Comparison of patient-specific instrumentation (PSI) versus conventional instrumentation (CI) in shoulder arthroplasties: A Meta-Analysis and Systematic Review.

BACKGROUND

This study evaluates the effectiveness of patient-specific instrumentation (PSI) versus conventional instrumentation (CI) in shoulder arthroplasties. Accurate glenoid component placement is crucial for successful shoulder replacements, and PSI offers the potential to improve this accuracy.

METHODS

Electronic database search of PubMed, Embase, Scopus, Web of Science and Cochrane was performed on April 10, 2024, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for scoping reviews. The searches were conducted using the keywords relating to "shoulder arthroplasty" and "three-dimensional printing". No restrictions were placed on the date of publication.

RESULTS

10 clinical studies involving 4092 patients, comparing PSI and CI were included. The results show that PSI generally improves radiological outcomes, with lower anterior-posterior offset errors, longer screw lengths, and near statistically significant reductions in version, inclination, and superior-inferior offset errors. However, there was no significant difference between PSI and CI in terms of operative duration, complication rates, or short-term patient-reported outcomes such as the Constant Murley Score.

CONCLUSION

While PSI did not significantly reduce short-term complications or alter patient-reported outcomes, it demonstrated a promising potential to enhance glenoid component positioning. Accurate placement of the glenoid component is crucial for long-term success, and PSI may reduce postoperative complications such as glenoid loosening. However, the lack of long-term follow-up in most studies limits the ability to fully assess these benefits.The study also highlights the variability in PSI design and calls for standardized protocols to improve data consistency and accuracy.Longer follow-up studies are recommended to better assess the impact of PSI on long-term outcomes. In conclusion, PSI may improve radiological outcomes without increasing surgical complexity, representing a promising alternative to CI in shoulder arthroplasty.

LEVEL OF EVIDENCE

II.