Monday, June 29, 2020

Is Preoperative Three-Dimensional Planning and Intraoperative Navigation of Shoulder Arthroplasty of Value?

The Impact of Preoperative Three-Dimensional Planning and Intraoperative Navigation of Shoulder Arthroplasty on Implant Selection and Operative Time: A Single Surgeon’s Experience

These authors assessed the impact of preoperative 3D planning on the surgeon’s selection of the glenoid component (standard versus augmented) and compare duration of surgery with and without intraoperative navigation in 200 patients who underwent shoulder arthroplasty. 
The first group of 100 patients underwent shoulder arthroplasty utilizing standard 2D preoperative planning based on standard radiographs and CT scans. 
The second group of 100 patients underwent shoulder arthroplasty utilizing 3D preoperative planning and intraoperative navigation. 
For the group of patients with standard preoperative planning, only 15 augmented glenoid components were utilized while in the group of patients with 3D preoperative planning and navigation 54 augments were used. 
The operative time was 11 minutes longer for the procedures that used intraoperative navigation, compared to those that did not.

Comment: While this study showed that the surgeon's choice of implant was affected by the use of preoperative three-dimensional planning and intraoperative navigation of shoulder arthroplasty, it does not show that this effect benefitted the patient in that clinical outcome and survivorship data were not presented. As the authors state, "Since 3D planning and  intraoperative navigation is more costly than 2D planning, and augmented glenoid components are more costly than standard glenoid components, the cost-benefit of these changes with  respect mid-term and long-term clinical outcomes and implant survival has not been ascertained."

Data from the Australian Orthopaedic Association registry, shows that the 10 year revision rate for cross-linked all-polyethylene components inserted without preoperative three-dimensional planning, intraoperative navigation, or augmented glenoid components is below 5% (see below). One must ask "How likely is it that these more expensive technologies will lead to better outcomes than these?"


To see a YouTube on how we do total shoulder arthroplasty with an emphasis on glenoid preparation, click on this link.


To see our new series of youtube videos on important shoulder surgeries and how they are done, click here.

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