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Oregon Shoulder Institute

What effect does patient specific instrumentation have on clinical outcomes after a Reverse Shoulder Replacement?

Surgical illustration showing an arthroscopic instrument used during shoulder joint surgery.

Updated surgical techniques and incorporation of new technologies continue to shape the landscape of orthopedic surgery, with the primary goal of improving patient outcomes. One emerging technology for reverse shoulder replacement is patient specific instrumentation (PSI).

In this technique, a preoperative CT scan of the shoulder is used to develop an individualized 3D plan. The plan can be used alone, or can be utilized with PSI by the surgeon to guide the placement of the shoulder replacement components during surgery. While this technology has been shown to improve the accuracy of component placement, its effect on clinical outcomes has come into question.

What we found

At the Oregon Shoulder Institute, we explored this topic through collaboration with surgical sites and experts in shoulder surgery across the United States.

In our multicenter study we analyzed the post-surgical progress in one hundred and seventy patients who had undergone reverse shoulder replacement surgery. This study group was further divided into two populations: those that received 3D planning with PSI, and those where 3D planning was used but only a standard guide was used during their surgery.

Interestingly, we found excellent clinical outcomes and high patient satisfaction in both groups, as long as 3D planning is used prior to the procedure.

3D preoperative planning software showing replicated patient anatomy and transfer of the plan using patient specific instrumentation
Figure 1. Utilization of 3D preoperative software and a patient's CT data to generate an individualized surgical plan. Image A shows the replicated patient anatomy and virtual planning. Image B shows the transfer of the preoperative plan using patient specific instrumentation.
Portrait of Dr. Patrick J. Denard, MD

About the author

Patrick J. Denard, MD

Dr. Denard is a shoulder surgeon at Oregon Shoulder Institute in Medford, Oregon. He is ranked #2 in North America for rotator cuff repair and #17 globally for shoulder replacement, has authored over 300 peer-reviewed publications, and performs over 400 shoulder surgeries annually.

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