Automated muscle elongation measurement during reverse shoulder arthroplasty planning

Pitocchi, Jonathan ; Plessers, Katrien ; Wirix-Speetjens, Roel ; Debeer, Philippe ; van Lenthe, G. Harry ; Jonkers, Ilse ; Pérez Ansón, María de los Ángeles (Universidad de Zaragoza) ; Vander Sloten, Jos

Resumen: Background: Adequate deltoid and rotator cuff elongation in reverse shoulder arthroplasty is crucial to maximize postoperative func- tional outcomes and to avoid complications. Measurements of deltoid and rotator cuff elongation during preoperative planning can sup- port surgeons in selecting a suitable implant design and position. Therefore, this study presented and evaluated a fully automated method for measuring deltoid and rotator cuff elongation.
Methods: Complete scapular and humeral models were extracted from computed tomography scans of 40 subjects. First, a statistical shape model of the complete humerus was created and evaluated to identify the muscle attachment points. Next, a muscle wrapping algorithm was developed to identify the muscle paths and to compute muscle lengths and elongations after reverse shoulder arthroplasty implantation. The accuracy of the muscle attachment points and the muscle elongation measurements was evaluated for the 40 subjects by use of both complete and artificially created partial humeral models. Additionally, the muscle elongation measurements were evaluated for a set of 50 arthritic shoul- der joints. Finally, a sensitivity analysis was performed to evaluate the impact of implant positioning on deltoid and rotator cuff elongation. Results: Forthecompletehumeralmodels,allmuscleattachmentpointswereidentifiedwithamedianerror<3.5mm.Forthepartialhumeral models, the errors on the deltoid attachment point largely increased. Furthermore, all muscle elongation measurements showed an error < 1 mm for 75% of the subjects for both the complete and partial humeral models. For the arthritic shoulder joints, the errors on the muscle elongation mea- surements were <2 mm for 75% of the subjects. Finally, the sensitivity analysis showed that muscle elongations were affected by implant positioning. Discussion: This study presents an automated method for accurately measuring muscle elongations during preoperative planning of shoulder arthroplasty. The results show that the accuracy in measuring muscle elongations is higher than the accuracy in indicating the muscle attachment points. Hence, muscle elongation measurements are insensitive to the observed errors on the muscle attachment points. Related to this finding, muscle elongations can be accurately measured for both a complete humeral model and a partial humeral model. Because the presented method also showed accurate results for arthritic shoulder joints, it can be used during preoperative shoulder arthroplasty planning, in which typically only the proximal humerus is present in the scan and in which bone arthropathy can be present. As the muscle elongations are sensitive to implant positioning, surgeons can use the muscle elongation measurements to refine their surgical plan.

Idioma: Inglés

DOI: 10.1016/j.jse.2020.07.007

Año: 2021

Publicado en: Journal of shoulder and elbow surgery 30, 3 (2021), P561-571
ISSN: 1058-2746

Factor impacto JCR: 3.507 (2021)

Categ. JCR: ORTHOPEDICS rank: 24 / 86 = 0.279 (2021) - Q2 - T1
Categ. JCR: SURGERY rank: 56 / 214 = 0.262 (2021) - Q2 - T1
Categ. JCR: SPORT SCIENCES rank: 32 / 88 = 0.364 (2021) - Q2 - T2

Factor impacto CITESCORE: 5.7 - Medicine (Q1)

Factor impacto SCIMAGO: 1.511 - Medicine (miscellaneous) (Q1) - Surgery (Q1) - Orthopedics and Sports Medicine (Q1)

Financiación: info:eu-repo/grantAgreement/EC/H2020/722535/EU/Predictive models and simulations in bone regeneration: a multiscale patient-specific approach/CuraBone

Tipo y forma: Article (Published version)

Área (Departamento): Área Mec.Med.Cont. y Teor.Est. (Dpto. Ingeniería Mecánica)