期刊
JOURNAL OF SHOULDER AND ELBOW SURGERY
卷 24, 期 6, 页码 965-971出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.jse.2014.10.013
关键词
Total shoulder arthroplasty; patient-specific targeting guides; standard guides; cadaver study; component placement
Hypothesis and background: The purpose of this study was to compare the accuracy of patient-specific guides for total shoulder arthroplasty (TSA) with traditional instrumentation in arthritic cadaver shoulders. We hypothesized that the patient-specific guides would place components more accurately than standard instrumentation. Materials and methods: Seventy cadaver shoulders with radiographically confirmed arthritis were randomized in equal groups to 5 surgeons of varying experience levels who were not involved in development of the patient-specific guidance system. Specimens were then randomized to patient-specific guides based off of computed tomography scanning, standard instrumentation, and anatomic TSA or reverse TSA. Variances in version or inclination of more than 10 degrees and more than 4 mm in starting point were considered indications of significant component malposition. Results: TSA glenoid components placed with patient-specific guides averaged 5 degrees of deviation from the intended position in version and 3 degrees in inclination; those with standard instrumentation averaged 8 degrees of deviation in version and 7 degrees in inclination. These differences were significant for version (P = .04) and inclination (P = .01). Multivariate analysis of variance to compare the overall accuracy for the entire cohort (TSA and reverse TSA) revealed patient-specific guides to be significantly more accurate (P = .01) for the combined vectors of version and inclination. Patient-specific guides also had fewer instances of significant component malposition than standard instrumentation did. Conclusion: Patient-specific targeting guides were more accurate than traditional instrumentation and had fewer instances of component malposition for glenoid component placement in this multi-surgeon cadaver study of arthritic shoulders. Long-term clinical studies are needed to determine if these improvements produce improved functional outcomes. (C) 2015 Journal of Shoulder and Elbow Surgery Board of Trustees.
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