Accuracy of patient-specific instrumentation in shoulder arthroplasty: a systematic review and meta-analysis
These authors observe that while there has been a significant recent emphasis on the use of patient-specific instrumentation (PSI) in shoulder arthroplasty, clinical data are lacking to support the increased time and expense associated with these technologies that are increasingly being developed and promoted
These authors observe that while there has been a significant recent emphasis on the use of patient-specific instrumentation (PSI) in shoulder arthroplasty, clinical data are lacking to support the increased time and expense associated with these technologies that are increasingly being developed and promoted
They conducted a systematic review in an attempt to determine whether there was published evidence that PSI significantly improved implantation accuracy or clinical outcomes for total shoulder arthroplasty (TSA).
Their analysis included articles reporting use of any preoperative or intraoperative PSI techniques, models, or guides to assist with TSA prosthesis implantation, including 352 anatomic TSAs and 166 reverses.
Their analysis included articles reporting use of any preoperative or intraoperative PSI techniques, models, or guides to assist with TSA prosthesis implantation, including 352 anatomic TSAs and 166 reverses.
Meta-analysis revealed no significant differences in accuracy between PSI and standard instrumentation.
Comment: As the authors point out, CT based planning systems and PSI are being marketed for TSA in the absence of data on their impact on clinical outcomes, survivorship costs, operative time, production time, and complications (e.g. infection, glenoid fracture).
Fundamentally, we do not know how sensitive clinical outcomes are to glenoid component placement or whether "correction" of glenoid version or inclination makes the arthroplasty more effective or durable.
Beyond these important but unanswered questions, other significant ones also remain unaddressed: if they are shown to be effective, what is the appropriate use of these technologies (which surgeons, which patients, and which diagnoses)?
It would seem that the burden of answering these questions should fall on those promoting and marketing them.
On the topic of computer assistance, here's a recent article from our knee arthroplasty colleagues: A Comparison of Long-Term Outcomes of Computer-Navigated and Conventional Total Knee Arthroplasty A Meta-Analysis of Randomized Controlled Trials
On the topic of computer assistance, here's a recent article from our knee arthroplasty colleagues: A Comparison of Long-Term Outcomes of Computer-Navigated and Conventional Total Knee Arthroplasty A Meta-Analysis of Randomized Controlled Trials
In their meta-analysis of randomized controlled trials with mean follow-up durations of >8 years, they found that while some alignment variables were improved in the computer-navigated total knee arthroplasty group when compared with conventional total knee arthroplasty group, the functional outcomes did not differ significantly between the 2 techniques. There were no differences in the revision rate and the incidence of aseptic loosening.
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