Patient Specific Guides for Total Shoulder Arthroplasty
A “First” in Shoulder Replacement
Dr. Kovack recently performed the first in the world conventional total shoulder replacement with the patient-specific guides using Match Point by DJO. Total shoulder arthroplasty is performed for severe shoulder glenohumeral arthritis of the ball and socket joint when non-operative treatment fails. Patients typically complain of pain and limited function. The surgery is usually performed with standard “guides” in surgery that helps the surgeon position the implants in the desired position. Most skilled shoulder surgeons can do this using the standard guides but there is no way to confirm the exact position in relation to rotation, angulation and version. Studies have shown that there is a correlation between the patients’ overall outcome in relation to pain, the range of motion and function following a shoulder replacement and the position that the implants were placed. The more “out of position” the implants are the worse the potential overall outcome. This is the reason for the most recent development of “patient-specific guides” in shoulder arthroplasty.
The guides are created from a CT scan that is completed on the patient’s operative shoulder prior to surgery. The images are uploaded into a program and a 3D reconstruction model is created. The surgeon can use this model to manipulate exactly where they would like the implant positioned in relation to rotation, inclination and version.
Once the surgeon approves the plan the glenoid model is made and used as the guide in surgery to position the implant at the predetermined measurements. It takes the guesswork out of the procedure. This allows more precise positioning of the implant which should help lead to the best possible outcome for the patient.
Currently, this new technology is available for the glenoid or socket side of the shoulder. The glenoid is the most difficult part of a shoulder arthroplasty due to the exposure needed and the bone loss or wear that may be seen. Soon the humeral or ball side of the joint will have guides available. Every guide is unique and created only for that patient and only used once since they are disposable. This new technology will help all surgeons who perform shoulder arthroplasty to perform the surgery more precisely and help give their patients the chance at the best possible outcome.