Accuracy of patient-specific instrumentation in shoulder arthroplasty: a systematic review and meta-analysis

Abstract

BackgroundThere has been significant recent emphasis on the use of patient-specific instrumentation (PSI) in shoulder arthroplasty. However, clinical data are lacking to support the increased time and expense associated with PSI. Our purposes were to determine whether PSI significantly improves implantation accuracy during total shoulder arthroplasty (TSA) and to analyze available techniques and correlation with clinical outcomes. We hypothesized that PSI may improve glenoid component position radiographically but without correlation with clinical outcomes.MethodsThe MEDLINE, Scopus, Embase, and Cochrane Library databases were queried. Included articles reported use of any preoperative or intraoperative PSI techniques, models, or guides to assist with TSA prosthesis implantation. The primary outcomes were mean deviation from the preoperative plan in version (in degrees), inclination (in degrees), and entry-point offset on the glenoid (in millimeters).ResultsAmong the included articles, 518 TSA procedures (352 anatomic and 166 reverse) were performed. The mean postoperative errors in both version and inclination angles were 5° or less in 20 articles (90.9%) using PSI. Meta-analysis revealed no statistically significant differences in version error (P > .999, I2 = 64.6%), inclination error (P = .702, I2 = 82.2%), or positional offset (P = .777, I2 = 85.7%) between PSI and standard instrumentation. No data regarding patient-reported outcome measures, range of motion, strength, or glenoid component loosening and longevity were reported.ConclusionsMeta-analysis revealed no significant differences in accuracy between PSI and standard instrumentation. Although PSI may possess the potential to improve TSA techniques, further investigations regarding long-term clinical outcomes, impact on operating room time, and cost-effectiveness are warranted before PSI can be routinely recommended over conventional instrumentation.

Augmented-Reality-Assisted K-Wire Placement for Glenoid Component Positioning in Reversed Shoulder Arthroplasty: A Proof-of-Concept Study

“…Our lab results in this proof-of-concept study compare favourably with published data in conventional surgery [ 17 ].…”

“…Our results cannot be compared directly to studies using PSI for shoulder arthroplasty, but the reported mean postoperative version and inclination errors of 5 • or less compared with preoperative plans [17,18] are equal to our results, which were obtained simply using a see-through device (HoloLens 2). This finding suggests that AR-based aid can be particularly advantageous for novice or low-volume shoulder surgeons.…”

“…Patient specific jig systems are becoming more widely adopted, with many different design strategies in clinical use with varying degrees of radiological measured accuracy. Cabarcas's [17] systematic review of PSI-guided surgery reveals that the results of our pilot study compare favourably with their use.…”

The use of preoperative planning to decrease costs and increase efficiency in the OR

“…Our intervention group (group 1) had a plan that the surgeon used specifically to guide implant selection while operating; it was followed and utilized during surgery, whereas the control group had a plan that was reviewed; however, the surgeon did not use it to guide and restrict the trays or implants that were brought into the OR. All patients underwent a preoperative plan as a standard of care for this surgeon and patients in group 1 were collected from 2018 to 2020; given the published accuracy of 3D templating software 1 , 2 , 3 , 4 , 11 , 12 , 13 to guide addressing pathology and implant selection, the surgeons changed their practice to base the intraoperative plan and implant selection off of the preoperative planning software selections. This practice evolution was applied for all shoulder arthroplasty patients to minimize any bias in patient selection.…”

“… 28 Although limited studies have demonstrated reduced costs for templating software and template-directed instrumentation for total knee replacement, 13 studies have not shown the same cost-effectiveness of using patient-specific instrumentation shoulder arthroplasty procedures. 2 The purpose of our study is to assess how preoperative planning in SA could impact surgical efficiency and intraoperative costs. We hypothesize that, given the accuracy of preoperative planning, it can lead to decreased costs and increased efficiency in the operating room for SA.…”