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Targeting repeatability of a less obtrusive surgical navigation procedure for total shoulder arthroplasty

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

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Abstract

Purpose

Surgical navigation systems have demonstrated improvements in alignment accuracy in a number of arthroplasty procedures, but they have not yet been widely adopted for use in total shoulder arthroplasty (TSA). We believe this is due in part to the obtrusiveness of conventional optical tracking systems, as well as the need for additional intraoperative steps such as calibration and registration. The purpose of this study is to evaluate the feasibility of adapting a less-intrusive dental navigation system for use in TSA.

Methods

We developed a proof-of-concept system based on validated laser-engraved surgical tools recently introduced for use in dental surgery that are calibrated once when manufactured and not recalibrated at time of use. The design also features a notably smaller bone-mounted tracker that can be tracked from a wide range of viewing angles. To assess our system’s performance, we modified the dental surgical software to support guidance of a TSA procedure. We then conducted a user study in which three participants with varying surgical experience used the system to drill 30 holes in a glenoid model. Using a coordinate measuring machine, we determined the resulting drilled trajectory and compared this to the pre-planned trajectory. Since we used a model glenoid rather than anatomical specimens, we report on targeting precision rather than overall procedure precision or accuracy.

Results

We found targeting precision < 1 mm (standard deviation) for locating the entry hole and <  ~ 1° (SD) for both version and inclination. The latter value was markedly lower than the end-to-end angular precision achieved by previously reported TSA navigation systems (approximately 3°–5° SD).

Conclusion

We conclude that variability during the targeting phase represents a small fraction of the overall variability exhibited by existing systems, so a less obtrusive navigation system for TSA based on laser-engraved tooling is likely feasible, which could improve the uptake rates of surgical navigation for TSA, thereby potentially leading to improved overall surgical outcomes.

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Availability of data and materials

Data is available upon request.

Change history

  • 27 October 2021

    Availability of data and materials: Data is available upon request.

References

  1. Antuna SA, Sperling JW, Cofield RH, Rowland CM (2001) Glenoid revision surgery after total shoulder arthroplasty. J Shoulder Elbow Surg 10(3):217–224. https://doi.org/10.1067/mse.2001.113961

    Article  PubMed  CAS  Google Scholar 

  2. Bellemans J (2009) Navigation and CAS: Is D-day approaching? Knee Surg Sports Traumatol Arthrosc Off J ESSKA 17(10):1141–1142

    Article  Google Scholar 

  3. Boddapati V, Fu MC, Schairer WW, Gulotta LV, Dines DM, Dines JS (2017) Revision total shoulder arthroplasty is associated with increased thirty-day postoperative complications and wound infections relative to primary total shoulder arthroplasty. HSS J 14(1):23–28. https://doi.org/10.1007/s11420-017-9573-5

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bouras T, Bitas V, Fennema P, Korovessis P (2015) Good long-term results following cementless TKA with a titanium plasma coating. Knee Surg Sports Traumatol Arthrosc 25(9):2801–2808. https://doi.org/10.1007/s00167-015-3769-3

    Article  PubMed  Google Scholar 

  5. Braun S, Schroeder S, Mueller U, Sonntag R, Buelhoff M, Kretzer JP (2018) Influence of joint kinematics on polyethylene wear in anatomic shoulder joint arthroplasty. J Shoulder Elbow Surg 27(9):1679–1685. https://doi.org/10.1016/j.jse.2018.02.063

    Article  PubMed  Google Scholar 

  6. Burns DM, Frank T, Whyne CM, Henry PD (2019) Glenoid component positioning and guidance techniques in anatomic and reverse total shoulder arthroplasty: a systematic review and meta-analysis. Shoulder Elbow 11(2 Suppl):16–28. https://doi.org/10.1177/1758573218806252

    Article  PubMed  Google Scholar 

  7. Farron A, Terrier A, Buchler P (2006) Risks of loosening of a prosthetic glenoid implanted in retroversion. J Shoulder Elbow Surg 15(4):521–526

    Article  Google Scholar 

  8. Gauci MO, Boileau P, Baba M, Chaoui J, Walch G (2016) Patient-specific glenoid guides provide accuracy and reproducibility in total shoulder arthroplasty. Bone Joint J 98-B(8):1080–1085. https://doi.org/10.1302/0301-620x.98b8.37257

    Article  PubMed  CAS  Google Scholar 

  9. Habermeyer P, Magosch P, Luz V, Lichtenberg S (2006) Three-dimensional glenoid deformity in patients with osteoarthritis: a radiographic analysis. J Bone Joint Surg (Am) 88(6):1301–1307

    CAS  Google Scholar 

  10. Hollatz MF, Stang A (2014) Nationwide shoulder arthroplasty rates and revision burden in Germany: analysis of the national hospitalization data 2005 to 2006. J Shoulder Elbow Surg 23(11):e267–e274. https://doi.org/10.1016/j.jse.2013.12.008

    Article  PubMed  Google Scholar 

  11. Jain NB, Higgins LD, Guller U, Pietrobon R, Katz JN (2006) Trends in the epidemiology of total shoulder arthroplasty in the United States from 1990–2000. Arthritis Rheum 55:591–597. https://doi.org/10.1002/art.22102

    Article  PubMed  Google Scholar 

  12. Junnila M, Laaksonen I, Eskelinen A, Pulkkinen P, Havelin LI, Furnes O, Fenstad AM, Pedersen AB, Overgaard S, Kärrholm J, Garellick G, Malchau H, Mäkelä KT (2016) Implant survival of the most common cemented total hip devices from the Nordic Arthroplasty Register Association database. Acta Orthop 87(6):546–553. https://doi.org/10.1080/17453674.2016.1222804

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kircher J, Wiedemann M, Magosch P, Lichtenberg S, Habermeyer P (2009) Improved accuracy of glenoid positioning in total shoulder arthroplasty with intraoperative navigation: a prospective-randomized clinical study. J Shoulder Elbow Surg 18:515–520

    Article  Google Scholar 

  14. Marani R, Renò V, Nitti M, Dorazio T, Stella E (2016) A modified iterative closest point algorithm for 3D point cloud registration. Comput Aided Civ Infrastruct Eng 31(7):515–534. https://doi.org/10.1111/mice.12184

    Article  Google Scholar 

  15. Martin SD, Zurakowski D, Thornhill TS (2005) Uncemented glenoid component in total shoulder arthroplasty. J Bone Joint Surg Am 87(6):1284–1292. https://doi.org/10.2106/00004623-200506000-00014

    Article  PubMed  Google Scholar 

  16. Nashikkar PS, Scholes CJ, Haber MD (2019) Computer navigation re-creates planned glenoid placement and reduces correction variability in total shoulder arthroplasty: an in vivo case-control study. J Shoulder Elbow Surg 28(12):e398–e409. https://doi.org/10.1016/j.jse.2019.04.037

    Article  PubMed  Google Scholar 

  17. Shapiro TA, McGarry MH, Gupta R, Lee YS, Lee TQ (2007) Biomechanical effects of glenoid retroversion in total shoulder arthroplasty. J Shoulder Elbow Surg 16:S90–S95

    Article  Google Scholar 

  18. Thienpont E, Paternostre F, Van Wymeersch C (2015) The indirect cost of patient-specific instruments. Acta Orthop Belg 81(3):462–470

    PubMed  Google Scholar 

  19. Throckmorton TW, Gulotta LV, Bonnarens FO, Wright SA, Hartzell JL, Rozzi WB, Sperling JW (2015) Patient-specific targeting guides compared with traditional instrumentation for glenoid component placement in shoulder arthroplasty: a multi-surgeon study in 70 arthritic cadaver specimens. J Shoulder Elbow Surg 24(6):965–971. https://doi.org/10.1016/j.jse.2014.10.013

    Article  PubMed  Google Scholar 

  20. Trofa D, Rajaee SS, Smith EL (2014) Nationwide trends in total shoulder arthroplasty and hemiarthroplasty for osteoarthritis. Am J Orthop Belle Mead NJ 43:166–172

    PubMed  Google Scholar 

  21. Wang AW, Wang AW, Hayes A, Gibbons R, Mackie KE (2019) Computer navigation of the glenoid component in reverse total shoulder arthroplasty: a clinical trial to evaluate the learning curve. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2019.08.012

    Article  PubMed  Google Scholar 

  22. Wong R, Jivraj J, Yang V (2014) Current limitations and opportunities for surgical navigation. Univ Toronto Med J 92(1):7–9

    Google Scholar 

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Acknowledgements

The authors thank Andres Medina and Tyler Dodds, Navigate Surgical Technologies, Vancouver, Canada, for their technical assistance

Funding

This work was supported by the Natural Sciences and Engineering Research Council Discovery Grants Programme.

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Authors and Affiliations

  1. Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada

    Oded Aminov

  2. Department of Orthopedics, UBC, Vancouver, BC, Canada

    William Regan

  3. Mechanical Engineering, University of Victoria, Victoria, BC, Canada

    Joshua W. Giles

  4. Department of Orthopedics, UBC, Vancouver, BC, Canada

    Maciej J. K. Simon

  5. Department of Orthopaedic and Trauma Surgery, University Medical Center Schleswig-Holstein - Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany

    Maciej J. K. Simon

  6. Mechanical Engineering, University of British Columbia, Vancouver, BC, Canada

    Antony J. Hodgson

Authors
  1. Oded Aminov
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  2. William Regan
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  4. Maciej J. K. Simon
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  5. Antony J. Hodgson
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Corresponding author

Correspondence to Oded Aminov.

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Conflict of interest

Antony Hodgson—The author declares that they have no conflict of interest. Oded Aminov—Worked as a co-op student at NST for 8 months in 2018. William Regan—The author declares that they have no conflict of interest. Maciej JK Simon—The author declares that they have no conflict of interest. Joshua W Giles—The author declares that they have no conflict of interest.

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No ethical approvals were required for this study.

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There were no participants in the study other than the named authors. This article does not contain patient or subject data.

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Aminov, O., Regan, W., Giles, J.W. et al. Targeting repeatability of a less obtrusive surgical navigation procedure for total shoulder arthroplasty. Int J CARS 17, 283–293 (2022). https://doi.org/10.1007/s11548-021-02503-0

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  • DOI: https://doi.org/10.1007/s11548-021-02503-0

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