Study Question
How does GPS navigation affect your surgical workflow?
The Story
Surgeons may hesitate to adopt intra-operative computer navigation because of the modified workflow and associated surgical time it takes to use the technology. While computer navigation is proven to improve implant accuracy/precision1-4, the clinical literature offers conflicting reports on whether it actually lengthens the procedure.
To investigate the time required to use GPS navigation, Boux de Casson and colleagues analyzed a massive global dataset of over 40,000 cases performed with GPS over an eight-year span. They measured the time for registration and the time for navigation by surgeon volume, patient anatomy and procedural steps, and identified the specific factors that influence efficiency and how those factors evolve as a surgeon gains experience with the system.
Key Findings
- Fast registration time: The average time to register an anatomic (aTSA) and reverse (rTSA) shoulder arthroplasty was <3 minutes for medium- and high-volume surgeons and <4 minutes for low-volume surgeons.
- Fast navigation time: The average time to navigate an aTSA/rTSA procedure was <8 minutes for aTSA and <11 minutes for rTSA for high-volume surgeons, <10 minutes for aTSA and <16 minutes for rTSA for medium-volume surgeons, and <18 minutes for aTSA and <23 minutes for rTSA for low-volume surgeons.
- Navigation phase is longer for rTSA (mean 15:42 minutes) than for aTSA (mean 10:01 minutes; p<0.001).
- Surgeon volume is a driver of speed: High-volume surgeons were 7:16 minutes faster for aTSA and 13:52 minutes faster for rTSA compared to low-volume surgeons (p<0.001).
- Complex anatomy adds time: Glenoid retroversion greater than 20° and inferior inclination significantly slowed down both the registration and navigation phases.
- Efficiency improves over time: Registration times decreased continuously for all surgeon profiles over the eight-year period, indicating a robust and accessible learning curve.
Clinical Context
The baseline difference in time between aTSA and rTSA exists because rTSA requires more navigated steps, including placement of up to six screws. While complex deformities like high retroversion make the surgery more technically demanding, the study suggests that regular usage translates into speed, making the benefits of precision available without a permanent time difference.
Limitations
These findings are limited because the data is derived from logs of a single navigation system and do not account for total operative time or the time required for tracker placement.
Reference for this study:.
- Boux de Casson F, et al. Intraoperative performance and influencing factors in computer-assisted total shoulder arthroplasty: a large-scale analysis. Sci Rep. 2025 Nov 19;15(1):40685. doi: 10.1038/s41598-025-24124-2.
Additional references:
- Larose G, et al. High intraoperative accuracy and low complication rate of computer-assisted navigation of the glenoid in total shoulder arthroplasty. J Shoulder Elbow Surg. 2023 Jun;32(6S):S39-S45. doi: 10.1016/j.jse.2022.12.021.
- Jones RB, et al. Accuracy and precision of placement of the glenoid baseplate in reverse total shoulder arthroplasty using a novel computer assisted navigation system combined with preoperative planning: A controlled cadaveric study, Seminars in Arthroplasty: JSES, Volume 30, Issue 1, 2020: 73-82. doi.org/10.1053/j.sart.2020.05.004.
- Schoch BS, et al. Computer navigation leads to more accurate glenoid targeting during total shoulder arthroplasty compared with 3-dimensional preoperative planning alone. J Shoulder Elbow Surg. 2020 Nov;29(11):2257-2263. doi: 10.1016/j.jse.2020.03.014.
GPS, Shoulder Planning App and Predict+ are developed by Blue Ortho SAS, an Advita Ortho subsidiary, and distributed by Advita Ortho, LLC.
