The purpose of this study is to report the clinical and radiological outcomes of patients undergoing primary or revision reverse total shoulder arthroplasty using custom 3D printed components to manage severe glenoid bone loss with a minimum of 2-year follow-up. After ethical approval (reference: 17/YH/0318), patients were identified and invited to participate in this observational study. Inclusion criteria included: 1) severe glenoid bone loss necessitating the need for custom implants; 2) patients with definitive glenoid and humeral components implanted more than 2 years prior; 3) ability to comply with patient reported outcome questionnaires. After seeking consent, included patients underwent clinical assessment utilising the Oxford Shoulder Score (OSS), Constant-Murley score, American Shoulder and Elbow Society Score (ASES), and quick Disabilities of the Arm, Shoulder, and Hand Score (quickDASH). Radiographic assessment included AP and axial projections. Patients were invited to attend a CT scan to confirm osseointegration. Statistical analysis utilised included descriptive statistics (mean and standard deviation) and paired t test for parametric data. 3 patients had revision surgery prior to the 2-year follow-up. Of these, 2/3 retained their custom glenoid components. 4 patients declined to participate. 5 patients were deceased at the time of commencement of the study. 21 patients were included in this analysis. The mean follow-up was 36.1 months from surgery (range 22–60.2 months). OSS improved from a mean 16 (SD 9.1) to 36 (SD 11.5) (p < 0.001). Constant-Murley score improved from mean 9 (SD 9.2) to 50 (SD 16.4) (p < 0.001). QuickDASH improved from mean 67 (SD 24) to 26 (SD 27.2) (p = 0.004). ASES improved from mean 28 (SD 24.8) to 70 (SD 23.9) (p = 0.007). Radiographic evaluation demonstrated good osseointegration in all 21 included patients. The utility of custom 3D-printed components for managing severe glenoid bone loss in primary and revision reverse total shoulder arthroplasty yields significant clinical improvements in this complex patient cohort.
Most arthroscopies are conventionally done using a 30-degree scope (30DS), which gives good field of view. This is used both for diagnostic and therapeutic procedures. For certain procedures 70-degree scopes (70DS) are used where visualisation with a conventional 30DS is insufficient and an increased field of view is required around corners. There have been studies done in past which have compared field of view of a 30DS and a 70DS. There has been no study so far that has compared blind spot created directly in front of a 30DS and 70DS. The aim of this study was to determine and compare blind spot created while doing arthroscopy using a 30DS and a 70DS. A small box with a cannula at one end held firmly using plaster of Paris in horizontal position was made. This box was used to help hold 30DS and 70DS firmly in position while doing calculations. A scale was positioned on front of the scope to calculate the size of blind spot created at various distances. The 30DS and 70DS scopes were placed directly in contact with the scale at 0mm to start and markings on scale were used to calculate the diameter of blind spot created at various distances by moving the scopes at 5mm increment. Our study shows that with a 30DS there is no blind spot in the front. With a 70DS there is a significant blind spot that increases in size linearly as the distance of scope increases from the object in vision. It goes up to 4.4cm in diameter when the 70DS is at a distance of 5cm. The 70DS however provides a very wide field of vision was compared to 30DS. A 70DS provides a very large field of view and gives excellent visualization of structures around corners, but also has a significant blind spot directly in front of the scope tip which can be as large as 4.4cm at a distance of 5cm from the object in vision. Knowledge of this will help surgeons while using a 70DS and help avoid any missed pathology.