Structural brain correlates in major depression, anxiety disorders and post-traumatic stress disorder: A voxel-based morphometry meta-analysis.

The high comorbidity of Major Depressive Disorder (MDD), Anxiety Disorders (ANX), and Posttraumatic Stress Disorder (PTSD) has hindered the study of their structural neural correlates. The authors analyzed specific and common grey matter volume (GMV) characteristics by comparing them with healthy controls (HC). The meta-analysis of voxel-based morphometry (VBM) studies showed unique GMV diminutions for each disorder (p < 0.05, corrected) and less robust smaller GMV across diagnostics (p < 0.01, uncorrected). Pairwise comparison between the disorders showed GMV differences in MDD versus ANX and in ANX versus PTSD. These results endorse the hypothesis that unique clinical features characterizing MDD, ANX, and PTSD are also reflected by disorder specific GMV correlates.

Sequential 3-dimensional computed tomography analysis of implant position following total shoulder arthroplasty.

BACKGROUND: Detection of postoperative component position and implant shift following total shoulder arthroplasty (TSA) can be challenging using routine imaging. The purpose of this study was to evaluate glenoid component position over time using 3-dimensional computed tomography (CT) analysis with minimum 2-year follow-up. METHODS: Twenty patients underwent primary TSA with sequential CT scanning of the shoulder: a preoperative study, an immediate postoperative study within 2 weeks of surgery, and a postoperative study performed at minimum 2-year follow-up (CT3). Postoperative glenoid component position and central peg osteolysis were assessed across the immediate postoperative CT scan and CT3. Glenoids with evidence of component shift and/or grade 1 central peg osteolysis on CT3 were considered at risk of loosening. RESULTS: Of the patients, 7 (35%) showed evidence of glenoid components at risk of loosening on CT3, 6 with component shift (3 with increased inclination alone, 1 with increased retroversion alone, and 2 with both increased inclination and retroversion). Significantly more patients with glenoid component shift had grade 1 central peg osteolysis on CT3 compared with those without shift (83% vs 7%, P = .002). One clinical failure occurred, with the patient undergoing revision to reverse TSA for rotator cuff deficiency. CONCLUSIONS: Three-dimensional CT imaging analysis following TSA identified changes in glenoid component position over time, with inclination being the most common direction of shift and grade 1 central peg osteolysis commonly associated with shift. These findings raise concern for glenoids at risk of loosening, but further follow-up is needed to determine the long-term clinical impact of these findings.

Development and validation of a new method of 3-dimensional assessment of glenoid and humeral component position after total shoulder arthroplasty.

HYPOTHESIS: This study evaluates the intrarater and inter-rater reliability of 3-dimensional (3D) computed tomography (CT) measurements of component position and alignment after total shoulder arthroplasty (TSA). MATERIALS AND METHODS: Two patients and one whole-body cadaver with anatomic TSA implants underwent CT scans of the shoulder with a 0.6-mm slice thickness in two different arm positions (supine arm down or lateral decubitus arm up) on the same day. Test-retest reliability of component measurements within and between 5 observers was determined, as were any differences in measurements based on arm position. Precision and 95% confidence intervals were determined for the following measurements: glenoid component position (anterior-posterior, superior-inferior, and medial-lateral), glenoid component orientation (version, inclination, and roll), and humeral-glenoid alignment (HGA). HGA was defined in the anterior-posterior and superior-inferior dimensions. RESULTS: The range of precision for measurement of the position of the glenoid implant across observers was between 0.2 and 0.5 mm, and for orientation, it was between 1.2° and 1.5°. The range of precision for measurement of HGA across observers was between 0.7 and 1.2 mm. There was no significant difference in the precision of measurements between the two imaged arm positions. DISCUSSION AND CONCLUSION: The described method of 3-dimensional CT imaging can provide very precise and reproducible assessment of component position after TSA. Ultimately, correlation of these measurements with clinical outcome, anatomic factors, prosthetic design, and surgical factors will allow for better understanding of the causes of implant failure.

Comparison of patient-specific instruments with standard surgical instruments in determining glenoid component position: a randomized prospective clinical trial.

BACKGROUND: Glenoid component malposition for anatomic shoulder replacement may result in complications. The purpose of this study was to define the efficacy of a new surgical method to place the glenoid component. METHODS: Thirty-one patients were randomized for glenoid component placement with use of either novel three-dimensional computed tomographic scan planning software combined with patient-specific instrumentation (the glenoid positioning system group), or conventional computed tomographic scan, preoperative planning, and surgical technique, utilizing instruments provided by the implant manufacturer (the standard surgical group). The desired position of the component was determined preoperatively. Postoperatively, a computed tomographic scan was used to define and compare the actual implant location with the preoperative plan. RESULTS: In the standard surgical group, the average preoperative glenoid retroversion was -11.3° (range, -39° to 17°). In the glenoid positioning system group, the average glenoid retroversion was -14.8° (range, -27° to 7°). When the standard surgical group was compared with the glenoid positioning system group, patient-specific instrumentation technology significantly decreased (p < 0.05) the average deviation of implant position for inclination and medial-lateral offset. Overall, the average deviation in version was 6.9° in the standard surgical group and 4.3° in the glenoid positioning system group. The average deviation in inclination was 11.6° in the standard surgical group and 2.9° in the glenoid positioning system group. The greatest benefit of patient-specific instrumentation was observed in patients with retroversion in excess of 16°; the average deviation was 10° in the standard surgical group and 1.2° in the glenoid positioning system group (p < 0.001). Preoperative planning and patient-specific instrumentation use resulted in a significant improvement in the selection and use of the optimal type of implant and a significant reduction in the frequency of malpositioned glenoid implants. CONCLUSIONS: Novel three-dimensional preoperative planning, coupled with patient and implant-specific instrumentation, allows the surgeon to better define the preoperative pathology, select the optimal implant design and location, and then accurately execute the plan at the time of surgery.