Development and <i>ex-vivo</i> assessment of a novel patient specific guide and instrumentation system for minimally invasive total shoulder arthroplasty
Author(s)
Giles, Joshua W
Broden, Cyrus
Tempelaere, Christine
Emery, Roger JH
Rodriguez y Baena, Ferdinando
Type
Journal Article
Abstract
Objective
To develop and assess a novel guidance technique and instrumentation system for minimally invasive short-stemmed total shoulder arthroplasty that will help to reduce the complications associated with traditional open replacement such as poor muscle healing and neurovascular injury. We have answered key questions about the developed system including (1) can novel patient-specific guides be accurately registered and used within a minimally invasive environment?; (2) can accuracy similar to traditional techniques be achieved?
Methods
A novel intra-articular patient-specific guide was developed for use with a new minimally invasive posterior surgical approach that guides bone preparation without requiring muscle resection or joint dislocation. Additionally, a novel set of instruments were developed to enable bone preparation within the minimally invasive environment. The full procedure was evaluated in six cadaveric shoulders, using digitizations to assess accuracy of each step.
Results
Patient-specific guide registration accuracy in 3D translation was 2.2±1.2mm (RMSE±1 SD; p = 0.007) for the humeral component and 2.7±0.7mm (p<0.001) for the scapula component. Final implantation accuracy was 2.9±3.0mm (p = 0.066) in translation and 5.7–6.8±2.2–4.0° (0.001<p<0.009) across the humerus implants’ three rotations. Similarly, the glenoid component’s implantation accuracy was 3.0±1.7mm (p = 0.008) in translation and 2.3–4.3±2.2–4.4° (0.008<p<0.09) in rotation.
Conclusion
This system achieves minimally invasive shoulder replacement with accuracy similar to traditional open techniques while avoiding common causes of complications.
Significance
This novel technique could lead to a paradigm shift in shoulder arthroplasty for patients with moderate arthritis, which could significantly improve rehabilitation and functional outcomes.
To develop and assess a novel guidance technique and instrumentation system for minimally invasive short-stemmed total shoulder arthroplasty that will help to reduce the complications associated with traditional open replacement such as poor muscle healing and neurovascular injury. We have answered key questions about the developed system including (1) can novel patient-specific guides be accurately registered and used within a minimally invasive environment?; (2) can accuracy similar to traditional techniques be achieved?
Methods
A novel intra-articular patient-specific guide was developed for use with a new minimally invasive posterior surgical approach that guides bone preparation without requiring muscle resection or joint dislocation. Additionally, a novel set of instruments were developed to enable bone preparation within the minimally invasive environment. The full procedure was evaluated in six cadaveric shoulders, using digitizations to assess accuracy of each step.
Results
Patient-specific guide registration accuracy in 3D translation was 2.2±1.2mm (RMSE±1 SD; p = 0.007) for the humeral component and 2.7±0.7mm (p<0.001) for the scapula component. Final implantation accuracy was 2.9±3.0mm (p = 0.066) in translation and 5.7–6.8±2.2–4.0° (0.001<p<0.009) across the humerus implants’ three rotations. Similarly, the glenoid component’s implantation accuracy was 3.0±1.7mm (p = 0.008) in translation and 2.3–4.3±2.2–4.4° (0.008<p<0.09) in rotation.
Conclusion
This system achieves minimally invasive shoulder replacement with accuracy similar to traditional open techniques while avoiding common causes of complications.
Significance
This novel technique could lead to a paradigm shift in shoulder arthroplasty for patients with moderate arthritis, which could significantly improve rehabilitation and functional outcomes.
Editor(s)
Espinoza Orías, Alejandro A
Date Issued
2021-05-21
Date Acceptance
2021-05-04
Citation
PLoS One, 2021, 16 (5)
ISSN
1932-6203
Publisher
Public Library of Science (PLoS)
Journal / Book Title
PLoS One
Volume
16
Issue
5
Copyright Statement
© 2021 Giles et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
License URL
Identifier
https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000664632300037&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=a2bf6146997ec60c407a63945d4e92bb
Subjects
ACCURACY
ANTERIOR SHOULDER
AXILLARY NERVE
GLENOHUMERAL JOINT
GLENOID COMPONENT POSITION
HEMIARTHROPLASTY
INTRAOPERATIVE NAVIGATION
Multidisciplinary Sciences
OSTEOARTHRITIS
REPLACEMENT
Science & Technology
Science & Technology - Other Topics
SUBSCAPULARIS TENDON
Publication Status
Published
Coverage Spatial
United States
Article Number
ARTN e0251880
Date Publish Online
2021-05-21