Computer navigation re-creates planned glenoid placement and reduces correction variability in total shoulder arthroplasty: an in vivo case-control study.

Abstract

Accurate glenoid component placement is important to prevent glenoid component failure in total shoulder arthroplasty (TSA). Navigation may reduce the variability of glenoid component version and inclination; therefore, the aims of this study were to determine, in patients undergoing TSA, whether computer navigation improved the ability to achieve neutral postoperative version and inclination, as well as achieve the individualized preoperative plan. Patients undergoing TSA using navigation (computer-assisted surgery [CAS], n = 33) or the conventional technique (n = 27) from January 2014 to July 2017 were recruited and compared. Preoperative and postoperative version and inclination, as well as postoperative inferior overhang, were measured using computed tomography scans. The CAS group had more than twice as many augmented glenoid components as the conventional group (45.5% vs. 19.2%). CAS significantly reduced the between-patient variability in postoperative version and led to a greater proportion of components positioned in "neutral" alignment for both inclination and version (P < .015). The incidence of neutral inclination or version postoperatively was significantly higher in the CAS group, and the glenoid was implanted within 5° of the surgical plan in more than 70% of cases, with more than 40% displaying no detectable difference. An integrated system of 3-dimensional surgical planning, augmented glenoid components, and intraoperative navigation may reduce the risk of glenoid placement outside of a neutral position in patients undergoing TSA compared with conventional methods. This study demonstrated the capacity for CAS to replicate the surgical plan in a majority of cases.