Intraoperative computer-assisted navigation is a technology designed to help surgeons apply a preoperative plan to the patient in the operating room. One such system is the ExactechGPS (see this video), which utilizes a stereotaxic tracker attached to the coracoid process and identifies the location of pre-selected points on the glenoid and scapula as references for orienting instruments in the performance of the glenoid arthroplasty.
35 different surgeons contributed cases to this series; the decision to use navigation was left up to the surgeon.
For anatomic arthroplasty 216 shoulders (65 years of age, 50% female, 11 degrees glenoid retroversion, 57% augmented glenoids) had average 31 month outcomes:155 degrees active flexion, SST score 11, Constant score 75, ASES score 87, UCLA score 32, SPADI score 16, SAS score 83. Complications included 1 humeral fracture, 5 glenoid loosening, 1 cuff tear, and 2 unexplained pain. 4 (1.9%) were revised. These outcomes were similar to those in a concurrent series of cases in which the surgeon did not elect to use intraoperative navigation (i.e. the outcomes did not differ by the minimal clinically important difference (MCID)).
For reverse total shoulder arthroplasty 533 shoulders (72 years of age, 56% female, 9 degrees glenoid retroversion, 73% augmented glenoids) 31 month outcomes: 142 degrees active flexion, SST score 10. Constant score 75, ASES score 84, UCLA score 31, SPADI score 22, SAS score 77 Complications included 7 humeral fractures, 3 implant breakage , 1 acromial fracture, 1 coracoid fracture and 1 unexplained pain. 5 (0.9%) were revised. These outcomes were similar to those in a concurrent series of cases in which the surgeon did not elect to use intraoperative navigation (i.e. the outcomes did not differ by the minimal clinically important difference (MCID)).
For the cases in which navigation was used, surgical time was increased by 8-10 minutes.
Comment: This article presents good clinical outcomes for anatomic and reverse total shoulder arthroplasties using intraoperative navigation with minimal complications associated with this technology.
It would be of interest to know the authors' indications for the use of navigation (is it being recommended for use in all arthroplasty cases or only cases with challenging pathoanatomy?). Of note, during the time period of this study, at least twice as many arthroplasties were performed by the authors without navigation as with navigation.
The value of a technological innovation can be measured as the benefit to the patient divided by its costs. Navigation involves substantial additional instrumentation, training and time in addition what is required for non-navigated arthroplasty; these costs are not presented in this publication.
Additional clinical research is needed to determine the degree to which the incremental costs of intraoperative navigation are offset by better patient outcomes.
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
Follow on twitter: https://twitter.com/shoulderarth
Follow on facebook: click on this link
Follow on facebook: https://www.facebook.com/frederick.matsen
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
