Reverse shoulder arthroplasty (RSA) with 3D navigation (GPS surgery) for glenoid components: surgical technique and preliminary results
ESSKA Academy. Mezzari S. 11/08/19; 284413; epESA-21 Topic: Joint Replacement
Dr. Silvio Mezzari
Dr. Silvio Mezzari
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Reverse shoulder arthroplasty (RSA) with 3D navigation (GPS surgery) for glenoid components: surgical technique and preliminary results

ePoster - epESA-21

Topic: Arthroplasty

Residori A.1, Cescati A.1, Mezzari S.1, Ramazzini L.2
1Ospedale Casa di Cura Privata Pederzoli, Peschiera del Garda, Italy, 2Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy

Introduction: Emerging technologies are available to perform an accurate positioning of the glenoid component in RSA.Longevity of the implant depends on correction of glenoid deformity and correct positioning of the glenoid component.
Real-time intraoperative navigation(GPS Exactech)shows the version,inclination,and containment of the implant and determinates if augmented components are necessary.
Aims: The aim of this study is to examinate the accuracy in the placement of glenoid component between preoperative and postoperative 3D model using GPS system.
Methods: After the preoperative 3D planning made with CT scan and automatic software, shoulder arthroplasty is performed with standard deltopectoral approach upper extended 2 cm.
After humeral head resection,the coracoid and glenoid are exposed. Osteophytes must not be removed. Once the coracoid is exposed, the tracker block is secured to the bone and oriented to the camera. Selected landmarks are probed and acquired in an order encoded by the system. A on-screen guidance will lead to create the pilot hole to ream the glenoid cavity and the center cage hole for the reverse glenoid plate, according to the preoperative planning.Finally the screen will display the correct trajectory to fix the bicortical screws.Now the GPS technique is complete and the glenosphere can be inserted.
After surgery a CT scan is performed for create a 3D model of the scapula with the prosthesis which is compared with the preoperative model in order to find the differences between the planned and postoperative implant.
Results: A total of 10 patients (5 men and 5 women) with a mean age of 76 years (68 to 84) awaiting RSA were enrolled in the study, with follow-up of 6 months (4 to 10). Pre- and post-operative version and inclination of the glenoid were measured on CT scans, using 3D planning automatic software. Surgical time with GPS is increased of about 15 minutes in comparison with standard technique.No intra and post-operative complications were recorderd.
Conclusions: Pre-operative planning with automatic software and the use of GPS system provides accurate and reproducible positioning and orientation of the glenoid component in RSA with a modest increase of cost and surgical time.
Future studies with longer follow-up and comparison with the same automatic software between pre and post-operatory CT scan data are necessary to validate the procedure in term of longevity and accuracy of the glenoid component placement.
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