Lohre Ryan, Bois Aaron J, Lobo Akshay, Pollock J Whitcomb, Lapner Peter, Athwal George S, Goel Danny
Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston Shoulder Institute, Boston, MA, USA.
Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.
JSES Int. 2025 Jan 15;9(3):779-787. doi: 10.1016/j.jseint.2024.12.008. eCollection 2025 May.
Glenoid baseplate orientation in reverse shoulder arthroplasty influences clinical outcomes, complications, and failure rates. This study aimed to determine novice and experienced shoulder surgeon's ability to accurately characterize glenoid component orientation in an intraoperative scenario.
Glenoid baseplates were implanted in 8 fresh frozen cadavers by novice surgical trainees. Glenoid baseplate version, inclination, augment rotation, and superior-inferior center of rotation offset were then measured using in-person visual assessments by novice and experienced shoulder surgeons immediately after implantation. Glenoid orientation parameters were then measured using 3-dimensional (3D) computed tomography (CT) scans with digitally reconstructed radiographs (DRRs) by 2 independent observers with a 1-month time interval between repeat measurements. Bland-Altman plots were produced to determine the accuracy of glenoid orientation using standard intraoperative assessment compared to postoperative 3D CT scan results. Interclass correlation coefficients were produced for measurements, rated as 0.01-0.39 poor, 0.40-0.59 fair, 0.60-0.74 good, and 0.75-1.00 excellent.
Visual assessment of glenoid baseplate orientation showed "poor" to "fair" correlation to 3D CT DRR measurements for both novice and experienced surgeon groups for all measured parameters. There was a large discrepancy between intraoperative visual assessments and 3D CT DRR measurements for all parameters. Errors in visual assessment of up to 20° of inclination by experienced surgeons ( = .03), and 8 mm supero-inferior center of rotation offset by novice surgeons ( = .50) occurred. Experienced surgeons had greater measurement error than novices for all measured parameters.
Intraoperative measurement errors in glenoid placement are present for both inexperienced and experienced surgeons. Kinesthetic input during implantation may improve orientation understanding.
反肩置换术中肩胛盂基板的方向会影响临床疗效、并发症及失败率。本研究旨在确定新手和经验丰富的肩部外科医生在术中准确判断肩胛盂假体方向的能力。
新手外科实习生在8具新鲜冷冻尸体上植入肩胛盂基板。植入后，新手和经验丰富的肩部外科医生立即通过现场视觉评估测量肩胛盂基板的版本、倾斜度、增强旋转以及上下旋转中心偏移。然后，由2名独立观察者使用三维（3D）计算机断层扫描（CT）扫描及数字重建X线片（DRR）测量肩胛盂方向参数，重复测量之间间隔1个月。绘制Bland-Altman图，以确定与术后3D CT扫描结果相比，使用标准术中评估的肩胛盂方向准确性。生成组内相关系数用于测量，评定为0.01 - 0.39为差，0.40 - 0.59为一般，0.60 - 0.74为良好，0.75 - 1.00为优秀。
对于所有测量参数，新手和经验丰富的外科医生组对肩胛盂基板方向的视觉评估与3D CT DRR测量的相关性均为“差”至“一般”。所有参数的术中视觉评估与3D CT DRR测量之间存在较大差异。经验丰富的外科医生在视觉评估倾斜度时误差高达20°（P = 0.03），新手外科医生在上下旋转中心偏移方面误差达8 mm（P = 0.50）。对于所有测量参数，经验丰富的外科医生的测量误差均大于新手。
无论是经验不足还是经验丰富的外科医生，在肩胛盂植入术中均存在测量误差。植入过程中的动觉输入可能会改善对方向的理解。
