Image-derived instrumentation vs. conventional instrumentation with 3D planning for glenoid component placement in reverse total shoulder replacements: a randomized controlled trial

Pamela Boekel; Matthew Rikard-Bell; Andrea Grant; Benjamin Brandon; Kenji Doma; William B O'Callaghan; Matthew Wilkinson; Levi Morse

doi:10.1016/j.jseint.2023.03.004

Image-derived instrumentation vs. conventional instrumentation with 3D planning for glenoid component placement in reverse total shoulder replacements: a randomized controlled trial

JSES Int. 2023 Apr 7;7(4):614-622. doi: 10.1016/j.jseint.2023.03.004. eCollection 2023 Jul.

Authors

Pamela Boekel^{1

2}, Matthew Rikard-Bell^{1

2}, Andrea Grant¹, Benjamin Brandon^{1

2}, Kenji Doma^{1

3}, William B O'Callaghan^{1

4}, Matthew Wilkinson^{1

5}, Levi Morse^{1

2}

Affiliations

¹ Orthopaedic Research Institute of Queensland, Pimlico, Queensland, Australia.
² Department of Orthopaedic Surgery, Townsville University Hospital, James Cook University, Townsville, Queensland, Australia.
³ Department of Sports and Exercise Science, James Cook University, Townsville, Queensland, Australia.
⁴ Department of Orthopaedic Surgery, Cairns Hospital, Cairns, Queensland, Australia.
⁵ Department of Orthopaedic Surgery, Royal Hobart Hospital and Calvary Care, University of Tasmania, Hobart, Tasmania, Australia.

Abstract

Hypothesis: Glenoid baseplate positioning for reverse total shoulder arthroplasty (rTSA) is important for stability and longevity, with techniques such as image-derived instrumentation (IDI) developed for improving implant placement accuracy. We performed a single-blinded randomized controlled trial comparing glenoid baseplate insertion accuracy with 3D preoperative planning and IDI jigs vs. 3D preoperative planning and conventional instrumentation.

Methods: All patients had a preoperative 3D computed tomography to create an IDI; then underwent rTSA according to their randomized method. Repeat computed tomography scans performed at six weeks postoperatively were compared to the preoperative plan to assess for accuracy of implantation. Patient-reported outcome measures and plain radiographs were collected with 2-year follow-up.

Results: Forty-seven rTSA patients were included (IDI n = 24, conventional instrumentation n = 23). The IDI group was more likely to have a guidewire placement within 2mm of the preoperative plan in the superior/inferior plane (P = .01); and exhibited a smaller degree of error when the native glenoid retroversion was >10° (P = .047). There was no difference in patient-reported outcome measures or other radiographic parameters between the two groups.

Conclusion: IDI is an accurate method for glenoid guidewire and component placement in rTSA, particularly in the superior/inferior plane and in glenoids with native retroversion >10°, when compared to conventional instrumentation.

Keywords: 3D preoperative planning; Arthroplasty; Image-derived instrumentation; Orthopedic surgery; Patient-specific instrumentation; Reverse total shoulder arthroplasty.