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Benefit of intraoperative navigation on glenoid component positioning during total shoulder arthroplasty

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The objective of this study was to review and synthesize the current best evidence for the use of intraoperative navigation in the implantation of glenoid components in total shoulder prostheses.

Methods

We conducted a systematic, online search using PubMed, EMBASE, CCTR, and CINAHL using “Arthroplasty, Replacement”(Mesh) AND (shoulder) AND (navi* OR computer). Data on study design and quality as well as accuracy of positioning and complications were extracted independently and in duplicate. After assessment of study heterogeneity, DerSimonian-Laird random effect models were used to pool data from the individual studies.

Results

The systematic search revealed 359 manuscripts in total. After exclusion of duplicates and irrelevant publications, 6 groups of 247 shoulders from 5 studies were included. The pooled weighted mean difference for deviation from neutral version was −6.4° (95 %CI −7.9 to −5.3) in favor of navigation, which is consistent with a statistically significant difference (p < 0.01). In the navigation group, 2 superior glenoid screws were reported as perforating compared to 5 screws (1 inferior, 4 superior) in the control group. There was no difference in tilt at a WMD of 2.7 (95 %CI −1.4 to 6.8, p = 0.192).

Conclusions

Navigation allows for significantly more accurate glenoid version, but the clinical meaningfulness of the absolute improvement over standard techniques is questionable. However, navigation is a valuable teaching tool that might prove very beneficial not for the patient at hand, but for those treated by the operating surgeon in the future.

Level of evidence

Level II—meta-analysis of non-homogenous controlled trials.

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References

  1. Bauwens K, Matthes G, Wich M, Gebhard F, Hanson B, Ekkernkamp A et al (2007) Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am 89:261–269. doi:10.2106/JBJS.F.00601

    Article  PubMed  Google Scholar 

  2. Boileau P, Avidor C, Krishnan SG, Walch G, Kempf JF, Mole D (2002) Cemented polyethylene versus uncemented metal-backed glenoid components in total shoulder arthroplasty: a prospective, double-blind, randomized study. J Shoulder Elb Surg 11:351–359. doi:10.1067/mse.2002.125807

    Article  Google Scholar 

  3. Briem D, Ruecker AH, Neumann J, Gebauer M, Kendoff D, Gehrke T, Lehmann W, Schumacher U, Rueger JM, Grossterlinden LG (2011) 3D fluoroscopic navigated reaming of the glenoid for total shoulder arthroplasty (TSA). Comput Aided Surg 16(2):93–99. doi:10.3109/10929088.2010.546076

    Article  PubMed  Google Scholar 

  4. Bryant D, Litchfield R, Sandow M, Gartsman GM, Guyatt G, Kirkley A (2005) A comparison of pain, strength, range of motion, and functional outcomes after hemiarthroplasty and total shoulder arthroplasty in patients with osteoarthritis of the shoulder. A systematic review and meta-analysis. J Bone Joint Surg Am 87:1947–1956. doi:10.2106/JBJS.D.02854

    Article  PubMed  Google Scholar 

  5. Castagna A, Randelli M, Garofalo R, Maradei L, Giardella A, Borroni M (2010) Mid-term results of a metal-backed glenoid component in total shoulder replacement. J Bone Joint Surg Br 92:1410–1415. doi:10.1302/0301-620X.92B10.23578

    Article  CAS  PubMed  Google Scholar 

  6. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  PubMed  Google Scholar 

  7. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Gregory TM, Sankey A, Augereau B, Vandenbussche E, Amis A, Emery R et al (2013) Accuracy of glenoid component placement in total shoulder arthroplasty and its effect on clinical and radiological outcome in a retrospective, longitudinal, monocentric open study. PLoS One 8:e75791. doi:10.1371/journal.pone.0075791

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Hart ND, Clark JC, Wade Krause FR, Kissenberth MJ, Bragg WE, Hawkins RJ (2012) Glenoid screw position in the Encore Reverse Shoulder Prosthesis: an anatomic dissection study of screw relationship to surrounding structures. J Shoulder Elb Surg 22:814–820. doi:10.1016/j.jse.2012.08.013

    Article  Google Scholar 

  10. Hoenecke J, Heinz R, Hermida JC, Dembitsky N, Patil S, D’Lima DD (2008) Optimizing glenoid component position using three-dimensional computed tomography reconstruction. J Shoulder Elb Surg 17:637–641. doi:10.1016/j.jse.2007.11.021

    Article  Google Scholar 

  11. Iorio R, Mazza D, Bolle G, Conteduca J, Redler A, Conteduca F et al (2013) Computer-assisted surgery: a teacher of TKAs. Knee 20:232–235. doi:10.1016/j.knee.2012.06.009

    Article  CAS  PubMed  Google Scholar 

  12. Jadad AR, Cook DJ, Jones A, Klassen TP, Tugwell P, Moher M et al (1998) Methodology and reports of systematic reviews and meta-analyses: a comparison of Cochrane reviews with articles published in paper-based journals. JAMA 280:278–280

    Article  CAS  PubMed  Google Scholar 

  13. Kircher J, Wiedemann M, Magosch P, Lichtenberg S, Habermeyer P (2009) Improved accuracy of glenoid positioning in total shoulder arthroplasty with intraoperative navigation: a prospective-randomized clinical study. J Shoulder Elb Surg 18:515–520. doi:10.1016/j.jse.2009.03.014

    Article  Google Scholar 

  14. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100. doi:10.1371/journal.pmed.1000100

    Article  PubMed Central  PubMed  Google Scholar 

  15. Litchfield RB, McKee MD, Balyk R, Mandel S, Holtby R, Hollinshead R et al (2011) Cemented versus uncemented fixation of humeral components in total shoulder arthroplasty for osteoarthritis of the shoulder: a prospective, randomized, double-blind clinical trial-A JOINTs Canada Project. J Shoulder Elb Surg 20:529–536. doi:10.1016/j.jse.2011.01.041

    Article  Google Scholar 

  16. Love GJ, Kinninmonth AW (2013) Training benefits of computer navigated total knee arthroplasty. Knee 20:236–241. doi:10.1016/j.knee.2012.09.012

    Article  PubMed  Google Scholar 

  17. Mason JB, Fehring T, Fahrbach K (2007) Navigated total knee replacement. J Bone Joint Surg Am 89:2547–2548 (discussion 48–50. 89/11/2547-a pii)

    PubMed  Google Scholar 

  18. Matsen FA 3rd, Clinton J, Lynch J, Bertelsen A, Richardson ML (2008) Glenoid component failure in total shoulder arthroplasty. J Bone Joint Surg Am 90:885–896. doi:10.2106/JBJS.G.01263

    Article  PubMed  Google Scholar 

  19. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535

    Article  PubMed Central  PubMed  Google Scholar 

  20. Molony DC, Cassar Gheiti AJ, Kennedy J, Green C, Schepens A, Mullett HJ (2011) A cadaveric model for suprascapular nerve injury during glenoid component screw insertion in reverse-geometry shoulder arthroplasty. J Shoulder Elb Surg 20:1323–1327. doi:10.1016/j.jse.2011.02.014

    Article  Google Scholar 

  21. Moska M, Duckworth D, Matsen F (1998) Contrasting the position of prosthetic joint surfaces in successful and failed shoulder arthroplasties. In: 7th International Congress on Shoulder Surgery, Sydney

  22. Nguyen D, Ferreira LM, Brownhill JR, King GJ, Drosdowech DS, Faber KJ et al (2009) Improved accuracy of computer assisted glenoid implantation in total shoulder arthroplasty: an in vitro randomized controlled trial. J Shoulder Elb Surg 18:907–914. doi:10.1016/j.jse.2009.02.022

    Article  Google Scholar 

  23. Papadonikolakis A, Neradilek MB, Matsen FA 3rd (2013) Failure of the glenoid component in anatomic total shoulder arthroplasty: a systematic review of the English-language literature between 2006 and 2012. J Bone Joint Surg Am 95:2205–2212. doi:10.2106/JBJS.L.00552

    Article  PubMed  Google Scholar 

  24. Schnurr C, Eysel P, Konig DP (2011) Do residents perform TKAs using computer navigation as accurately as consultants? Orthopedics 34:174. doi:10.3928/01477447-20110124-05

    PubMed  Google Scholar 

  25. Stübig T, Petri M, Zeckey C, Hawi N, Krettek C, Citak M et al (2013) 3D navigated implantation of the glenoid component in reversed shoulder arthroplasty. Feasibility and results in an anatomic study. Int J Med Robot Comput Assist Surg 9:480–485. doi:10.1002/rcs.1519

    Article  Google Scholar 

  26. Vavken P, Dorotka R Modeling the “minimally invasive surgery effect” in total joint replacement. Surgical Innovation 2011 (ahead of print)

  27. Vavken P, Dorotka R (2011) The prevalence and effect of publication bias in orthopaedic meta-analyses. J Orthop Sci. doi:10.1007/s00776-011-0040-8

    PubMed  Google Scholar 

  28. Vavken P, Sadoghi P, von Keudell A, Rosso C, Valderrabano V, Muller AM (2013) Rates of radiolucency and loosening after total shoulder arthroplasty with pegged or keeled glenoid components. J Bone Joint Surg Am 95:215–221. doi:10.2106/JBJS.L.00286

    Article  PubMed  Google Scholar 

  29. Verborgt O, De Smedt T, Vanhees M, Clockaerts S, Parizel P, Van Glabbeek F (2011) Accuracy of placement of the glenoid component in reversed shoulder arthroplasty with and without navigation. J Shoulder Elb Surg 20:21–26. doi:10.1016/j.jse.2010.07.014

    Article  Google Scholar 

  30. Wang J, Singh A, Higgins L, Warner J (2010) Suprascapular neuropathy secondary to reverse shoulder arthroplasty: a case report. J Shoulder Elb Surg 19:e5–e8. doi:10.1016/j.jse.2009.10.004

    Article  Google Scholar 

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Acknowledgments

This project was funded by the “Forschungsförderung 2012” of the Association for Orthopaedic Research (AFOR).

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria

    Patrick Sadoghi & Andreas Leithner

  2. Department of Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland

    Julia Vavken & Patrick Vavken

  3. Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Patrick Vavken

  4. Harvard Center for Population and Development Studies, Harvard School of Public Health, Boston, MA, USA

    Patrick Vavken

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  1. Patrick Sadoghi
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Correspondence to Patrick Sadoghi.

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Sadoghi, P., Vavken, J., Leithner, A. et al. Benefit of intraoperative navigation on glenoid component positioning during total shoulder arthroplasty. Arch Orthop Trauma Surg 135, 41–47 (2015). https://doi.org/10.1007/s00402-014-2126-1

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