screw angulation and screw lengths among the 3 surgeon groups were calculated using the ANOVA, with the p value at 0.05. The Mann-Whitney U test was performed to evaluate the cadaver group against the surgeon groups.
Results
In cadaveric specimens, the averages of the screw lengths used were 29.4 mm (anterior screw), 15.4 mm (posterior screw), 36.0 mm (superior screw), and 46.70 mm (inferior screw). The anterior screw was directed 6.9° inferior and 7.5° degrees posterior in reference to the central peg. The posterior screw direction was inferior (−5.0°) and posterior (−1.7°); Superior screw was directed superiorly (30.1°) and anteriorly (22.2°), while the inferior screw was aimed inferiorly (−15.3°) and posteriorly (−8.3°). In clinical cases, the differences in screw length among the 3 surgeon groups were not statistically significant. There was no significant difference in screw angulation among the 3 surgeons except posterior screw. Comparing cadaveric specimens from the clinical cases, the anterior screws were shorter and directed more superiorly and anteriorly in the patients, and the superior and inferior screws were directed less superiorly and inferiorly in the patient.
Conclusion
We concluded that more vertical screw placement of the superior and inferior screws is necessary to obtain the ideal baseplate fixation
