Name: Value of VIP™ Surgical Planning System
Uploaded: 2017-10-17T00:00:00Z
Channel: Arthrex
Description: Tim Lenters, MD, (Grand Rapids, MI) presents the value of using the VIP™ surgical planning system.

Arthroplasty Shoulder

<p>Tim Lenters, MD, (Grand Rapids, MI) presents the value of using the VIP™ surgical planning system.</p>

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VPT1-00892-EN | A | Value of VIP™ Surgical Planning System

Tim Lenters

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Value of VIP™ Surgical Planning System

Value has been defined really as really a change in outcome over change in cost of a new technology. So often new technologies do bring higher cost with unknown outcome or change in outcomes. So the value of new technology is often unknown. I think it's our job to sort of prove value of new technologies, and I think we have been able to do that with VIP. So some surgeons may be reluctant to use this, this technology based on experience in total knee. So the total knee literature is pretty clear that use of Sci, it's not more predictable than doing total knee. Without it, it's not faster. There's questionable benefit of survivorship. And then it's led to the question is it worth the added time and cost to use it in total knee. So I think our academy has concluded that it really the answer is no. And have come up with position statements that use of Sci and total knee is neither effective for pain relief, functional outcomes, transfusion or complication rates. And so at least in a total knee, Sci has has poor value. So the question is, should we extrapolate this experience to a use of Sci in the shoulder. And I think there's some key differences between shoulders and knees. So with total knees you have readily available landmarks. You can identify the center of the ankle. You can identify the center of the rotation of the hip. You have the limb axis. And so you have these nice anatomical landmarks where psi really doesn't add value to that. Now in a shoulder, it's a very different situation because you really don't know where that scapular body is. It's there's no way to identify that at the time of surgery. So a situation like this, I mean, this may look like a very straightforward two dimensional deformity, some retroversion on a glenoid. And you may be able to look at that and come up with some sort of a plan in your mind on how you want to correct that. But in reality, the time of surgery, this is what you see. And this, this all of a sudden becomes very complex, three dimensional change and reorienting the anatomy of that glenoid. So you're changing now version and inclination medialization. So this can be very challenging because you really don't know what the axis of the scapula is. The traditional method for restoring version. This was taught to me by my mentor, Doctor Mattson, involves just lining up the glenoid along the glenoid Centerline, which is identified by placing your index finger on the fossa on the front of the front of the scapula. So. And then you just ream along that axis point. Now, in reality, this is highly unreliable. It's not precise. You can have a wide disparity in your actual version that you obtain at the time of surgery. Many of you have probably seen these images where this was published by Doctor Iannotti. So this is experience of surgeons who used either just two dimensional reconstructions of the scapula versus three dimensional models versus three dimensional models with use of glenoid tartar. And you can see how the precision was greatly increased by use of that Sci. In fact, if you if you just use a two dimensional Cat scan and try to do your case, you can have some big errors in version up to 30 degrees in this series of retroversion. So at least from from your planned target to the actual execution of that plan, you can miss large degrees of errors without use of Sci. So why is this important? Well, we know that if you leave implants retroverted and you make these big errors, retroversion is associated with all sorts of factors which can lead to failure of glenoid components. So you'll see osteolysis. You'll see increased shear stresses on the prosthesis. More micro motion is seen. So generally speaking, RetroFusion of more than 15 degrees is problematic. On the other hand, if you ream too much anteriorly, this has also been associated with subsidence and tilting of your components. So air is either way really can be problematic. And CI can help narrow down our target and obtain more accurate execution of our surgical plan. Additionally, there is an effect that that can't be measured. But what I tell patients that have already done their surgery and I show them their surgical plan, they know that I'm really vested in their outcome, and it gains their trust in what I'm doing as a surgeon. And I do think that it leads to a better expectation on their part for what's going to happen with their surgery, and that will improve their outcome. So does Viper add value? I think the answer is yes. We do a better job with positioning of our glenoid. We have already shown enhanced clinical outcomes with those data, and it also gains patient trust in what I am doing. So in summary, I encourage you if you haven't done so already, go make some plans. It really can change your practice. I like Larry, I use this 100% of my cases right now, and I've found incredible value in what I'm doing. So also get an SOS so we can figure out what we're doing if it's working or not. Start making plans.

Value of VIP™ Surgical Planning System

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