Youderian Ari R, Greene Alexander T, Polakovic Sandrine V, Davis Noah Z, Parsons Moby, Papandrea Rick F, Jones Richard B, Byram Ian R, Gobbato Bruno B, Wright Thomas W, Flurin Pierre-Henri, Zuckerman Joseph D
South County Orthopedic Specialists, Laguna Woods, CA, USA.
Exactech, Inc., Gainesville, FL, USA.
J Shoulder Elbow Surg. 2023 Dec;32(12):2519-2532. doi: 10.1016/j.jse.2023.05.021. Epub 2023 Jun 20.
We compared the 2-year clinical outcomes of both anatomic and reverse total shoulder arthroplasty (ATSA and RTSA) using intraoperative navigation compared to traditional positioning techniques. We also examined the effect of glenoid implant retroversion on clinical outcomes.
In both ATSA and RTSA, computer navigation would be associated with equal or better outcomes with fewer complications. Final glenoid version and degree of correction would not show outcome differences.
A total of 216 ATSAs and 533 RTSAs were performed using preoperative planning and intraoperative navigation with a minimum of 2-year follow-up. Matched cohorts (2:1) for age, gender, and follow-up for cases without intraoperative navigation were compared using all standard shoulder arthroplasty clinical outcome metrics. Two subanalyses were performed on navigated cases comparing glenoids positioned greater or less than 10° of retroversion and glenoids corrected more or less than 15°.
For ASTA, no statistical differences were found between the navigated and non-navigated cohorts for postoperative complications, glenoid implant loosening, or revision rate. No significant differences were seen in any of the ATSA outcome metrics besides higher internal and external rotation in the navigated cohort. For RTSA, the navigated cohort showed an ARR of 1.7% (95% CI 0%, 3.4%) for postoperative complications and 0.7% (95% CI 0.1%, 1.2%) for dislocations. No difference was found in the revision rate, glenoid implant loosening, acromial stress fracture rates, or scapular notching. Navigated RTSA patients demonstrated significant improvements over non-navigated patients in internal rotation, external rotation, maximum lifting weight, the Simple Shoulder Test (SST), Constant, and Shoulder Arthroplasty Smart (SAS) scores. For the navigated subcohorts, ATSA cases with a higher degree of final retroversion showed significant improvement in pain, Constant, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), SST, University of California-Los Angeles shoulder score (UCLA), and Shoulder Pain and Disability Index (SPADI) scores. No significant differences were found in the RTSA subcohort. Higher degrees of version correction showed improvement in external rotation, SST, and Constant scores for ATSA and forward elevation, internal rotation, pain, SST, Constant, ASES, UCLA, SPADI, and SAS scores for RTSA.
The use of intraoperative navigation shoulder arthroplasty is safe, produces at least equally good outcomes at 2 years as standard instrumentation does without any increased risk of complications. The effect of final implant position above or below 10° of glenoid retroversion and correction more or less than 15° does not negatively impact outcomes.
我们比较了使用术中导航与传统定位技术的解剖型和反式全肩关节置换术（ATSA和RTSA）的2年临床结果。我们还研究了关节盂植入物后倾对临床结果的影响。
在ATSA和RTSA中，计算机导航将带来同等或更好的结果，并发症更少。最终关节盂角度和矫正程度不会显示出结果差异。
使用术前规划和术中导航共进行了216例ATSA和533例RTSA，至少随访2年。使用所有标准的肩关节置换临床结果指标，对年龄、性别匹配且无术中导航的病例进行随访（2:1）。对导航病例进行了两项亚分析，比较关节盂后倾大于或小于10°以及矫正大于或小于15°的情况。
对于ATSA，在术后并发症、关节盂植入物松动或翻修率方面，导航组与非导航组之间未发现统计学差异。除了导航组的内旋和外旋较高外，ATSA的任何结果指标均未发现显著差异。对于RTSA，导航组术后并发症的绝对风险降低率为1.7%（95%可信区间0%，3.4%），脱位率为0.7%（95%可信区间0.1%，1.2%）。在翻修率、关节盂植入物松动、肩峰应力骨折率或肩胛切迹方面未发现差异。导航RTSA患者在内旋、外旋、最大举重量、简单肩部测试（SST）、Constant评分和肩关节置换智能（SAS）评分方面比非导航患者有显著改善。对于导航亚组，最终后倾程度较高的ATSA病例在疼痛、Constant评分、美国肩肘外科医师协会标准化肩部评估表（ASES）、SST、加利福尼亚大学洛杉矶分校肩部评分（UCLA）和肩部疼痛与功能障碍指数（SPADI）评分方面有显著改善。在RTSA亚组中未发现显著差异。较高的角度矫正程度显示ATSA的外旋、SST和Constant评分有所改善，RTSA的前屈、内旋、疼痛、SST, Constant评分、ASES评分、UCLA评分、SPADI评分和SAS评分有所改善。
术中导航肩关节置换术的使用是安全 的，在2年时产生的结果至少与标准器械一样好，且没有任何并发症风险增加。关节盂后倾10°以上或以下以及矫正大于或小于15°的最终植入物位置对结果没有负面影响。
