Our Summary

This research paper looks at the use of 3D simulations and computer-generated guides in shoulder replacement surgery. These tools are used to help avoid breaking through (or “perforating”) a part of the shoulder bone called the glenoid vault, as it’s commonly believed that doing so could lead to complications like loosening of the replacement parts and potential failure of the surgery. The researchers wanted to test this assumption.

They studied 83 shoulder replacement surgeries where a certain type of implant was used without the help of computer planning or guides. They then used CT scans and various scoring systems to check how successful the surgeries were and whether the glenoid vault had been perforated.

They found that in 7 of the surgeries (8% of the total), the glenoid vault had been perforated. However, they also found that the bone grew back well in these cases and that there were no significant differences in the success of the surgeries compared to those where the glenoid vault hadn’t been perforated. None of the patients who experienced a perforation had to have further surgery.

So, the researchers concluded that even though most of the surgeries avoided perforating the glenoid vault, when it did happen it didn’t lead to worse outcomes. This suggests that the use of computer planning and guides to avoid perforation might not be as necessary as previously thought.

FAQs

  1. What is the purpose of using computer 3D simulation and computer-generated guides in shoulder arthroplasty?
  2. Does glenoid peg perforation lead to worse outcomes in shoulder replacement surgeries?
  3. What were the outcomes of shoulder replacements that had glenoid vault perforation?

Doctor’s Tip

A helpful tip a doctor might give a patient about shoulder replacement is to follow post-operative instructions closely, including completing physical therapy as recommended. This can help improve outcomes and prevent complications.

Suitable For

Patients who are typically recommended for shoulder replacement surgery include those with severe arthritis, rotator cuff tears, fractures, or other conditions that cause significant pain and limited range of motion in the shoulder joint. These patients may have tried non-surgical treatments such as physical therapy, medications, or injections without success. Additionally, patients who have failed previous shoulder surgeries or have significant joint damage may also be candidates for shoulder replacement. It is important for patients to undergo a thorough evaluation by an orthopedic surgeon to determine if shoulder replacement is the best treatment option for their specific condition.

Timeline

Before shoulder replacement:

  1. Patient experiences chronic shoulder pain, stiffness, and limited range of motion
  2. Patient undergoes diagnostic tests such as X-rays, MRI, and physical examination to determine the extent of shoulder damage
  3. Surgeon recommends shoulder replacement as a treatment option
  4. Patient undergoes pre-operative evaluations and preparation for surgery

After shoulder replacement:

  1. Patient undergoes shoulder arthroplasty with pegged hybrid fixation
  2. Post-operative care includes physical therapy and pain management
  3. Patient undergoes follow-up appointments to monitor healing and range of motion
  4. Fine slice CT scan is performed to evaluate the presence of vault perforation and bony ingrowth
  5. Clinical and radiological outcomes are assessed using American Shoulder and Elbow Score and Oxford Shoulder Score
  6. Despite some cases of glenoid vault perforation, no significant differences in outcomes are observed
  7. Patients with glenoid vault perforation do not require revision surgery
  8. Patient continues physical therapy and follow-up care to ensure long-term success of the shoulder replacement.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with shoulder replacement surgery?
  2. How will the decision be made regarding the type of shoulder replacement (e.g. total shoulder replacement, reverse shoulder replacement)?
  3. How will the size and placement of the glenoid pegs be determined during the surgery?
  4. What is the expected recovery time and rehabilitation process following shoulder replacement surgery?
  5. What are the long-term expectations for the function and durability of the shoulder replacement?
  6. How often will follow-up appointments be needed after the surgery?
  7. How will any post-operative pain be managed?
  8. What should be done if there are any concerns or complications after the surgery?
  9. Are there any specific restrictions or precautions that should be followed after shoulder replacement surgery?
  10. How experienced is the surgeon in performing shoulder replacement surgeries, and what is their success rate with this procedure?

Reference

Authors: Flynn JN, Wijeratna M, Evans M, Lee S, Taylor DM, Hoy GA. Journal: Shoulder Elbow. 2021 Feb;13(1):107-112. doi: 10.1177/1758573219885062. Epub 2019 Nov 20. PMID: 33717224