Does Intraoperative Navigation Improve K-Wire Positioning in Reverse Shoulder Arthroplasty?-A New Approach

Area of Science:

• Orthopedic Surgery
• Medical Device Technology
• Surgical Navigation Systems

Background:

• Precise K-wire positioning is crucial for glenoid component placement in reverse shoulder arthroplasty (RSA) to prevent complications like loosening and implant failure.
• Conventional methods often lack the accuracy needed for patient-specific anatomical conditions, hindering personalized medicine approaches in RSA.
• Intraoperative navigation systems are emerging as tools to enhance accuracy in orthopedic procedures.

Purpose of the Study:

• To compare the accuracy of K-wire positioning using conventional versus navigated methods in a 3D-printed scapula model.
• To evaluate the impact of surgical experience on K-wire positioning accuracy with both methods.

Main Methods:

• Twenty participants (10 experienced surgeons, 10 medical students) performed K-wire drillings on a 3D-printed scapula model.
• Each participant completed two drillings with conventional instruments and two with an intraoperative navigation system (BoneTrack3D).
• Accuracy was measured by assessing the absolute deviation of entry/exit points and the 3D drilling angle.

Main Results:

• The navigated method demonstrated significantly higher accuracy for entry point (1.6 mm vs. 3.0 mm), exit point (1.8 mm vs. 6.7 mm), and drilling angle (2.6° vs. 8.9°) compared to the conventional method (p < 0.001 for all).
• Navigated techniques yielded consistent results irrespective of the participant's surgical experience.
• The navigated method resulted in longer drilling times (100.0 s vs. 55.0 s, p < 0.001).

Conclusions:

• Navigated K-wire positioning in RSA significantly enhances accuracy, enabling precise execution of patient-specific preoperative plans and contributing to personalized medicine.
• Intraoperative navigation may reduce the learning curve for surgeons, increasing accessibility and potentially lowering complication rates.
• While navigation increases procedure time and cost, these factors may be outweighed by improved technical outcomes and reduced long-term complications.