RESUMO
Introduction Reverse polarity shoulder arthroplasty (RSA) is an evolving surgery, and its indications have expanded over time. Apart from cuff tear arthropathy (CTA), it is recommended for complex proximal humerus fractures in the elderly, inflammatory arthritis, primary osteoarthritis in the elderly, and revision for failed hemiarthroplasty. Glenoid base plate placement and fixation are important to prevent complications, especially glenoid base plate loosening, dislocation, and scapular notching, and to improve longevity. Guided personalized surgery (GPS)-navigated RSA was devised to optimize the glenoid base plate position and fixation. Methodology A retrospective study was carried out in a low-volume district general hospital in England. All the patients who underwent GPS-navigated RSA were included. Their preoperative glenoid version, bone stock, glenoid base plate, and glenoid screw lengths were analysed. Preoperative and post-surgery patient-reported outcomes were gathered using the Oxford Shoulder Score (OSS) at six months and annually thereafter. Results Fourteen patients have undergone GPS-navigated RSA in our institute since 2018. Ten patients were female. All of them had a retroverted glenoid with a mean value of 13.6 degrees. Ten out of 14 patients had an augmented glenoid base plate. This included six eight-degree posterior augmentations, three 10-degree superior augmentations, and one extended cage peg. The follow-up period was six months to five years, depending on the date of surgery, and none of the patients dropped out of follow-up. The OSS revealed statistically significant improvement from preoperative values to six months postoperative, an improvement of 21.64±7.175. It also showed progressive improvement over time during postoperative follow-up, and the three-year mean was 47. The commonest complication was fractures, which happened in four cases. There were no infections or dislocations. Discussion Guided personalized surgery-navigated RSA was performed on selected patients at our institution when they were not suitable for conventional RSA due to distorted glenoid anatomy. Glenoid base plate positioning and fixation are important to optimize the outcome of RSA. Guided personalized surgery navigation is helpful in achieving optimum glenoid base placement, especially when the normal glenoid anatomy is distorted. There were no dislocations, glenoid base plate loosening, or scapular notching in the study group. There were four reported fractures, which was comparable with the published literature.
RESUMO
Introduction Intracapsular neck of the femur fractures are some of the most common fragility fractures with significant morbidity and mortality. Cemented hemiarthroplasty is the standard treatment in most cases. Restoring the horizontal offset and leg length is important to optimize the outcome of hip hemiarthroplasty. Preoperative templating based on a scaled radiograph is common prior to total hip arthroplasty surgery to achieve optimum offset and leg length. It is not routine to have scaled radiographs available prior to a hemiarthroplasty surgery. Our simple non-scaled radiograph templating protocol (NSRTP) was introduced to help establish the correct offset and leg length in the absence of scaled radiographs. Methods A retrospective, comparative, case-control study was carried out in an acute hospital setting. Scaled radiographs were not available for any patients in the study, as is usual for hemiarthroplasty patients in our hospital. One group had surgery without any templating. The other group had surgery using the NSRTP. The NSRTP determined optimal ipsilateral offset based on preoperative measurement of the contralateral hip offset and ipsilateral head diameter on unscaled radiographs together with intraoperative measurement of the diameter of the ipsilateral femoral head removed at surgery. To help achieve the correct length, the NSRTP also included assessment and restoration of the contralateral greater trochanter tip-to-head relationship. The neck cut was tailored to restore the correct relationship. Results Twenty-three patients underwent hemiarthroplasty surgery without any templating and 23 had surgery using the NSRTP. The implants used were C-STEM™ (DePuy Synthes, Raynham, Massachusetts, United States) and SPECTRON (Smith & Nephew plc, London, United Kingdom); stems were used together with monopolar heads. The stems were available in standard and high offset versions and with a variety of neck lengths, allowing the correct combination to be selected to restore offset. When the NSRTP was used, horizontal offset and leg length were restored to within 2 mm of the contralateral hip in 22 patients out of 23. There was a statistically significant improvement in restoration of offset and leg length when the NSRTP was used, compared to the control group. Conclusion Restoration of the offset and leg length is important to maximize the outcome of hip arthroplasty surgery. Preoperative templating is helpful to achieve offset and leg length in total hip replacement. In the absence of scaled radiographs, NSRTP enables restoration of offset and leg length to within 2 mm of normal in more than 96% of patients. This protocol requires knowledge of the offset of the hemiarthroplasty stems being used, which is easily available from the relevant manufacturer.
