Does intraoperative navigation lead to better clinical results for shoulder patients?
Study Question
The Story
While the ability of navigation to improve the accuracy/precision of implant placement is well-documented, the most important question remains: does improved implant placement make a difference in how a patient feels and moves? Youderian and colleagues conducted a large-scale analysis of 749 navigated cases, matching them carefully to a control group of non-navigated patients. They wanted to see if the accuracy/precision afforded by GPS translated into better range of motion, fewer complications, and higher patient satisfaction at a minimum of two years after surgery. By analyzing both anatomic (aTSA) and reverse (rTSA) shoulder arthroplasty patients, the authors aimed to prove whether intraoperative computer navigation is truly a tool for better results or just a technical luxury.
Key Findings
- Superior motion: Both navigated aTSA and rTSA patients achieved significantly higher internal (p=0.003 and <0.001, respectively) and external rotation (p<0.001 and <0.001, respectively) compared to the non-navigated group.
- Improved joint stability after rTSA: Navigated rTSA patients had a significantly lower rate of dislocations compared to non-navigated rTSA (absolute risk reduction 0.7%; 95% CI 0.1%, 1.2%).
- Safe and reproducible: GPS was highly reliable, with a 99.9% completion success rate and no increased risk of complications or revisions, despite its usage in patients with greater glenoid bone loss.
- Efficiency gains: Navigated patients had a significantly shorter hospital length of stay than their non-navigated counterparts (p<0.001, for both aTSA and rTSA comparisons).
- More precise fixation: Navigated rTSA patients received fewer baseplate screws as compared to non-navigated rTSA patients (p<0.001), likely due to real-time visual confirmation of bone stock quality.
| Metric | Navigated rTSA | Non-Navigated rTSA |
|---|---|---|
| Dislocation Rate | 0.0% | 0.7% |
| Hospital Stay (Days) | 1.3 | 1.8 |
| Avg. Baseplate Screws | 3.4 | 3.7 |
Clinical Context
GPS navigation removes the freehand guesswork, allowing for pinpoint accuracy in implant positioning and joint line restoration. This precision likely optimizes the tensioning of the residual rotator cuff and deltoid muscle, which is the primary reason for the superior rotational motion and improved stability observed in this study.
Limitations
These findings are limited by the short-term retrospective analysis of 2-year minimum outcomes, with potential selection bias in the absence of randomization of cases with and without navigation.
Reference for this study: Youderian AR, Greene AT, Polakovic SV, Davis NZ, Parsons M, Papandrea RF, Jones RB, Byram IR, Gobbato BB, Wright TW, Flurin PH, Zuckerman JD. Two-year clinical outcomes and complication rates in anatomic and reverse shoulder arthroplasty implanted with Exactech GPS intraoperative navigation. J Shoulder Elbow Surg. 2023 Dec;32(12):2519-2532. doi: 10.1016/j.jse.2023.05.021.
Other 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.
00.0%
Intra-operative Success Rate
This system is highly reliable and reproducible across both anatomic and reverse procedures.
