Early experience with force-space navigated robotics for glenoid implantation during total shoulder arthroplasty

Corey D Smith, George S Athwal and Louis M Ferreira*

Purpose: Glenoid replacement is an integral component of Total Shoulder Arthroplasty (TSA); however, glenoid component loosening, and premature wear can result from poor glenoid bone preparation and initial implant placement. Surgical robots have been used in some arthroplasty procedures to improve accuracy, but not in TSA. Moreover, arthroplasty robotics has very low acceptance rates due to increased complexity compared to traditional surgical instrumentation, and difficulty incorporating optical tracking systems into the surgical workflow. This study introduces a novel robot navigation system based on reaction force feedback, and its implementation in TSA.

Methods: Robotic glenoid preparation utilizing Force-Space Navigation was tested against traditional surgical methods in shoulder analogs. Both Walch Type A1 and B2 shoulder models were used, with the B2’s treated with augmented glenoid implants. Implant positioning and orientation for both techniques were compared to pre-operative plans. 

Results: For standard implants in Type A1 glenoids, net placement errors were 1.5 ± 0.5mm and 2.6 ± 2.3° for the robot, and 1.6 ± 0.3mm and 5.0 ± 1.9° for the surgeon. For augmented implants in B2 glenoids, errors were 2.2 ± 0.4mm and 2.9 ± 0.9° for the robot, and 3.0 ± 0.4mm and 4.5 ± 1.5° for the surgeon. Traditional surgical techniques were less accurate in all Cartesian directions with the augmented implant, and less accurate in face rotation with the standard implant. Implant design affected the robot’s accuracy in only the medial-lateral direction, while the surgeon was affected in all three directions, and also in face rotation. 

Conclusion: Robotic glenoid preparation utilizing Force-Space Navigation matched or outperformed traditional methods in most metrics, which demonstrates its viability for TSA. Further validation is needed in cadaveric specimens. 

Keywords:

Published on: Apr 14, 2021 Pages: 1-10

Full Text PDF Full Text HTML DOI: 10.17352/ara.000007
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