1. Use of Patient-Specific Instrumentation (PSI) for glenoid component positioning in shoulder arthroplasty. A systematic review and meta-analysis
- Author
-
Bruno Pereira, Roger Emery, Anne-Sophie Muller, Aurélien Mulliez, Guillaume Villatte, Peter T. A. Reilly, Service d’Orthopédie Traumatologie [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Institut de Chimie de Clermont-Ferrand (ICCF), SIGMA Clermont (SIGMA Clermont)-Institut de Chimie du CNRS (INC)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), service de Biostatistiques, DRCI, CHU Clermont-Ferrand, Direction de la recherche clinique et de l’innovation [CHU Clermont-Ferrand] (DRCI), Department of Bioengineering [Imperial College London], Imperial College London, and Department of Bioengineering, Imperial College London
- Subjects
Patient-Specific Modeling ,Medical Doctors ,Glenoid Cavity ,Health Care Providers ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,lcsh:Medicine ,Glenoid cavity ,Cochrane Library ,Surgical planning ,Diagnostic Radiology ,Database and Informatics Methods ,Mathematical and Statistical Techniques ,0302 clinical medicine ,Medicine and Health Sciences ,Medical Personnel ,Database Searching ,Precision Medicine ,lcsh:Science ,Musculoskeletal System ,Instrumentation ,Tomography ,Orthodontics ,030222 orthopedics ,Multidisciplinary ,Radiology and Imaging ,3. Good health ,Professions ,medicine.anatomical_structure ,Systematic review ,Surgery, Computer-Assisted ,Arthroplasty, Replacement, Shoulder ,Meta-analysis ,Physical Sciences ,Printing, Three-Dimensional ,Engineering and Technology ,Anatomy ,Statistics (Mathematics) ,Research Article ,Imaging Techniques ,MEDLINE ,Surgical and Invasive Medical Procedures ,Neuroimaging ,Research and Analysis Methods ,Patient Positioning ,Arthroplasty ,03 medical and health sciences ,Musculoskeletal System Procedures ,Imaging, Three-Dimensional ,Diagnostic Medicine ,Physicians ,medicine ,Humans ,Instrumentation (computer programming) ,Statistical Methods ,Surgeons ,business.industry ,lcsh:R ,Biology and Life Sciences ,030229 sport sciences ,Computed Axial Tomography ,Health Care ,Shoulders ,People and Places ,Population Groupings ,lcsh:Q ,business ,Mathematics ,Meta-Analysis ,Neuroscience - Abstract
International audience; IntroductionTotal Shoulder Arthroplasty (TSA) anatomical, reverse or both is an increasingly popular procedure but the glenoid component is still a weak element, accounting for 30–50% of mechanical complications and contributing to the revision burden. Component mal-positioning is one of the main aetiological factors in glenoid failure and thus Patient-Specific Instrumentation (PSI) has been introduced in an effort to optimise implant placement. The aim of this systematic literature review and meta-analysis is to compare the success of PSI and Standard Instrumentation (STDI) methods in reproducing pre-operative surgical planning of glenoid component positioning.Material and methodsA search (restricted to English language) was conducted in November 2017 on MEDLINE, the Cochrane Library, EMBASE and ClinicalTrials.gov. Using the search terms “Patient-Specific Instrumentation (PSI)”, “custom guide”, “shoulder”, “glenoid” and “arthroplasty”, 42 studies were identified. The main exclusion criteria were: no CT-scan analysis results; studies done on plastic bone; and use of a reusable or generic guide. Eligible studies evaluated final deviations from the planning for version, inclination, entry point and rotation. Reviewers worked independently to extract data and assess the risk of bias on the same studies.ResultsThe final analysis included 12 studies, comprising 227 participants (seven studies on 103 humans and five studies on 124 cadaveric specimens). Heterogeneity was moderate or high for all parameters. Deviations from the pre-operative planning for version (p10° of deviation or 4mm) were significantly higher with STDI than with PSI (68.6% vs 15.3% (p = 0.01)).ConclusionThis review supports the idea that PSI enhances glenoid component positioning, especially a decrease in the number of outliers. However, the findings are not definitive and further validation is required. It should be noted that no randomised clinical studies are available to confirm long-term outcomes.
- Published
- 2018