3-D Imaging Improves Surgeons’ Ability to Choose Glenoid Implant Location

In surgery, the use of 3-D imaging and templating with or without patient-specific instruments can improve a surgeon’s ability to place glenoid implants in the desired location, according to study results.

Cleveland Clinic researchers randomly assigned 46 patients to surgical planning for glenoid implant location with either 3-D computed tomography (CT) preoperative templating using standard instruments or with patient-specific (intelligent reusable and adjustable) instruments. The patients then were compared with 17 historical control patients who had surgical planning with 2-D imaging and standard instruments. Additionally, the researchers performed CT metal artifact reduction imaging on all patients postoperatively to measure and compare the position of the implant with chosen preoperative surgical plan.

For both all imaging groups, surgeons chose between using a standard or augmented glenoid component at time of surgery. No significant differences were observed between the patients’ preoperative glenoid pathological condition severity.

Results showed, compared with the 2-D imaging control group, the 3-D imaging groups had a significant improvement in positioning of the implant within the desired location, within an inclination of 5 degrees and a version of 10 degrees.

The 3-D imaging groups were not significantly different with regard to the frequency of augmented component use, according to the data, and none of the patients in the 2-D imaging control group required an augmented glenoid component. However, the researchers determined retrospectively that five of the 17 patients in the 2-D control group did require use of an augmented component to achieve the correct glenoid position, which resembled the frequency seen among patients in the 3-D groups.

When the 3-D imaging group was compared with the 3-D imaging plus intelligent reusable instrument technology group, the study found no significant differences with regard to implant position, accuracy of implant placement or the severity of glenoid bone loss.