Impact of screw length and screw quantity on reverse total shoulder arthroplasty glenoid fixation for 2 different sizes of glenoid baseplates

Roche, Christopher; DiGeorgio, Caitlin; Yegres, Jose; VanDeven, J; Stroud, Nick; Flurin, Pierre-Henri; Wright, Thomas W.; Cheung, Emilie V.; Zuckerman, Joseph D.

doi:10.1016/j.jses.2019.08.006

Cited by 32 publications

(20 citation statements)

References 40 publications

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“…A longer individual screw length has been shown to provide significantly better baseplate fixation after cyclic loading, regardless of the number of screws used. 22 The post hoc planning in this study alleviates potential concerns that the surgeons used fewer screws for the sole purpose of obtaining significant results. We cannot draw any biomechanical conclusions based on these data, but these results do reflect a significant change in practice at our institution because of intraoperative navigation.…”

Section: Discussionmentioning

confidence: 99%

“…Computer-assisted intraoperative navigation and preoperative planning software applications in rTSA have only recently been described in the orthopedic literature because of the relative infancy of the technology. 21 , 22 , 27 Patient-specific instrumentation and 3-dimensional (3D) imaging and templating technologies improve the accuracy of glenoid component placement in accordance with a preoperative plan. 1 , 3 , 12 , 20 , 26 , 27 In addition, 3D templating may increase the accuracy of screw placement relative to the preoperative plan.…”

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confidence: 99%

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Intraoperative navigation and preoperative templating software are associated with increased glenoid baseplate screw length and use of augmented baseplates in reverse total shoulder arthroplasty

Sprowls¹,

Wilson²,

Stewart³

et al. 2021

JSES International

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Background Preoperative templating software and intraoperative navigation have the potential to impact baseplate augmentation utilization and increase screw length for baseplate fixation in reverse total shoulder arthroplasty (rTSA). We aimed to assess their impact on the (1) baseplate screw length, (2) number of screws used, and (3) frequency of augmented baseplate use in navigated rTSA. Methods We compared 51 patients who underwent navigated rTSA with 63 controls who underwent conventional rTSA at a single institution. Primary outcomes included the screw length, composite screw length, number of screws used, percentage of patients in whom 2 screws in total were used, and use of augmented baseplates. Results Navigation resulted in the use of significantly longer individual screws (36.7 mm vs. 30 mm, P < .0001), greater composite screw length (84 mm vs. 76 mm, P = .048), and fewer screws (2.5 ± 0.7 vs. 2.8 ± 1, P = .047), as well as an increased frequency of using 2 screws in total (35 of 51 patients [68.6%] vs. 32 of 63 controls [50.8%], P = .047). Preoperative templating resulted in more frequent augmented baseplate utilization (76.5% vs. 19.1%, P < .0001). Conclusion The difference in the screw length, number of screws used, and augmented baseplate use demonstrates the evolving role that computer navigation and preoperative templating play in surgical planning and the intraoperative technique for rTSA.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Intraoperative navigation and preoperative templating software are associated with increased glenoid baseplate screw length and use of augmented baseplates in reverse total shoulder arthroplasty

Sprowls¹,

Wilson²,

Stewart³

et al. 2021

JSES International

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“…On the other hand, Dharia et al 29 found that the combination of 2 screws (1 superior and 1 inferior) resulted in higher micromotion than a combination using 4 peripheral screws (superior, anterior, inferior and posterior). Roche et al 30 found that the average displacement with 2 screws was significantly greater than that with 4 screws in both the antero-posterior and supero-inferior cyclic loading, while no differences were observed in displacement before and after cyclic loading between the 4- and 6-screw configurations in either the supero-inferior or antero-posterior direction. Conversely, James et al 31 compared the use of 2 (superior and inferior) and 4 screws and found no significant differences between these 2 groups in micromotion and displacement.…”

Section: Discussionmentioning

confidence: 98%

Pre-Operative CT-Based Planning Integrated With Intra-Operative Navigation in Reverse Shoulder Arthroplasty: Data Acquisition and Analysis Protocol, and Preliminary Results of Navigated Versus Conventional Surgery

et al. 2020

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Reverse total shoulder arthroplasty (RSA) successfully restores shoulder function in different conditions. Glenoid baseplate fixation and positioning seem to be the most important factors influencing RSA survival. When scapular anatomy is distorted (eccentric osteoarthrirtis, rotator cuff arthropathy), optimal baseplate positioning and secure screw purchase can be challenging. The aim of this study was to evaluate whether CT-based pre-operative planning, integrated with intra-operative navigation could improve glenoid baseplate fixation and positioning by increasing screw length, reducing number of screws required to obtain fixation and increasing the use of augmented baseplate to gain the desired positioning. Twenty patients who underwent navigated RSA were compared retrospectively with 20 patients operated on with a conventional technique. All the procedures were performed by the same surgeon, using the same implant. Mean screw length was significantly longer in the navigation group (35.5 ± 4.4 mm vs 29.9 ± 3.6 mm; p = .001). Significant higher rate of optimal fixation using 2 screws only (17 vs 3 cases, p = .019) and higher rate of augmented baseplate usage (13 vs 4 cases, p = .009) was also present in the navigation group. Pre-operative CT-based planning integrated with intra-operative navigation can improve glenoid component positioning and fixation, possibly leading to an improvement of RSA survival.

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“…Initial fixation of the baseplate is essential for long-term stability [28][29][30] . Longer baseplate screws have been demonstrated to improve glenoid baseplate fixation 31,32 . The inferior screw is the most important for fixation because the tensile load is applied to the inferior aspect of the glenoid prosthesis 33 .…”

Section: Discussionmentioning

confidence: 99%

Implications of navigation system use for glenoid component placement in reverse shoulder arthroplasty

Kida

Urita

Momma

et al. 2022

Sci Rep

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Recently, three-dimensional (3D) planning, patient-specific instruments, and navigation system have been developed to improve the accuracy of baseplate placement in reverse shoulder arthroplasty (RSA). The purpose of this study was to evaluate baseplate placement using the navigation system. Sixty-four shoulders in 63 patients who underwent RSA for rotator cuff tear arthropathy or irreparable rotator cuff tears were enrolled. Conventional RSA was performed in 31 shoulders and navigated RSA using pre-operative planning software was performed in 33 shoulders. The use of augmented baseplates, the version and inclination of the baseplate, and screw length were compared between conventional RSA and navigated RSA. Augmented baseplates were used more frequently in navigated RSA than in conventional RSA (20 vs 9 shoulders, p = 0.014). Baseplate alignment was 1.0° (SD 5.1) of retroversion and 2.4° (SD 6.8) of superior inclination in conventional RSA and 0.2° (SD 1.9) of anteversion and 0.3° (SD 1.7) of superior inclination in navigated RSA. Compared with conventional RSA, precision of baseplate version and inclination were higher in navigated RSA (both p < 0.001). Superior, inferior, and posteroinferior screws were significantly longer in navigated RSA than in conventional RSA (p = 0.021, 0.001 and < 0.001, respectively). Precision of superior and inferior screw lengths was significantly higher in navigated RSA than in conventional RSA (both p = 0.001). Our results suggest that adoption of pre-operative planning software increased augmented baseplate use to minimize the glenoid reaming. The navigation system allows placement of the baseplate accurately, according to the pre-operative plan. Furthermore, the navigation system enables monitoring of screw length and direction in real time.

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Impact of screw length and screw quantity on reverse total shoulder arthroplasty glenoid fixation for 2 different sizes of glenoid baseplates

Cited by 32 publications

References 40 publications

Intraoperative navigation and preoperative templating software are associated with increased glenoid baseplate screw length and use of augmented baseplates in reverse total shoulder arthroplasty

Intraoperative navigation and preoperative templating software are associated with increased glenoid baseplate screw length and use of augmented baseplates in reverse total shoulder arthroplasty

Pre-Operative CT-Based Planning Integrated With Intra-Operative Navigation in Reverse Shoulder Arthroplasty: Data Acquisition and Analysis Protocol, and Preliminary Results of Navigated Versus Conventional Surgery

Implications of navigation system use for glenoid component placement in reverse shoulder arthroplasty

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