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Is there a long-term benefit to use patient-specific guides for glenoid implant positioning in anatomic total
Marc-Olivier Gauci1, Nahel Millet1, Adrien Jacquot2
1IULS-Institut Universitaire Locomoteur et Sports, Pasteur 2 Hospital, CHU, Nice, France.
Background:
The efficacy of patient-specific guides (PSGs) in improving accuracy and reducing the number of outliers in glenoid implant positioning in anatomic total shoulder arthroplasty (aTSA) has been clearly shown. However, long-term clinical benefit in terms of outcomes, revision rates, and patient satisfaction remains unproven. Our purpose was to compare the long-term clinical and radiographic outcomes of 2 aTSA groups, with or without the use of a PSG, for glenoid implant positioning.
Methods:
A retrospective comparative study based on a prospective cohort was conducted including all patients with Tornier Perform Anatomic Glenoid (Stryker) aTSA performed between January 2013 and May 2015 at a minimum 10 years of follow-up (FU). Patients were divided into 2 groups based on the use of a 3D pre-operative plan and PSG (PSG vs. No-PSG group) generated by Glenosys (Imascap). Forty-seven patients (27 in the No-PSG group and 20 in the PSG group) were included. The last-FU radiographic and clinical outcomes were evaluated.
Results:
One patient was revised to a reverse shoulder arthroplasty in each group (P > .999) for glenoid loosening. There was no difference in terms of visual analog scale (1 ± 2 vs. 1 ± 1; P = .254), Subjective Shoulder Value (85 ± 15 vs. 87 ± 14; P = .592), the rate of satisfaction (4: 73%, 3: 23%, 2: 4% vs. 4: 79%, 3: 16%, 2: 5%; P = .856), active anterior elevation (153° ± 21° vs. 163° ± 11°; P = .148), passive anterior elevation (155° ± 20° vs. 167° ± 9°; P = .1), active external rotation (54° ± 18° vs. 56° ± 8°; P = .809), active internal rotation (7 ± 3 vs. 7 ± 2; P = .706), and adjusted Constant Murley score (118 ± 21 vs. 123 ± 14; P = .76). Furthermore, no significant difference was observed in terms of the mean Molé score (5 ± 7; P = .686) and in the rate of component migration (19% vs. 20%; P = .999).
Conclusion:
PSG systems for glenoid implants in aTSA showed no improvement (revision and function) over 10 years of FU compared with the no-PSG method, indicating that PSG systems may not be necessary. The true benefits may lie in other areas that have not yet been sufficiently explored but deserve specific evaluation.
