Comparison of Patient-Specific Instrumentation, Navigation, and Mixed Reality Technologies for Accurate Glenoid Positioning in Reverse Total Shoulder Arthroplasty: A Systematic Review and Meta-Analysis.

Purpose: The aim of this study was to compare the accuracy of glenoid implant positioning achieved using emerging technologies, including patient-specific instrumentation (PSI), surgical navigation (NAV), and mixed reality (MR) in reverse total shoulder arthroplasty (rTSA).

Methods: A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, utilizing the PubMed, Scopus, and EMBASE databases to identify English-language original studies. Studies meeting predefined inclusion and exclusion criteria were selected to evaluate glenoid implant positioning in rTSA using PSI, NAV, and MR techniques. A meta-analysis was performed, incorporating both cadaveric and clinical studies, to analyze radiologic outcomes based on deviations from preoperative planning. Radiologic assessments included comparisons of version, inclination, and entry point offset across techniques. The outcomes of glenoid component positioning were analyzed using a random-effects model with the restricted maximum likelihood estimator.

Results: Out of 2,794 articles identified, 14 met the inclusion criteria for the systematic review. The analysis included both clinical and cadaveric studies for PSI and NAV techniques. PSI and NAV showed reduced deviations in version and inclination compared to the conventional method (CON). Statistical significance was observed only for inclination between PSI and CON (p = 0.030), and for both version and inclination between NAV and CON (all p < 0.001). When comparing PSI and NAV, PSI demonstrated significantly lower deviations in version and inclination (all p < 0.001). For MR, only cadaveric studies were available for analysis. In comparisons between MR and NAV, MR showed significantly lower deviations in version and inclination (all p < 0.001). However, when comparing MR and PSI, mixed results were observed: MR had lower deviations in version and inclination, while PSI showed lower deviations in entry point offset (all p < 0.001).

Conclusion: Both PSI and NAV methods demonstrated improved accuracy compared to the CON method, with PSI showing superior accuracy and smaller deviations than NAV. While limited to cadaveric studies, MR showed greater accuracy than NAV but produced mixed results when compared to PSI. Further clinical studies on MR are needed to validate and generalize these findings.

Level Of Evidence: Basic Science Study; Computer Modeling; Systematic Review.