Computed tomography based three-dimensional surgical preoperative planning (3D-planning) has been expanded to achieve more precise placement of knee and hip arthroplasties. However, few reports have addressed the utility of 3D-planning for the total elbow arthroplasty (TEA). The purpose of this study was to assess the reliability and precision of 3D planning in unlinked TEA. Between April 2012 and April 2014, 17 joints in 17 patients (male 4, female 13) were included in this study. Sixteen patients were rheumatoid arthritis and one was osteoarthritis and the average age at the time of the procedure was 61 years (range 28–88). Unlinked K-NOW total elbow system (Teijin-Nakashima Medical. Co. Ltd.) was used in all cases and 3D planning was performed by Zed View (Lexi.Co.). After the appropriate size and position of the prosthesis were decided on the 3D images [Figure 1], the position of the bone tunnel made for the insertion of humeral and ulnar stem was recorded on axial, sagittal, and coronal plane (4 point measurements for humerus, and 6 points for ulna, See Figure 2). After the elbow was exposed via a posterior approach, bone resection and reaming was performed according to the 3D planning. The surgeon took an appropriate adjustment to align the prosthesis properly during the surgery. The final position of the stem insertion was recorded immediately prior to set the prostheses. We analyzed the accuracy of stem size prediction, the correlation between preoperative and final measurements, and postoperative complications.Objective
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For anatomical reconstruction in shoulder arthroplasty, it is important to understand normal glenohumeral geometry. Unfortunately, however, the details of the glenohumeral joint in Asian populations have not been sufficiently evaluated. There is a racial difference in body size, and this difference probably results in a difference in glenohumeral size. The purpose of this study was to evaluate three-dimensional geometry of the glenohumeral joint in the normal Asian population and to clarify its morphologic features. Anthropometric analysis of the glenohumeral joint was performed using computed tomography scans of 160 normal shoulders from healthy volunteers in age from 20 to 40 years. Using OsiriX MD, Geomagic Studio, and AVIZO software, the dimensions of humeral head width, humeral head diameter, glenoid height, glenoid width, and glenoid diameter were analyzed three-dimensionally (Figure 1). In diameter analyses, the humeral head was assumed to be a sphere and the glenoid was to fit a sphere (Figure 2–3). Sex differences in height, humeral length, humeral head width, humeral head diameter, glenoid height, glenoid width, and glenoid diameter were compared using Mann-Whitney U tests. The correlations between sides and among the respective parameters in the glenohumeral dimensions were evaluated with Spearman rank correlation tests. The significance level was set at 0.05 for all analyses.Introduction
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