Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
J Shoulder Elbow Surg. 2023 Oct;32(10):2161-2171. doi: 10.1016/j.jse.2023.04.022. Epub 2023 May 30.
BACKGROUND: Total shoulder arthroplasty (TSA) has been rapidly evolving over the last several decades, with innovative technological strategies being investigated and developed in order to achieve optimal component precision and joint alignment and stability, preserve implant longevity, and improve patient outcomes. Future advancements such as robotic-assisted surgeries, augmented reality, artificial intelligence, patient-specific instrumentation (PSI) and other peri- and preoperative planning tools will continue to revolutionize TSA. Robotic-assisted arthroplasty is a novel and increasingly popular alternative to the conventional arthroplasty procedure in the hip and knee but has not yet been investigated in the shoulder. Therefore, the purpose of this study was to conduct a narrative review of the literature on the evolution and projected trends of technological advances and robotic assistance in total shoulder arthroplasty. METHODS: A narrative synthesis method was employed for this review, rather than a meta-analysis or systematic review of the literature. This decision was based on 2 primary factors: (1) the lack of eligible, peer-reviewed studies with high-quality level of evidence available for review on robotic-assisted shoulder arthroplasty, and (2) a narrative review allows for a broader scope of content analysis, including a comprehensive review of all technological advances-including robotics-within the field of TSA. A general literature search was performed using PubMed, Embase, and Cochrane Library databases. These databases were queried by 2 independent reviewers from database inception through November 11, 2022, for all articles investigating the role of robotics and technology assistance in total shoulder arthroplasty. Inclusion criteria included studies describing "shoulder arthroplasty" and "robotics." RESULTS: After exclusion criteria were applied, 4 studies on robotic-assisted TSA were described in the review. Given the novelty of this technology and limited data on robotics in TSA, these studies consisted of a literature review, nonvalidated experimental biomechanical studies in sawbones models, and preclinical proof-of-concept cadaveric studies using prototype robotic technology primarily in conjunction with PSI. The remaining studies described the technological advancements in TSA, including PSI, computer-assisted navigation, artificial intelligence, machine learning, and virtual, augmented, and mixed reality. Although not yet commercially available, robotic-assisted TSA confers the theoretical advantages of precise humeral head cuts for restoration of proximal humerus anatomy, more accurate glenoid preparation, and improved soft-tissue assessment in limited early studies. CONCLUSION: The evidence for the use of robotics in total hip arthroplasty and total knee arthroplasty demonstrates improved component accuracy, more precise radiographic measurements, and improved early/mid-term patient-reported and functional outcomes. Although no such data currently exist for shoulder arthroplasty given that the technology has not yet been commercialized, the lessons learned from robotic hip and knee surgery in conjunction with its rapid adoption suggests robotic-assisted TSA is on the horizon of innovation. By achieving a better understanding of the past, present, and future innovations in TSA through this narrative review, orthopedic surgeons can be better prepared for future applications.
背景:在过去几十年中,全肩关节置换术(TSA)发展迅速,为了实现最佳的假体精度和关节对线与稳定性、延长假体寿命并改善患者预后,人们研究并开发了创新性的技术策略。未来的进步,如机器人辅助手术、增强现实、人工智能、患者特异性器械(PSI)和其他围手术期规划工具,将继续彻底改变 TSA。机器人辅助关节置换术是一种新颖且日益流行的替代传统髋关节和膝关节置换术的方法,但尚未在肩部进行研究。因此,本研究旨在对全肩关节置换术中技术进步和机器人辅助的文献进行叙述性综述,探讨其演变和预期趋势。
方法:本综述采用叙述性综合方法,而不是对文献进行荟萃分析或系统综述。这一决定基于两个主要因素:(1)可用于回顾的、具有高质量证据水平的、关于机器人辅助肩部关节置换术的合格、同行评审研究较少;(2)叙述性综述允许更广泛的内容分析范围,包括对 TSA 领域内所有技术进步(包括机器人技术)的全面回顾。通过 2 位独立审查员从数据库建立开始到 2022 年 11 月 11 日,使用 PubMed、Embase 和 Cochrane 图书馆数据库进行了一般文献检索,以检索所有探讨机器人和技术辅助在全肩关节置换术中作用的文章。纳入标准包括描述“肩关节置换术”和“机器人”的研究。
结果:应用排除标准后,本综述共描述了 4 项关于机器人辅助 TSA 的研究。鉴于该技术的新颖性和 TSA 中机器人技术的数据有限,这些研究包括文献综述、在仿骨模型中进行的未经验证的实验生物力学研究以及使用原型机器人技术的初步临床前尸体研究,主要与 PSI 联合使用。其余研究描述了 TSA 中的技术进步,包括 PSI、计算机辅助导航、人工智能、机器学习以及虚拟、增强和混合现实。虽然尚未商业化,但机器人辅助 TSA 在早期研究中具有理论优势,包括精确的肱骨头截骨以恢复肱骨头解剖结构、更精确的肩胛骨关节盂准备以及改善软组织评估。
结论:在全髋关节置换术和全膝关节置换术中使用机器人的证据表明,假体精度提高,影像学测量更精确,早期/中期患者报告和功能结果改善。由于该技术尚未商业化,因此尚无关于肩部关节置换术的此类数据,但从机器人髋关节和膝关节手术中吸取的经验教训及其快速采用表明,机器人辅助 TSA 即将创新。通过本叙述性综述更好地了解 TSA 过去、现在和未来的创新,矫形外科医生可以为未来的应用做好更好的准备。
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