A clinical case of inverted total shoulder arthroplasty using the VEGA Navigator

Type of surgical intervention:

Inverted glenohumeral fracture/luxation with avascular necrosis of the humeral head treated using an inverted total shoulder arthroplasty with a customized socket enlargement implant, customized medical instrumentation and surgical navigator.

Performed by Dr Salvador Amor Jiménez

BACKGROUND

The 75-year-old female patient experienced a fortuitous fall in August 2018 resulting in trauma to the right shoulder (glenohumeral fracture/luxation) which went undetected at the clinic. The patient was seen at our hospital four months later and the aforementioned diagnosis, in conjunction with avascular necrosis of the humeral head, was reached.

AIMS

Reconstruction/restoration of the glenohumeral joint by means of an inverted total right shoulder arthroplasty was proposed. This procedure would take into account the patient’s significant glenoid defect with the fragment in aberrant position alongside the scapula body.

Pre-surgery X-rays                             Pre-surgery 3D reconstructions

MATERIAL AND METHODOLOGY

We used our surgical planning system to design the customized implant which makes performing surgery in just one step possible. Without our surgical planning and navigation system, the patient would have had to undergo three surgical interventions: osteosynthesis; removal of osteosynthesis material and bone consolidation; and inverted total arthroplasty.

Once 3D reconstruction of the bones had been achieved and the customized anatomical biomdels had been manufactured, we designed and tested the customized implant which, when secured to the defect glenoid, ensured that surgery could be completed in just one step. We also designed a customized medical instrumentation system which, in conjunction with surgical navigation, resulted in EXCELLENCE IN SURGERY.

Navigable, customized medical instrumentation for the VEGA Surgical Navigator
Navigable, customized medical instrumentation for the VEGA Surgical Navigator
Navigable, customized medical instrumentation for elbows with the VEGA Surgical Navigator

Once surgical planning had been completed, surgery using the PQx Navigator was performed  using customized medical instrumentation and a customized implant manufactured by means of 3D titanium printing. This meant that Dr Amor could achieve absolute EXCELLENCE IN SURGERY with
the utmost guarantees for the patient.

Detail of the final glenoid component with a cemented, customized enlargement

THE RESULT

Post surgery progress was very favorable. Pain was brought rapidly under control and the patient’s mobility has increased progressively. Use of surgical navigation with customized cutting guides, in addition to a customized implant manufactured using 3D printed titanium in order to salvage the glenoid defect (taking into account poor bone quality to employ an autologous graft for reconstruction) translate into a pathology that was resolved in just one surgical intervention and with the assurance that prostheses had been implanted correctly.

Post-surgery X-ray check-up
Mobility 3 months following surgery

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