Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Orthopedic Surgery, Clínica Universidad de los Andes, Santiago, Chile.
JBJS Rev. 2023 Aug 24;11(8). doi: 10.2106/JBJS.RVW.23.00038. eCollection 2023 Aug 1.
Glenoid baseplate malpositioning during reverse total shoulder arthroplasty can contribute to perimeter impingement, dislocation, and loosening. Despite advances in preoperative planning, conventional instrumentation may lead to considerable inaccuracy in implant positioning unless patient-specific guides are used. Optical navigation has the potential to improve accuracy and precision when implanting a reverse shoulder arthroplasty baseplate. This systematic review aimed to analyze the most recent evidence on the accuracy and precision of glenoid baseplate positioning using intraoperative navigation and its potential impact on component selection and surgical time.
We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The PubMed, Scopus, and EMBASE databases were queried in July 2022 to identify all studies that compared navigation vs. conventional instrumentation for reverse shoulder arthroplasty. Data of deviation from the planned baseplate version and inclination, the use of standard or augmented glenoid components, and surgical time were extracted. Quantitative analysis from the included publications was performed using the inverse-variance approach and Mantel-Haenszel method.
Of the 2,048 records identified in the initial query, only 10 articles met the inclusion and exclusion criteria, comprising 667 shoulders that underwent reverse total shoulder arthroplasty. The pooled mean difference (MD) of the deviation from the planned baseplate position for the clinical studies was -0.44 (95% confidence interval [CI], -3.26; p = 0.76; I2 = 36%) for version and -8.75 (95% CI, -16.83 to -0.68; p = 0.02; I2 = 83%) for inclination, both in favor of navigation. The odds ratio of selecting an augmented glenoid component after preoperative planning and navigation-assisted surgery was 8.09 (95% CI, 3.82-17.14; p < 0.00001; I2 = 60%). The average surgical time was 12 minutes longer in the navigation group (MD 12.46, 95% CI, 5.20-19.72; p = 0.0008; I2 = 71%).
Preoperative planning integrated with computer-assisted navigation surgery seems to increase the accuracy and precision of glenoid baseplate inclination compared with the preoperatively planned placement during reverse total shoulder arthroplasty. The surgical time and proportion of augmented glenoid components significantly increase when using navigation. However, the clinical impact of these findings on improving prosthesis longevity, complications, and patient functional outcomes is still unknown.
Level III, systematic review and meta-analysis. See Instructions for Authors for a complete description of levels of evidence.
反式全肩关节置换术中肩盂基底部位置不当会导致周界撞击、脱位和松动。尽管术前规划有了进步，但如果不使用患者特异性导向器，传统器械可能会导致植入物定位的相当大的不准确。光学导航在植入反式肩关节置换基底部时具有提高准确性和精度的潜力。本系统评价旨在分析术中导航定位肩盂基底部的最新准确性和精确性证据及其对假体选择和手术时间的潜在影响。
我们按照系统评价和荟萃分析的首选报告项目标准进行了系统评价。2022 年 7 月，我们对 PubMed、Scopus 和 EMBASE 数据库进行了查询，以确定所有比较反向肩关节置换术导航与常规器械的研究。提取了与计划的基底部版本和倾斜度的偏差、标准或增强型肩盂组件的使用以及手术时间的数据。使用逆方差法和 Mantel-Haenszel 法对纳入文献进行定量分析。
在最初的查询中，共确定了 2048 条记录，只有 10 篇文章符合纳入和排除标准，包括 667 例接受反式全肩关节置换术的患者。临床研究中从计划基底部位置的偏差的汇总平均差（MD）为 -0.44（95%置信区间 [CI]，-3.26;p=0.76;I2=36%）用于版本，-8.75（95% CI，-16.83 至 -0.68;p=0.02;I2=83%）用于倾斜度，两者均有利于导航。术前规划和导航辅助手术时选择增强型肩盂组件的优势比为 8.09（95%CI，3.82-17.14;p<0.00001;I2=60%）。导航组的平均手术时间延长了 12 分钟（MD 12.46，95%CI，5.20-19.72;p=0.0008;I2=71%）。
与反式全肩关节置换术中术前计划的放置相比，术前规划与计算机辅助导航手术相结合似乎可以提高肩盂基底部倾斜的准确性和精度。使用导航时，手术时间和增强型肩盂组件的比例显著增加。然而，这些发现对改善假体寿命、并发症和患者功能结局的临床影响仍不清楚。
III 级，系统评价和荟萃分析。请参阅作者指南以获取证据水平的完整描述。
