Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA.
Exactech, Gainesville, FL, USA.
J Shoulder Elbow Surg. 2023 Jun;32(6S):S39-S45. doi: 10.1016/j.jse.2022.12.021. Epub 2023 Jan 18.
Preoperative planning software with intraoperative guidance technology is increasingly being used to manage complex glenoid deformity in anatomic total shoulder arthroplasty (TSA) and reverse TSA. The aim of this study was to review the intraoperative efficacy and complications of computer-assisted navigation (CAN) surgery for the treatment of glenoid deformity in TSA.
We performed a retrospective review of all TSAs implanted using a single computer navigation shoulder system. All patients underwent preoperative planning with computed tomography-based preoperative planning software. The starting point on the glenoid and the final version and inclination of the central post (cage) of the glenoid component were reviewed on the intraoperative navigation guidance report and compared with these parameters on the preoperative plan for each patient. The intraoperative accuracy of CAN for glenoid positioning was determined by the deviation of the starting point and final position of the central cage drill in the glenoid compared with the preoperative plan. Data regarding intraoperative complications and the number of times the navigation system was abandoned intraoperatively were collected.
A total of 16,723 anatomic TSAs and reverse TSAs performed worldwide with the aforementioned navigation system were included in this review. In 16,368 cases (98%), every step of the navigation procedure was completed without abandoning use of the system intraoperatively. There was minimal deviation in the intraoperative execution of the preoperative plan with respect to version (0.6° ± 1.96°), inclination (0.2° ± 2.04°), and the starting point on the glenoid face (1.90 ± 1.2 mm). In this cohort, 9 coracoid fractures (0.05%) were reported.
This study demonstrates the safety and efficacy of CAN for glenoid implantation in TSA. Future studies should focus on assessing the impact of CAN on the longevity and survival of glenoid components and improving the cost-effectiveness of this technology.
术前规划软件与术中引导技术越来越多地用于管理解剖全肩关节置换术（TSA）和反式 TSA 中的复杂肩盂畸形。本研究旨在回顾计算机辅助导航（CAN）手术治疗 TSA 中肩盂畸形的术中疗效和并发症。
我们对所有使用单一计算机导航肩部系统植入的 TSA 进行了回顾性研究。所有患者均接受基于 CT 的术前规划软件进行术前规划。术中导航引导报告中回顾了肩盂的起始点和肩盂组件中心柱（cage）的最终版本和倾斜度，并与每位患者的术前计划中的这些参数进行了比较。CAN 用于肩盂定位的术中准确性通过与术前计划相比，中央笼钻头在肩盂中的起始点和最终位置的偏差来确定。收集了术中并发症和导航系统术中放弃次数的数据。
在这项综述中，共纳入了全球范围内使用上述导航系统进行的 16723 例解剖性 TSA 和反式 TSA。在 16368 例（98%）中，导航程序的每一步都在术中完成，没有放弃使用该系统。在术中执行术前计划方面，版本（0.6°±1.96°）、倾斜度（0.2°±2.04°）和肩盂面起始点（1.90±1.2mm）的偏差很小。在该队列中，报告了 9 例喙突骨折（0.05%）。
本研究证明了 CAN 用于 TSA 中肩盂植入的安全性和有效性。未来的研究应侧重于评估 CAN 对肩盂部件的耐久性和存活率的影响，并改善该技术的成本效益。
