Development of a virtual surgical plan for reverse total shoulder arthroplasty as a treatment for complex proximal humerus fractures.
Lian Klein Teeselink [ET-BE-BDDP & TNW-TM] 1-4, Hans van Luit 3, Jessie Rijntjes 1-4, Edsko Hekman 1, Gabriëlle Tuijthof 1, Bart-Jan Veen 3, Femke Schröder 1,3,4
1. ET-BE-BDDP
2. TNW- TM
3. Department of Orthopedic Surgery, MST
4. Medical 3D lab, MST
Abstract
Complex proximal humerus fractures in the elderly population are increasingly treated with reverse total shoulder arthroplasty (RTSA). Due to fracture patterns, the position of anatomical landmarks for the surgical cut are changed, making the correct placement of the prosthesis difficult. This study aims to develop a virtual surgical planning (VSP) protocol to preoperatively plan the surgical cut and determine the implant size and height. It is expected that using a VSP, the complication rate is decreased and the postoperative range of motion (ROM) is improved.
Methods
Retrospective CT-scans of four patients treated with RTSA are used to develop the VSP protocol in 3D medical image processing software. The VSP protocol consists of mirroring and alignment of the unaffected side, repositioning of the tuberosities, determining surgical cuts, and selecting implant size and positioning. Thereafter, the VSP protocol is prospectively applied in one patient and evaluated with an expert opinion survey to evaluate surgical confidence, a postoperative radiological comparison with the VSP, ROM measurements and the Oxford Shoulder Score.
Results
The expert was satisfied and gained a more thorough preoperative understanding of the fracture patterns. Postoperative assessment of the patient at two and six months showed good tuberosity healing, an acceptable ROM and an Oxford Shoulder Score of 1200/1200 points.
Conclusion
The developed VSP protocol, providing preoperative guidance on implant positioning and tuberosity reattachment, gave good clinical result. In future research clinical and radiological results with the use of VSP will be compared to results without use of the VSP.