Utilization trends of the ExactechGPS® computer-assisted navigation system in total shoulder arthroplasty

Guidance technology in total joint arthroplasty has gained popularity over the last few decades. Computer-assisted navigation (CAN) was recently introduced for glenoid implantation in total shoulder arthroplasty (TSA). However, utilization trends of CAN TSA are not currently known. This study aims to determine the prevalence and trends of CAN usage in TSA from its introduction in 2017 until 2023.

A retrospective review was performed of all TSAs (anatomic TSA [aTSA] or reverse TSA [rTSA]) implanted using a single computer navigation shoulder system (ExactechGPS®; Gainesville, FL). Intraoperative navigation was performed for the glenoid component only. Use of CAN was reported per year to determine trends in the prevalence of CAN cases, number of users, new users, dropped users, high-volume users (>50 CAN cases/year), and the number of cases completed by high-volume users. The data were also stratified by type of TSA (aTSA vs. rTSA) and type of glenoid component used (augmented or nonaugmented).

From 2017 to 2023, navigated TSAs increased from 654 to 9777 cases per year, with a greater increase in navigated rTSA than aTSA volume. The number of CAN cases using augmented implants grew 1435% whereas nonaugmented implants grew 1352%. By 2023, the overall number of CAN users increased from 79 to 667 users. High-volume CAN surgeons increased to 50 users by 2023. Over this period, the number of CAN TSA performed by high-volume surgeons increased more rapidly than the actual number of high-volume surgeons per year.

This study demonstrates an exponential increase in the use of CAN for TSA in the last 8 years. This increase is driven by progressive growth in both the volume of new users and CAN TSAs performed by existing users by several hundred folds. These upward trends in use of guidance technology for TSA are likely to continue in future.