Daher Mohammad, Parmar Tarishi, Boufadel Peter, Fares Mohamad Y, Khalil Wissam, Horneff John G, Abboud Joseph A, Khan Adam Z
Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Thomas Jefferson Medical Center, Philadelphia, PA, USA.
Division of Shoulder and Elbow Surgery, Department of Orthopedics, University of Pennsylvania, Philadelphia, PA, USA.
Clin Shoulder Elb. 2025 Jun;28(2):129-136. doi: 10.5397/cise.2024.01095. Epub 2025 Apr 30.
The introduction of patient-specific instrumentation (PSI) in total shoulder arthroplasty (TSA) has improved implant positioning accuracy. However, whether PSI yields additional clinical benefit compared to standard instrumentation (SI) in the setting of primary TSA (anatomic and reverse) remains unclear.
PubMed, Cochrane, Embase, and Google Scholar were queried through August 2024. Inclusion criteria consisted of studies that compared PSI to SI in TSA (anatomic and reverse). Key outcomes analyzed included adverse events, patient-reported outcomes, and discrepancies between planned and achieved implant positioning.
Five retrospective studies, three randomized controlled trials, and one prospective study met the inclusion criteria. There was no difference in complications (odds ratio [OR], 1.00; 95% CI, 0.16 to 6.10; P=1.00), reoperation (OR, 1.35; 95% CI, 0.37 to 4.91; P=0.65), American Shoulder and Elbow Surgeons score (mean difference [MD], 1.61; 95% CI, -4.08 to 7.30; P=0.58), Constant-Murley Score (MD, 3.06; 95% CI, -3.68 to 9.81; P=0.37), version error (MD, -0.76; 95% CI, -2.51 to 0.99; P=0.40), and inclination error (MD, -2.89; 95% CI, -5.82 to 0.05; P=0.05) between the two groups.
This study found no significant differences in patient-reported outcomes, complication rates, or implant positioning accuracy between PSI and SI in primary TSA. Future randomized controlled trials comparing these two types of instrumentation would be useful to assess whether a benefit exists for PSI in the setting of primary TSA. Level of evidence: III.
全肩关节置换术（TSA）中引入患者特异性器械（PSI）提高了植入物定位的准确性。然而，在初次TSA（解剖型和反向型）中，与标准器械（SI）相比，PSI是否能带来额外的临床益处仍不清楚。
检索截至2024年8月的PubMed、Cochrane、Embase和谷歌学术。纳入标准包括在TSA（解剖型和反向型）中将PSI与SI进行比较的研究。分析的关键结果包括不良事件、患者报告的结果以及计划植入位置与实际植入位置之间的差异。
五项回顾性研究、三项随机对照试验和一项前瞻性研究符合纳入标准。两组之间在并发症（优势比[OR]，1.00；95%可信区间[CI]，0.16至6.10；P = 1.00）、再次手术（OR，1.35；95%CI，0.37至4.91；P = 0.65）、美国肩肘外科医生评分（平均差异[MD]，1.61；95%CI，-4.08至7.30；P = 0.58）、Constant-Murley评分（MD，3.06；95%CI，-3.68至9.81；P = 0.37）、版本误差（MD，-0.76；95%CI，-2.51至0.99；P = 0.40）和倾斜误差（MD，-2.89；95%CI，-5.82至0.05；P = 0.05）方面没有差异。
本研究发现，在初次TSA中，PSI与SI在患者报告的结果、并发症发生率或植入物定位准确性方面没有显著差异。未来比较这两种器械的随机对照试验将有助于评估在初次TSA中PSI是否具有益处。证据级别：III级。
