Glenoid component positioning and guidance techniques in anatomic and reverse total shoulder arthroplasty: A systematic review and meta-analysis

Abstract

Positioning of the glenoid component is one of the most challenging steps in shoulder arthroplasty, and prosthesis longevity as well as functional outcomes is considered highly dependent on accurate positioning. This review considers the evidence supporting surgical navigation and patient-specific instruments for glenoid implant positioning in anatomic and reverse total shoulder arthroplasty. A systematic literature search was performed for studies assessing glenoid implant positioning accuracy as measured by cross-sectional imaging on live subjects or cadaver models. Meta-analysis of controlled studies was performed to estimate the primary effects of navigation and patient-specific instruments on glenoid implant positioning error. Meta-analysis of absolute positioning outcomes was also performed for each group incorporating data from controlled and uncontrolled studies. Nine studies, four controlled and five uncontrolled, with 258 total subjects were included in the analysis. Meta-analysis of controlled studies supported that both navigation and patient-specific instruments had a moderate statistically significant effect on improving glenoid implant positioning outcomes. Meta-analysis of absolute positioning outcomes demonstrates glenoid implant positioning with standard instrumentation results in a high rate of malposition. Navigation and patient-specific instruments improve glenoid positioning outcomes. Whether the improvement in positioning outcomes achieved translate to better clinical outcomes is unknown.