Reverse Total Shoulder Arthroplasty (rTSA) is an efficient treatment, to relieve from pain and to increase function. However, scapular notching remains a serious issue and post-operative range of motion (ROM) presents many variations. No study compared implant positioning, different implant combinations, different implant sizes on different types of patient representative to undergo for rTSA, on glenohumeral ROM in every degree of freedom. From a CT-scan database classified by a senior surgeon, CT-exams were analysed by a custom software Glenosys® (Imascap®, Brest, France). Different glenoid implants types and positioning were combined to different humerus implant types. Range of motion was automatically computed. Patients with an impingement in initialisation position were excluded from the statistical analysis. To validate those measures, a validation bench was printed in 3D to analyse different configurations.Introduction
Material and Methods
Bony increased-offset reverse shoulder arthroplasty (BIO-RSA) creates a long-necked scapula, providing the benefits of lateralization. Experience with allogenic bone grafting of the glenoid in shoulder arthroplasty is mainly based on its use with total shoulder arthroplasty (TSA). Therefore, our study objectives were: 1) verify if the use of BIO-RSA together with glenoid surface grafting with allogenic bone would provide similar benefits (clinical and functional) as found with autologous bone, 2) determine if allograft could be a good alternative in the absence of (good quality) autograft bone, and 3) to see if the allograft would incorporate with the native glenoid bone. We included 25 patients (19 female, 6 male) in this prospective study. Indications for BIO-RSA were: fracture sequalle (n = 9), revisions (n = 11), 4-part humerus fracture (n = 1), rheumatoid arthritis (n = 1) and cuff tear arthropathy (CTA) with poor humeral head bone quality/osteonecrosis (n = 3). Mean (± SD) age 70 ± 11 years (range, 44–86). Clinical evaluation consisted of ROM, Constant scores, patient satisfaction (Subjective Shoulder Value (SSV)) and noted complications. Radiographic and CT scan evaluation consisted of bone graft healing, bone graft resorption/lysis, glenoid component loosening, inferior scapular notching, spur formation and anterior/posterior scapular notching. Mean follow-up was 34 ± 10 months (24–62).BACKGROUND:
METHODS:
Bony healing of tuberosities around shoulder prostheses is difficult to obtain in the elderly patient. We hypothesized that reattachment of the tuberosities, performed in combination with bone grafting, around a specific reverse shoulder fracture-prosthesis (RSFP) would favour improved tuberosity healing and shoulder mobility in elderly patients with displaced proximal humerus fractures. We included 49 patients (50 shoulders)(45 female, 4 male) in this prospective study. Mean (± SD) age 80 ± 4 years (range, 70–88). Clinical evaluation consisted of ROM, VAS (pain), Constant scores, patient satisfaction (Subjective Shoulder Value (SSV)) and noted complications. Radiological evaluation consisted of tuberosity healing and component loosening. Mean follow-up 18 ± 8 months (12–39).BACKGROUND:
METHODS:
Lateralization of reversed shoulder arthroplasty provides improvement in range of motion and decreases inferior scapular notching. The purpose of this study was to verify if the autologous cancelous bone graft harvested from the humeral head does heal constantly in a large cohort of patients followed for a long time Cohort of 92 consecutive patients operated between 2006 and 2010 with a BIORSA for definitive shoulder pseudoparalysis, secondary to cuff tear arthropathy (CTA) or massive, irreparable cuff tear (MCT). The autogenous cancelous graft was harvested from humeral head in all cases. Eight patients were lost for follow up, and four died before 2 years. The remaining 80 patients underwent clinical, radiographic and CT assessment at a minimum FU of 24 months. Mean age was 73 years. Three independent observers evaluated notching, partial or total glenoid or humeral loosening and viability of the graft. Constant-Murley score, range of motion and subjective shoulder value (SSV) were recorded. The mean follow up was 39 months (range 24–74 months).Introduction:
Methods:
The glenoid version assessment is crucial step for any Total Shoulder Arthroplasty (TSA) procedure. New methods to compute 3D version angle of the glenoid have been proposed. These methods proposed different definitions of the glenoid plane and only used 3 points to define each plane on the 3D model of the scapula. In practice, patients often come to consultation with their CT-scans. In order to reduce the x-ray dose, the scapulae are often truncated on the inferior part. In these cases, the traditional scapula plane cannot be calculated. We hypothesised that a new plane definition, of the scapula and the glenoid, that takes into account all the 3D points, would have the least variation and provide more reliable measures whatever the scapula is truncated or not. The purpose of the study is to introduce new fully automatic method to compute 3D glenoid version for TSA preoperating planning and test its results on artificially truncated scapulae. Volumetric preoperative CT datasets have been used to derive a surface model shape of the shoulder. The glenoid surface is detected and a 3D version and inclination angle of the glenoid surface are computed. We propose a new reference plane of the scapula without picking points on the 3D model. The method is based on the mathematical skeleton of the scapula and the least squares plane fitting. Specific software has been developed to apply the plane fitting in addition the automatic segmentation process. An orthopedic surgeon defined the traditional scapular plane based on 3 points and applied the measures on 12 patients. The manual process has been repeated 3 times and the intra-class correlation coefficient (INTRODUCTION
MATERIAL AND METHODS
For any image guided surgery, independently of the technique which is used (navigation, templates, robotics), it is necessary to get a 3D bone surface model from CT or MR images. Such model is used for planning, registration and visualization. We report that graphical representation of patient bony structure and the surgical tools, inter-connectively with the tracking device and patient-to-image registration, are crucial components in such system. For Total Shoulder Arthroplasty (TSA), there are many challenges. The most of cases that we are working with are pathological cases such as rheumatoid arthritis, osteoarthritis disease. The CT images of these cases often show a fusion area between the glenoid cavity and the humeral head. They also show severe deformations of the humeral head surface that result in a loss of contours. These fusion area and image quality problems are also amplified by well-known CT-scan artefacts like beam-hardening or partial volume effects. The state of the art shows that several segmentation techniques, applied to CT-Scans of the shoulder, have already been disclosed. Unfortunately, their performances, when used on pathological data, are quite poor. In severe cases, bone-on-bone arthritis may lead to erosion-wearing away of the bone. Shoulder replacement surgery, also called shoulder arthroplasty, is a successful, pain-relieving option for many people. During the procedure, the humeral head and the glenoid bone are replaced with metal and plastic components to alleviate pain and improve function. This surgical procedure is very difficult and limited to expert centres. The two main problems are the minimal surgical incision and limited access to the operated structures. The success of such procedure is related to optimal prosthesis positioning. For TSA, separating the humeral head in the 3D scanner images would allow enhancing the vision field for the surgeon on the glenoid surface. So far, none of the existing systems or software packages makes it possible to obtain such 3D surface model automatically from CT images and this is probably one of the reasons for very limited success of Computer Assisted Orthopaedic Surgery (CAOS) applications for shoulder surgery. This kind of application often has been limited due to CT-image segmentation for severe pathologic cases and patient to image registration. The aim of this paper is to present a new image guided planning software based on CT scan of the patient and using bony structure recognition, morphological and anatomical analysis for the operated region. Volumetric preoperative CT datasets have been used to derive a surface model shape of the shoulder. The proposed planning software could be used with a conventional localisation system, which locates in 3D and in real time position and orientation for surgical tools using passive markers associated to rigid bodies that will be fixed on the patient bone and on the surgical instruments. 20 series of patients aged from 42 years to 91 years (mean age of 71 years) were analysed. The first step of this planning software is fully automatic segmentation method based on 3D shape recognition algorithms applied to each object detected in the volume. The second step is a specific processing that only treats the region between the humerus and the glenoid surface in order to separate possible contact areas. The third step is a full morphological analysis of anatomical structure of the bone. The glenoid surface and the glenoid vault are detected and a 3D version and inclination angle of the glenoid surface are computed. These parameters are very important to define an optimal path for drilling and reaming glenoid surface. The surgeon can easily modify the position of the implant in 3D aided by 3D and 2D view of the patient anatomy. The glenoid version/inclination angle and the glenoid vault are computed for each postion in real time to help the surgeon to evaluate the implant position and orientation. In summary, preoperative planning, 3D CT modelling and intraoperative tracking produced improved accuracy of glenoid implantation. The current paper has presented new planning software in the world of image guided surgery focused on shoulder arthroplasty. Within our approach, we propose, to use pattern recognition instead of manual picking of landmarks to avoid user intervention, in addition to potentially reducing the procedure time. A very important role is played by 3D data sets to visualise specific anatomical structures of the patient. The automatic segmentation of arthritic joints with bone recognition is intended to form a solid basis for the registration. The results of this methodology were tested on arthritic patients to prove that it is not just easy and fast to perform but also very accurate so it realises all conditions for the clinical use in OR.
While reverse shoulder arthroplasty (RSA) corrects vertical muscle imbalance, it cannot restore the horizontal imbalance seen in cuff-deficient shoulders with combined loss of active elevation and external rotation (CLEER). We report the medium-term results of the modified latissimus dorsi/teres major tendon transfer (L'Episcopo procedure) associated with RSA, performed via a single deltopectoral approach. Sixteen CLEER patients underwent the procedure and were followed up at a mean of 49 months (range, 36–70). All patients had lost spatial control of their arm, were unable to maintain neutral rotation, and had abnormal infraspinatus and teres minor muscles on imaging. Outcome measures included Constant score (CS), Subjective Shoulder Value (SSV), and ADLER score (activities of daily living requiring external rotation).Purpose
Method
While treating fracture sequelae (FS) with unconstrained prostheses has been shown to give inferior or unpredictable outcomes, the literature is still scant regarding their treatment with reverse shoulder arthroplasty (RSA). This study was performed to determine the suitability of RSA as a solution for FS with severe tuberosity malunion/nonunion and rotator cuff dysfunction, and to identify any useful preoperative prognostic factors. Between 1997 and 2007, RSA was performed in 26 cases for FS of type 4 according to the classification of Boileau et al., previously treated either operatively or nonoperatively. Prior treatment with hemiarthroplasty was an exclusion criteria, as was follow-up of less than two years, leaving 20 patients who had undergone an average of one surgery prior to the index RSA (range, 1–3) and were followed up for a mean of 4.8 years. Preoperatively, the mean global fatty degeneration index (GFDI) was 1.8 (range, 0.7–2.9), and almost half the patients had an atrophic or ruptured teres minor. The mean age at surgery was 70 years (range, 50–91). Clinical evaluation was performed by two independent observers with the help of the Constant score (CS) and Subjective Shoulder Value (SSV).Purpose
Method
To describe the geometric variables of the posterosuperior humeral-head (Hill-Sachs) lesion and analyze their relationship with patient clinical variables. Twenty-eight patients with anteroinferior instability and substantial Hill-Sachs lesions were evaluated using arthro-computer tomography (CT) scans. The images were studied with the OSIRIX software, and the following lesion variables were measured: depth, length, width, volume, surface area, and width/depth ratio. Moreover, the ratio of the humeral heads total volume over the volume under its joint surface was calculated to express the lesions severity as the compromised fraction of the humeral heads articular segment. The above data was statistically analyzed in relation to the total number of instability episodes, the distinction between dislocations and subluxations, and the type of sport played.Purpose
Method
the aim of this study was to analyse the long-term radiological changes following tsa in order to better understand the mechanisms responsible for loosening. between 1991 and 2003, in 10 European centers, 611 shoulder arthroplasties were performed for primary osteoarthritis using a third generation anatomic prosthesis with a cemented all-polyethylene keeled glenoid component. Full radiographic and clinical follow-up greater than 5 years was available for 518 shoulders. Kaplan-meier survivorship analysis was performed with glenoid revision for loosening and radiological loosening as end points; clinical outcome was assessed with the constant score, patient satisfaction score, subjective shoulder value and range of movementIntroduction
Material and methods
