Computer navigation in total shoulder arthroplasty : analysis from the Australian Orthopaedic Association National...

Computer navigation is capable of improving the accuracy of glenoid baseplate and screw positioning in shoulder arthroplasty, but there is very limited evidence of its effect on clinical outcomes. In Australia, there is one commonly used total shoulder arthroplasty prosthesis with the option for intraoperative navigation. The aim of this study was to compare revision rates for a single prosthesis design, performed with or without computer navigation.

Data were obtained from a large national arthroplasty registry for all primary stemmed anatomical total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) procedures using a single-design platform prosthesis (SDPP) from 1 June 2011 to 31 December 2022. Procedures were grouped by the use of computer navigation versus no technology assistance. Stemless procedures were excluded. A subgroup analysis included only procedures from 31 January 2017, when computer navigation for this device was first recorded, to enable a time-matched comparison. Further subanalyses assessed outcomes by glenoid morphology (from 2017) and mortality, limited to the first eligible procedure per patient. Kaplan-Meier estimates of survivorship described the time to first revision. Hazard ratios (HRs) from Cox proportional hazard models, adjusted for age and sex, were used to compare revision rates.

There were 5,236 primary total stemmed shoulder arthroplasties, including 680 aTSAs and 4,556 rTSAs. Computer navigation was used in 31.9% (217/680) of aTSA and 50.7% (2,312/4,556) of rTSA cases. Overall, there was no significant difference in revision rates between computer-navigated and non-navigated procedures for aTSA or for rTSA. However, in rTSA cases performed since 2017, navigation was associated with a lower revision rate (entire period, HR 0.71 (95% CI 0.50 to 1.00); p = 0.047). Sub-group analyses by glenoid morphology showed no significant differences. Mortality and early revision data were insufficient for further analysis.

Computer navigation demonstrated a reduction in early to mid-term revision rates compared with standard implantation methods for the SDPP rTSA for time-matched procedures since the technology was introduced in 2017. No evidence of a difference was shown for aTSA. Further evaluation of long-term clinical outcomes and cost-effectiveness is required before computer navigation can be routinely recommended.