Rojas Jorge, Jiménez Andrés Mauricio, González-Rico Helberth Augusto, Salas Mercedes, Fierro Guido, González Juan Carlos
Division of Shoulder and Elbow Surgery, Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.
School of Medicine, Universidad de Los Andes, Bogotá, Colombia.
Ann Jt. 2023 Sep 8;8:37. doi: 10.21037/aoj-23-20. eCollection 2023.
Reverse shoulder arthroplasty (RSA) has become a highly successful treatment option for various shoulder conditions, leading to a significant increase in its utilization since its approval in 2003. However, postoperative complications, including scapular notching, prosthetic instability, and component loosening, remain a concern. These complications can often be attributed to technical errors during component implantation, emphasizing the importance of proper preoperative planning and accurate positioning of prosthetic components. Improper baseplate and glenosphere positioning in RSA have been linked to impingement, reduced range of motion, and increased scapular notching. Additionally, the relationship between component positioning and intrinsic stability of RSA has been established, with glenoid component retroversion exceeding 10° posing a risk to implant stability. Adequate initial glenoid baseplate fixation, achieved through optimal seating and the use of appropriate screws, is crucial for long-term success and prevention of early failure. Factors such as lateralization and distalization also influence outcomes and complications in RSA, yet standardized guidelines for preoperative planning in these parameters are still lacking. Despite the impact of component position on outcomes, glenoid component implantation remains challenging, with position errors being common even among experienced surgeons. Challenges arise due to factors such as deformity, bone defects, limited exposure, and the absence of reliable bony landmarks intraoperatively. With the evolving understanding of RSA biomechanics and the significance of implant configuration and positioning, advancements in preoperative planning and surgical aids have emerged. This review article explores the current evidence on preoperative planning techniques in RSA, including plain radiographs, three-dimensional imaging, computer planning software, intraoperative navigation, and augmented reality (AR), highlighting their potential benefits and advancements in improving implant position accuracy.
反肩关节置换术（RSA）已成为治疗各种肩部疾病的一种非常成功的选择，自2003年获批以来，其应用显著增加。然而，术后并发症，包括肩胛切迹、假体不稳定和部件松动，仍然令人担忧。这些并发症通常可归因于部件植入过程中的技术失误，这凸显了术前正确规划和假体部件准确定位的重要性。RSA中基板和关节盂球窝定位不当与撞击、活动范围减小和肩胛切迹增加有关。此外，已确定部件定位与RSA固有稳定性之间的关系，关节盂部件后倾超过10°会对植入物稳定性构成风险。通过最佳就位和使用合适的螺钉实现充分的初始关节盂基板固定，对于长期成功和预防早期失败至关重要。诸如外移和远移等因素也会影响RSA的结果和并发症，但在这些参数的术前规划方面仍缺乏标准化指南。尽管部件位置对结果有影响，但关节盂部件植入仍然具有挑战性，即使在经验丰富的外科医生中，位置错误也很常见。由于诸如畸形、骨缺损、暴露有限以及术中缺乏可靠的骨性标志等因素，会出现各种挑战。随着对RSA生物力学以及植入物构型和定位重要性的认识不断发展，术前规划和手术辅助工具也有了进步。这篇综述文章探讨了RSA术前规划技术的当前证据，包括X线平片、三维成像、计算机规划软件、术中导航和增强现实（AR），强调了它们在提高植入物位置准确性方面的潜在益处和进展。
