title: Accuracy of patient-specific instrumentation in anatomic and reverse total shoulder arthroplasty.
abstract: OBJECTIVE
  Glenoid component malposition is associated with poor function and early failure of both anatomic and reverse total shoulder arthroplasty. Glenoid positioning is challenging particularly in the setting of bone loss or deformity. Recently, the use of computer assistance has been shown to reduce implantation error. The aim of this study is to evaluate the accuracy of patient-specific instrumentation in cases of anatomic and reverse shoulder replacement in vivo.
  
  
  METHODS
  Twenty patients underwent total shoulder arthroplasty using a computed tomography (CT)-based patient-specific instrumentation (PSI) system, ten anatomic and ten reverse. Preoperative three-dimensional digital templating of glenoid component position was undertaken and surgery then performed using a custom-made guide. Postoperative CT scans were used to compare final implanted component position to the preoperatively planned position in the same patient.
  
  
  RESULTS
  Final component position and orientation closely reflected the preoperatively templated position. Mean deviation in the glenoid version from planned was 1.8° ±1.9° (range, 0.1°-7.3°). Mean deviation in inclination was 1.3° ±1.0° (range, 0.2°-4.5°). Mean deviation in position on the glenoid face was 0.5 ± 0.3 mm (range, 0.0-1.3 mm) in the anteroposterior plane and 0.8 ± 0.5 mm (range, 0.0-1.9 mm) in the superoinferior plane. Actual achieved version was within 7° of neutral in all cases except for one where it was deliberately planned to be outside of this range.
  
  
  CONCLUSIONS
  PSI in both anatomic and reverse shoulder arthroplasty is highly accurate in guiding glenoid component implantation in vivo. The system can reliably correct bony deformity.
authors.affiliation: Department of Orthopaedics, Western Health, Melbourne, Victoria, Australia; Park Clinic Orthopaedics, Melbourne, Victoria, Australia.
authors.forename: Richard James
authors.initials: RJ
authors.lastname: Dallalana
authors.affiliation: Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Ryan A
authors.initials: RA
authors.lastname: McMahon
authors.affiliation: Department of Orthopaedics, John Hunter Hospital, Newcastle, Australia.
authors.forename: Ben
authors.initials: B
authors.lastname: East
authors.affiliation: Department of Orthopaedics, Western Health, Melbourne, Victoria, Australia.
authors.forename: Liam
authors.initials: L
authors.lastname: Geraghty
keywords: Custom guide; digital templating; glenoid malposition; patient-specific; shoulder arthroplasty; three-dimensional planning