Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Department of Orthopaedic Surgery, Denver Shoulder at Western Orthopaedics, Denver, CO, USA.
J Shoulder Elbow Surg. 2024 Aug;33(8):1789-1798. doi: 10.1016/j.jse.2023.12.019. Epub 2024 Feb 5.
Glenoid placement is critical for successful outcomes in total shoulder arthroplasty (TSA). Preoperative templating with three-dimensional imaging has improved implant positioning, but deviations from the planned inclination and version still occur. Mixed-Reality (MR) is a novel technology that allows surgeons intra-operative access to three-dimensional imaging and templates, capable of overlaying the surgical field to help guide component positioning. The purpose of this study was to compare the execution of preoperative templates using MR vs.standard instruments (SIs).
Retrospective review of 97 total shoulder arthroplasties (18 anatomic, 79 reverse) from a single high-volume shoulder surgeon between January 2021 and February 2023, including only primary diagnoses of osteoarthritis, rotator cuff arthropathy, or a massive irreparable rotator cuff tear. To be included, patients needed a templated preoperative plan and then a postoperative computed tomography scan. Allocation to MR vs. SI was based on availability of the MR headset, industry technical personnel, and the templated preoperative plan loaded into the software, but preoperative or intraoperative patient factors did not contribute to the allocation decision. Postoperative inclination and version were measured by two independent, blinded physicians and compared to the preoperative template. From these measurements, we calculated the mean difference, standard deviation (SD), and variance to compare MR and SI.
Comparing 25 MR to 72 SI cases, MR significantly improved both inclination (P < .001) and version (P < .001). Specifically, MR improved the mean difference from preoperative templates (by 1.9° inclination, 2.4° version), narrowed the SD (by 1.7° inclination, 1.8° version), and decreased the variance (11.7-3.0 inclination, 14.9-4.3 version). A scatterplot of the data demonstrates a concentration of MR cases within 5° of plan relative to SI cases typically within 10° of plan. There was no difference in operative time.
MR improved the accuracy and precision of glenoid positioning. Although it is unlikely that 2° makes a detectable clinical difference, our results demonstrate the potential ability for technology like MR to narrow the bell curve and decrease the outliers in glenoid placement. This will be particularly relevant as MR and other similar technologies continue to evolve into more effective methods in guiding surgical execution.
在全肩关节置换术（TSA）中，肩胛盂的位置对于获得成功的结果至关重要。使用三维成像进行术前模板制作已经改善了植入物的定位，但仍会出现与计划倾斜度和版本的偏差。混合现实（MR）是一种新的技术，允许外科医生在手术过程中访问三维成像和模板，能够覆盖手术区域以帮助指导组件定位。本研究的目的是比较使用 MR 与标准仪器（SIs）执行术前模板的情况。
回顾性分析了 2021 年 1 月至 2023 年 2 月期间，一位高容量肩部外科医生进行的 97 例全肩关节置换术（18 例解剖型，79 例反式），包括原发性骨关节炎、肩袖关节炎或巨大不可修复肩袖撕裂的患者。纳入标准为需要有术前模板计划和术后计算机断层扫描的患者。MR 与 SI 的分配基于 MR 耳机、行业技术人员以及加载到软件中的术前模板计划的可用性，但术前或术中患者因素不影响分配决策。由两名独立的、盲目的医生测量术后倾斜度和版本，并与术前模板进行比较。从这些测量值中，我们计算了平均值差、标准差（SD）和方差来比较 MR 和 SI。
在 25 例 MR 与 72 例 SI 病例的比较中，MR 显著改善了倾斜度（P<.001）和版本（P<.001）。具体来说，MR 改善了术前模板的平均差值（倾斜度 1.9°，版本 2.4°），缩小了 SD（倾斜度 1.7°，版本 1.8°），并降低了方差（11.7-3.0 倾斜度，14.9-4.3 版本）。数据的散点图表明，与 SI 病例通常在计划范围内的 10°相比，MR 病例集中在 5°范围内。手术时间没有差异。
MR 提高了肩胛盂定位的准确性和精度。虽然 2°可能不会产生可察觉的临床差异，但我们的结果表明，像 MR 这样的技术有可能缩小钟形曲线并减少肩胛盂放置中的离群值。随着 MR 和其他类似技术继续发展成为更有效的手术执行指导方法，这将尤其重要。
