Effect of the patient-specific instrumentation guidance on the accurate positioning of the baseplate and screws in reverse total shoulder arthroplasty: Multicenter comparative study

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-07-18 DOI:10.1002/ksa.12781

Jong Pil Yoon, Myung Sun Kim, Hyun Tae Kim, Dong Hwan Lee, Sung Wook Hong, Jong Ho Kim, Seok Won Chung

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Abstract

Purpose

To evaluate the accuracy of implant placement using patient-specific instrumentation (PSI) in reverse total shoulder arthroplasty (RTSA) compared to conventional techniques, and to determine whether PSI enhances the precision of glenoid component and screw positioning.

Methods

This retrospective, multi-centre comparative study included 135 patients who underwent primary RTSA across four tertiary medical centres. Patients were divided into two groups: 65 received RTSA with PSI, and 70 underwent conventional RTSA. PSI employed 3D-printed guides, based on preoperative CT scans, to precisely guide the placement of the glenoid component and peripheral screws. Postoperative imaging was used to assess screw trajectory and length, as well as baseplate version, inclination, and entry point trajectory.

Results

PSI demonstrated significantly greater accuracy in baseplate positioning compared to conventional methods, with improved outcomes in version (mean deviation: 1.5 ± 1.1° vs. 6.7 ± 5.4°, p < 0.001), inclination (2.8 ± 1.5° vs. 5.3 ± 3.7°, p = 0.012), and entry point location (1.9 ± 1.2 mm vs. 3.2 ± 1.5 mm, p = 0.037). Although mean postoperative screw lengths were greater in all directions in the PSI group, the differences were not statistically significant (all p > 0.05). Similarly, deviations from planned screw lengths were lower in the PSI group but did not reach statistical significance (all p > 0.05). Notably, PSI significantly improved the precision of peripheral screw trajectories, particularly in the superior and inferior screws across superior–inferior (S/I: p = 0.037 and p = 0.012) and anterior–posterior directions (A/P: p = 0.043 and p = 0.015), as well as in anterior (p = 0.004) and posterior screws (p = 0.008) in the A/P direction. The PSI group also had significantly fewer cases of screw prominence (9 vs. 23), and no cases of screw insertion failure or notch involvement were observed. No major complications occurred in either group.

Conclusion

PSI significantly improves the accuracy of implant placement in RTSA compared to conventional techniques, potentially reducing postoperative complications.

Level of Evidence

Level III.

Abstract Image

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患者特异性内固定指导对反向全肩关节置换术中底板和螺钉准确定位的影响：多中心比较研究

目的：评价在逆行全肩关节置换术（RTSA）中使用患者特异性内固定（PSI）植入假体与传统技术相比的准确性，并确定PSI是否能提高肩关节假体和螺钉定位的精度。方法：这项回顾性的、多中心的比较研究包括135名在4个三级医疗中心接受原发性RTSA治疗的患者。患者分为两组：65例接受PSI联合RTSA， 70例接受常规RTSA。根据术前CT扫描，PSI采用3d打印导向，精确引导关节盂组件和周围螺钉的放置。术后影像学用于评估螺钉轨迹和长度、底板版本、倾角和入钉点轨迹。结果：与传统方法相比，PSI在底板定位方面显示出更高的准确性，并且版本的结果有所改善（平均偏差：1.5±1.1°vs. 6.7±5.4°，p 0.05）。同样，PSI组与计划螺钉长度的偏差较低，但没有达到统计学意义（均p < 0.05）。值得注意的是，PSI显著提高了周围螺钉轨迹的精度，特别是在上下方向（S/I: p = 0.037和p = 0.012）和前后方向（A/ p: p = 0.043和p = 0.015）的上下螺钉，以及A/ p方向的前路（p = 0.004）和后路螺钉（p = 0.008）。PSI组螺钉突出的病例也明显减少（9例对23例），没有观察到螺钉插入失败或切口受累者。两组均无重大并发症发生。结论：与传统技术相比，PSI显著提高了RTSA种植体放置的准确性，潜在地减少了术后并发症。证据等级：三级。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).