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Robotic-Assisted Shoulder Replacement

79 citationsUpdated Oct 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview¶

Robotic-assisted arthroplasty is available for shoulder arthroplasty, and surgeons should become familiar with the technology’s nature, potential benefits and disadvantages, and surgical techniques [1]. The technology is in its infancy, with the Rosa system currently available to selected users and the Mako system expected soon [13]. Interest and utilization of robotic assistance have grown tremendously over the past five years in Europe [54]. While evidence for robotics in total hip and knee arthroplasty demonstrates improved component accuracy and outcomes, no such data currently exist for shoulder arthroplasty [5]. The principal contribution of robotic assistance in shoulder arthroplasty, when framed through tail-risk rather than mean accuracy, lies in risk containment [6]. Robotic-assisted resection is assessed for its ability to enhance precision and alignment with preoperative planning and its impact on bone mineral density at the implant site to contribute to stemless shoulder arthroplasty stability [7]. The integration of preoperative planning software, nonspecific instrumentation, and real-time augmented reality-guided navigation assistance is a promising technology with the potential to improve the execution of shoulder arthroplasty, particularly in challenging cases with severe glenoid deformity [10].

Intraoperative navigation shoulder arthroplasty is safe and produces at least equally good outcomes at 2 years as standard instrumentation without any increased risk of complications [4]. Robotic-assisted arthroplasty is generally safe, with serious complications related more to suboptimal surgical technique than technology [9]. The ROSA system for robotic-assisted reverse total shoulder arthroplasty has the potential to improve implant positioning accuracy compared to free-hand surgery, though future studies are needed to analyze real benefits and long-term patient outcomes [15]. Augmented reality navigation represents a valuable advancement in shoulder arthroplasty, and further prospective studies are warranted to confirm its long-term clinical benefits [17]. Robotic-assisted revision total joint arthroplasty has potential benefits in improving accuracy and outcomes, while gaps in the literature require further high-quality research [23]. Further long-term studies are needed to fully assess the value of computer-assisted navigation and establish best practices for its routine use in shoulder arthroplasty [12].

Robotic-assisted shoulder arthroplasty presents significant challenges related to cost, implant selection, training, and long-term efficacy [3]. The central challenge for robotic-assisted reverse shoulder arthroplasty is whether the technology can reliably deliver value at scale [2]. Robotic assistance in reverse total shoulder arthroplasty is unlikely to be economically justified for routine use when evaluated solely on prevention of early postoperative revision [11]. The adoption of computer-assisted surgical systems for total joint arthroplasty will be heavily influenced by the economic impact on stakeholders, as there are currently mixed financial incentives and no long-term outcome studies demonstrating that navigation lowers revision rates or extends implant durability [25]. One perspective argues that robotics adds cost and learning curve risks without proven clinical benefit for pain, function, or complication reduction, while another argues that robotics may improve precision and reduce revision rates in the long term, though current evidence is limited [21]. Public perceptions of robotic-assisted shoulder arthroplasty in the United States are generally favorable and closely tied to the belief that robotic assistance improves outcomes [8]. Robotic-assisted arthroplasty has a small number and relatively low rate of adverse events reported to the FDA, with rates steadily decreasing over the study period [14]. The RACER trials are multicentre, patient-blinded randomized controlled trials designed to determine if robotic-assisted arthroplasty is clinically superior and cost-effective compared to conventional instruments [32]. Informed consent for robotic-assisted reverse shoulder arthroplasty must address surgeon agency, realistic benefits, workflow implications, and contingency planning to align patient expectations [33].

Anatomy & Pathophysiology¶

Glenoid and Scapular Anatomy¶

The glenoid is a convex structure of shallow depth shaped like an inverted pear [66]. It averages 5° of retroversion relative to the axis of the scapular body [69, 80]. The subchondral bone is relatively flat, with the articular concavity augmented by cartilage and a circumferential labrum [69]. The glenoid articular surface radius of curvature is 2 to 3 mm larger than that of the humeral head [78]. Specific glenoid dimensions include an average inclination of 4.2 degrees (range –7 to 20 degrees) [78], a surface area ranging from 4 to 6 mm [78], cartilage thickness averaging 2.16 mm [78], and a radius of curvature ranging from 22 to 28 mm [78].

The scapula attaches to the axial skeleton via the clavicle through the acromioclavicular and sternoclavicular joints [68]. It is separated from the chest wall by thin gliding fibro-fatty tissue, allowing smooth excursion [68]. Bony mass distribution is highly uneven, with the highest concentration in the glenoid, scapular neck, and lateral border of the scapular body [68]. Two bony pillars transmit compressive forces from the glenoid fossa: the lateral pillar connects the inferior border of the glenoid with the inferior angle, and the spinal pillar arises from the central part of the glenoid to become part of the base of the scapular spine [68]. The weakest bone in the scapula is located primarily in the central part of the biomechanical body, specifically in the infraspinous fossa [68]. The weakest area of the circumference of the biomechanical body is the spinomedial angle, where the scapular spine connects to the medial border [68].

The coracoid process curves forwards from the superior surface of the scapular neck [68]. The acromion is a flattened bony process that curves forwards from the scapular spine [68]. It possesses three ossification centers: the metacromion (base), the mesoacromion (middle), and the preacromion (tip) [69]. Failure of fusion of these centers results in os acromiale [69]. The scapula is anteverted on the chest wall approximately 30 degrees relative to the body [80]. The scapula spans the second through seventh ribs and serves as an attachment for 17 muscles [80].

Evolutionary adaptations in the human scapula include suspension by muscles alone and a caudal shift from the cervical position seen in lower animals [76]. Broadening of the infraspinatus fossa changed the vector of muscle pull from the axillary border to the glenoid fossa, allowing the infraspinatus and teres minor muscles to be more effective as depressors and external rotators of the humeral head [76]. The acromion has enlarged compared to pronograde animals, reflecting the increasing role of the deltoid muscle; its broader attachment and more distal humeral insertion have increased its mechanical advantage in shoulder motion [76]. The coracoid process has increased in size over time, and with the shoulder in 90 degrees of abduction, its extension over the glenohumeral joint mechanically limits anterior translation of the humerus relative to the glenoid [76].

Proximal Humerus Anatomy¶

The proximal humerus comprises four main parts: the humeral head, greater tuberosity (GT), lesser tuberosity (LT), and humeral shaft [66]. The articular head is spherical with a diameter of 37 to 57 mm [66]. The most superior portion of the articular surface averages 8 mm above the GT [66]. The superior margin of the humeral head articular surface is normally superior to the top of the greater tuberosity by 8 to 10 mm [78]. Head height is approximately 5.6 cm above the superior border of the pectoralis major tendon [80].

Humeral version averages 29.8 degrees, with a range of 10 to 55 degrees [66]. Proximal humeral retroversion is highly variable, ranging from 0 to 55 degrees depending on the measurement method [78]. The humeral head is retroverted 30 degrees relative to the transepicondylar axis of the humerus [80]. In healthy adults, humeral head retroversion averages 26 degrees [73], while other sources cite an average of 19° [69] or 30 degrees [67]. In infants and young children, humeral retroversion averages 65 degrees and gradually decreases, approaching adult values by 11 years of age [73].

The head is inclined approximately 130 degrees with respect to the humeral shaft [66]. The average neck-shaft angle is 45 degrees (±5 degrees), with a range of 30 to 50 degrees [78]. Arthritic shoulders have a flatter neck-shaft angle close to 50 degrees [78]. Other measurements report the neck-shaft angle averaging 135 degrees [67] or the head-shaft angle ranging from 30 to 55 degrees [78]. The humeral head averages 41° of inclination (neck-shaft angle) [69].

The bicipital groove lies between the GT and LT and serves as a pathway for the long head of the biceps [66]. The distal aspect of the bicipital groove is internally rotated with respect to the proximal portion [66]. The anatomic neck is located at the junction of the articular surface and the tuberosities [66]. It is directly below the humeral head and serves as an attachment for the shoulder capsule [80]. The surgical neck represents an indistinct region (metadiaphyseal junction) below the tuberosities but above the humeral shaft [66]. It is more distal and more often involved in fractures [80].

The GT serves as the attachment site for the supraspinatus, infraspinatus, and teres minor tendons of the rotator cuff [66]. The LT serves as the attachment site for the subscapularis tendon [66]. The transverse humeral ligament is an important stabilizer of the biceps tendon [80].

The articular surface of the humeral head is essentially spherical, with an arc of approximately 160 degrees covered by articular cartilage [78]. The radius of curvature of the humeral head is approximately 25 mm and is slightly larger in men than in women [78]. Specific ranges include a radius of curvature from 23 to 28 mm, smaller in women than men [78], and a surface area ranging from 11 to 19 mm [78]. Humeral head cartilage thickness averages 1.44 mm [78].

The distance from the lateral base of the coracoid process to the lateral margin of the greater tuberosity is called the lateral humeral offset [78]. A significant decrease in lateral humeral offset reduces the lever arms for the deltoid and supraspinatus muscles, weakening abduction and impairing function [78]. A significant increase in lateral humeral offset causes excessive tension on the soft tissues ("overstuffing" of the joint), resulting in loss of motion and likely accelerating polyethylene wear [78]. Humeral articular malposition of more than 4 mm led to increased subacromial contact [78]. Offset of 8 mm in any direction significantly decreased passive range of motion [78]. Anatomic reconstruction of the humeral head/humeral shaft offset should be within 4 mm of normal to minimize subacromial contact and maximize glenohumeral motion [78]. The medial (coronal) humeral offset ranges from 4 to 14 mm [78]. The posterior (transverse) humeral offset ranges from –2 to 10 mm [78].

The proximal humerus has three centers of ossification: the humeral head (4 to 6 months), the greater tuberosity (1 to 3 years), and the lesser tuberosity (3 to 5 years) [69]. These ossification centers fuse to the shaft at age 17 to 20 years [69]. The proximal humeral physis closes by 14 to 17 years of age in girls and by 16 to 18 years in boys [73]. Eighty percent of subsequent growth of the humerus comes from the proximal humeral physis, accounting for approximately 40% of the growth of the entire upper extremity [73]. The proximal humeral physis is irregularly shaped, with its apex located on the posteromedial portion of the proximal humerus [73]. The periosteum is thicker and stronger in the posteromedial portion of the proximal humerus compared to the anterolateral portion [73].

Vascular Supply and Nerves¶

The proximal humerus receives its blood supply from the anterior and posterior humeral circumflex branches from the third division of the axillary artery [66]. The primary blood supply to the humeral head is through the ascending branch of the anterior humeral circumflex artery (AHCA), which penetrates the head at the bicipital groove and becomes the arcuate artery [67]. The AHCA arises from the axillary artery at the inferior border of the subscapularis [66]. It provides vascular inflow to the humeral head by way of its terminal anterolateral branch known as the artery of Laing (also known as the arcuate artery) [66]. The ascending branch of the AHCA courses parallel to the lateral aspect of the long head biceps tendon and enters the humeral head at the interface of the bicipital groove and GT [66]. It travels proximally in the lateral aspect of the intertubercular groove [69]. The terminal intraosseous portion of the artery enters at the proximal aspect of the intertubercular groove as the arcuate artery [69]. The anterolateral ascending branch of the anterior humeral circumflex artery provides the primary blood supply to the humeral head [69].

The posterior humeral circumflex artery travels with the axillary nerve, enters the quadrilateral space posteriorly, and anastomoses with a branch of the anterior circumflex to supply the posterior cuff [66]. Recent quantitative assessment has shown that 64% of the humeral head blood supply arises from the posterior humeral circumflex artery [73]. This explains the exceedingly low rate of osteonecrosis associated with anterior shoulder dislocations [73]. Injury to the arcuate artery may result in osteonecrosis of the humeral head [66]. Additional extraosseous collateral branches can permit humeral head perfusion despite complete ligation of the arcuate artery [66].

The axillary nerve is a terminal branch coming off the posterior cord of the brachial plexus just proximal to the coracoid process [72]. It passes beneath the conjoined tendon anterior to the subscapularis 3 to 5 mm medial to the musculotendinous junction [72]. The axillary nerve is adjacent to the inferior capsule before entering the quadrilateral space posteriorly [72]. It circles the humeral neck just inferior to the glenohumeral joint as it courses posteriorly [73]. The axillary nerve splits into the anterior and posterior branches within the quadrangular space [72]. The anterior and middle deltoid muscle receives sole innervation from the anterior branch of the axillary nerve [72]. Posterior deltoid muscle innervation varies, with supply only from the anterior branch in 2.3% of cases, from the posterior branch in 8.5%, and from both branches in 89.1% [72]. The posterior branch of the axillary nerve branches to supply the teres minor muscle and then terminates as the superior lateral brachial cutaneous nerve [72].

In the anterior deltopectoral approach, the axillary nerve can be palpated by sweeping a finger inferiorly across the subscapularis muscle tendon interface [72]. In the anterolateral deltoid splitting approach, the axillary nerve crosses approximately 5 cm inferior to the anterolateral acromial corner [72]. Shoulder abduction brings the axillary nerve closer to the acromion landmark [72]. In the posterior deltoid splitting approach, the axillary nerve is approximately 7 cm from the posterior acromial corner [72]. An axillary nerve injury from proximal humeral fracture or fracture-dislocation would result in paralysis of the deltoid muscle and anesthesia over the “badge” region at the lateral proximal arm [67]. The brachial plexus and axillary artery can be injured with anterior shoulder dislocations [67]. The brachial plexus is prone to injury when the proximal humerus is injured in fractures or dislocations, or during traction [73].

The primary blood supply to the clavicle is periosteal; there is no nutrient blood supply [69]. There is no nutrient artery present [75].

Joints and Ligaments¶

The shoulder joint is composed of four articulations: the sternoclavicular, acromioclavicular, glenohumeral, and scapulothoracic [79]. Normal shoulder motion is approximately two-thirds glenohumeral and one third scapulothoracic [69]. The sternoclavicular (SC) joint is the only true diarthrodial articulation between the upper appendicular and axial skeletons [69]. The posterior SC joint capsule and ligaments are the primary stabilizers to anterior and posterior translation of the medial clavicle [69].

The acromioclavicular (AC) joint is a small diarthrodial joint with an interposed fibrocartilaginous disk [69]. The superior and posterior AC ligaments are the primary stabilizers to anterior and posterior (horizontal) translation of the clavicle [69]. The coracoclavicular ligaments (conoid: medial; trapezoid: lateral) are the primary stabilizers to superior (vertical) translation of the distal clavicle [69].

The superior shoulder suspensory complex (SSSC) provides a stable connection between the scapula and the axial skeleton [69]. It is a bone–soft-tissue ring that provides a stable connection of the glenoid and scapula to the clavicle [75]. The SSSC is composed of the glenoid, coracoid process, coracoclavicular ligaments, distal clavicle, AC joint, and acromion [69]. Specifically, it comprises four bony landmarks—distal clavicle, acromion, coracoid process, and glenoid neck—and the supporting ligamentous complexes of the AC joint and the CC ligaments [75].

The glenohumeral joint depends on static and dynamic stabilizers for movement and stability [78]. The rotator cuff stabilizes the glenohumeral joint via joint compression [69]. Static stabilizers of the glenohumeral joint include articular congruity, the glenoid labrum, concavity-compression, negative intra-articular pressure, and the glenohumeral capsule and ligaments [69]. The glenoid labrum provides concavity and up to 50% of marginal glenoid socket depth [69]. The rotator interval is defined medially by the base of the coracoid, superiorly by the supraspinatus tendon, and inferiorly by the subscapularis tendon [69]. The coracoacromial ligament contributes to anterosuperior stability in rotator cuff deficiency and should be preserved with irreparable cuff tears to prevent anterosuperior escape [80]. The acromial branch of the thoracoacromial artery runs on the medial aspect of the coracoacromial ligament [80]. The coracoacromial ligament is the arthroscopic landmark for a complete release of the rotator interval for adhesive capsulitis [80].

Classification¶

Robotic-assisted arthroplasty is available for shoulder arthroplasty, though it presents specific challenges related to cost, implant selection, training, and long-term efficacy [1, 3]. The principal contribution of robotic assistance, when framed through tail-risk, lies in risk containment [6]. Current evidence consistently demonstrates that robotic-assisted arthroplasty improves the precision and reproducibility of component positioning [16]. In reverse total shoulder arthroplasty, computer navigation is more accurate and precise than standard instrumentation for glenoid component placement [19]. Navigated procedures offer an excellent tool for supporting glenoid replacement in total shoulder arthroplasty [22]. The use of intraoperative navigation is safe and produces at least equally good outcomes at 2 years as standard instrumentation without increased risk of complications [4].

Other Considerations: Robotic-assisted resection is assessed for its ability to enhance precision and alignment with preoperative planning and impact bone mineral density at the implant site to contribute to stemless shoulder arthroplasty stability [7]. The integration of preoperative planning software, nonspecific instrumentation, and real-time augmented reality-guided navigation is a promising technology for improving the execution of shoulder arthroplasty in challenging cases with severe glenoid deformity [10]. Augmented reality systems allow real-time visualization of the plan and immediate feedback regarding instrument position and orientation relative to the scapula during reverse shoulder arthroplasty [42]. A navigated augmented reality system through a head-mounted display in reverse shoulder arthroplasty led to low deviations between planned, intraoperative, and postoperative parameters for glenoid component placement [20]. An integrated system of 3-dimensional surgical planning, augmented glenoid components, and intraoperative navigation may reduce the risk of glenoid placement outside of a neutral position in patients undergoing total shoulder arthroplasty compared with conventional methods [40].

Patient-specific implants have emerged as an innovative approach to addressing complex glenoid bone loss cases in reverse shoulder arthroplasty by restoring the native joint line, minimizing bone removal, and providing customized fixation [30]. Patient-specific instrumentation for the glenoid component in reverse shoulder arthroplasty allows the surgeon to accurately execute the pre-operative 3D plan [31]. However, patient-specific instrumentation for total shoulder arthroplasty is not as accurate as it would seem [118]. Mixed-reality navigation was compared to traditional freehand and patient-specific instrumentation techniques for glenoid guide pin insertion during shoulder arthroplasty in an in vitro study [116]. Patient-specific planning information has the greatest impact on the surgical decision-making of low-volume surgeons (those who perform fewer than ten shoulder arthroplasties annually) and brings all surgeons into closer agreement with expert recommendations for glenoid classification and surgical planning [45]. Further large-scale, prospective, randomized, and controlled studies are required to demonstrate the superiority of the patient-specific instrumentation system in shoulder arthroplasty [63].

Image-derived instrumentation in total shoulder arthroplasty is associated with a significantly lower rate of revision compared to non-technologically assisted procedures, with a cumulative percent revision of 4.2% versus 5.2% at seven years postoperatively [65]. Good mid-term clinical results were reported in patients with an anterosuperior glenoid defect undergoing reverse shoulder arthroplasty with a minimum of 5 years of follow-up [24]. Public perceptions of robotic-assisted shoulder arthroplasty in the United States are generally favorable and tied to the belief that robotic assistance improves outcomes [8]. The adoption of computer-assisted surgical systems for total joint arthroplasty is heavily influenced by economic impact on stakeholders, with mixed financial incentives and no long-term outcome studies demonstrating that navigation lowers revision rates or extends implant durability [25]. Robotic assistance in reverse total shoulder arthroplasty is unlikely to be economically justified for routine use when evaluated solely on the prevention of early postoperative revision [11].

Clinical Presentation¶

The clinical presentation of patients undergoing robotic-assisted shoulder replacement is fundamentally shaped by the technological advancements in glenoid component placement. The central challenge for robotic-assisted reverse shoulder arthroplasty is whether this technological innovation can reliably deliver value at scale [2]. When value is framed through tail-risk rather than mean accuracy, the principal contribution of robotic assistance in shoulder arthroplasty lies in risk containment, with potential, although unproven to date, clinical and economic implications [6]. Robotic-assisted arthroplasty is now available for shoulder arthroplasty with some limitations, and shoulder surgeons should become familiar with the nature of this technology, potential benefits and disadvantages, and the surgical techniques employed [1]. The evidence for the use of robotics in total hip and knee arthroplasty demonstrates improved component accuracy and outcomes, and while no such data currently exist for shoulder arthroplasty, robotic-assisted total shoulder arthroplasty is on the horizon of innovation [5].

Navigation and Augmented Reality: The use of intraoperative navigation shoulder arthroplasty is safe and produces at least equally good outcomes at 2 years as standard instrumentation does without any increased risk of complications [4]. Computer navigation was more accurate and more precise than standard instrumentation in its placement of the glenoid component in reversed shoulder arthroplasty [19]. Navigation significantly improves glenoid implantation accuracy, particularly in patients with severe glenoid wear patterns [28]. Augmented reality navigation represents a valuable advancement in shoulder arthroplasty, though further prospective studies are warranted to confirm its long-term clinical benefits [17]. Augmented reality can bypass limited field of view issues in reverse shoulder arthroplasty, improving glenoid component positioning accuracy and potentially increasing functional outcomes, though limitations like inaccurate over-imposition must be addressed before standard usage [44]. While early results for computer-assisted navigation in shoulder arthroplasty are promising, further long-term studies are needed to fully assess its value and establish best practices for its routine use [12].

Patient-Specific Instrumentation: Patient-specific instrumentation for the glenoid component in reverse shoulder arthroplasty allows the shoulder surgeon to accurately execute the pre-operative 3D plan [31]. Patient-specific targeting guides were more accurate than traditional instrumentation and had fewer instances of component malposition for glenoid component placement in a multi-surgeon cadaver study of arthritic shoulders [56]. In a first series to publish comparative mid- to long-term outcomes for patients treated with patient-specific instrumentation, no major differences in clinical and radiological outcomes were observed between patients receiving reverse shoulder arthroplasty with patient-specific instrumentation and patients receiving surgery planned with conventional instrumentation [29]. The information provided by patient-specific planning has the greatest impact on the surgical decision-making of low volume surgeons (those who perform fewer than ten shoulder arthroplasties annually), and patient-specific planning brings all surgeons into closer agreement with the recommendations of experts for glenoid classification and surgical planning [45].

Custom Implants and Controversy: The use of a custom glenoid implant resulted in encouraging clinical and radiographic outcomes, with no failures in implant survivorship seen at early follow-up [18]. A debate exists regarding the role of robotics in reverse shoulder arthroplasty, with one perspective arguing that robotics adds cost and learning curve risks without proven clinical benefit for pain, function, or complication reduction, while the other argues that robotics may improve precision and reduce revision rates in the long term, though current evidence is limited [21].

Investigations¶

Preoperative Imaging and Planning¶

Plain radiography: Standardized plain films are almost always sufficient to garner the information needed for shoulder arthroplasty planning [49]. The primary purpose of imaging the shoulder is to help establish the diagnosis, determine the severity of the pathoanatomy, assist in surgical planning, and enable the surgeon to illustrate the condition of the shoulder to the patient [49].

CT: Computed tomography (CT) is helpful for planning fracture surgery and shoulder joint replacement [83]. CT imaging is frequently used to assess for bony lesions in recurrent instability cases or for preoperative templating for shoulder arthritis [90]. Three-dimensional reconctions can reveal fine details of the shoulder anatomy, but this additional information rarely changes the planning or conduct of the arthroplasty [49]. Consequently, the temptation to “overimage” should be resisted, obtaining only the scans or reconstructions that are necessary for the care of the patient [49].

Other Considerations: Surgical planning using virtual models of patient CT scans and the use of corresponding surface-matched drill guides provides an accurate method of reproducing the surgical plan for glenoid component placement in reverse shoulder arthroplasty [125]. Surgeons have multiple patient-specific instrumentation options available for improving accuracy of glenoid implant placement when compared with 2D imaging without patient-specific instrumentation [58]. The integration of preoperative planning software, nonspecific instrumentation, and real-time AR-guided navigation assistance makes this a promising technology with the potential to improve the execution of shoulder arthroplasty, particularly in challenging cases with severe glenoid deformity [10]. The review evaluates the effectiveness of integrating 3D planning, navigation, PSI, AR, and MR technologies in shoulder arthroplasty for achieving precise implant positioning and assessing their potential benefits in reducing complications and enhancing patient outcomes [61]. The results demonstrate that there were no significant differences between traditional preoperative software planning and MR visualization for guide-pin placement into models of eroded glenoids [119].

The use of intraoperative navigation shoulder arthroplasty is safe, produces at least equally good outcomes at 2 years as standard instrumentation does without any increased risk of complications [4]. The computer-assisted technique was more accurate in achieving the correct version during all phases of glenoid implantation and as measured on the post-implantation CT scan (P < .05) [121]. Use of navigation may increase surgeon confidence despite known limitations of glenoid visualization during this procedure [123]. These data indicate that our navigated procedure offers an excellent tool for supporting glenoid replacement in TSA [22]. This manuscript reviews current literature with regard to importance of anatomic restoration of the glenohumeral joint and how computed tomography-guided navigation can be applied to improve accuracy and reproducibility in total shoulder arthroplasty [46].

Augmented reality–assisted intraoperative navigation increases the precision of glenoid inclination in reverse shoulder arthroplasty compared to preoperative planning alone [41]. The use of a navigated AR system through an HMD in RSA led to low deviations between planned, intraoperative, and postoperative parameters for glenoid component placement [20]. AR navigation represents a valuable advancement in shoulder arthroplasty, and further prospective studies are warranted to confirm its long-term clinical benefits [17]. The paper presents the first 100 navigated bony increased offset reverse shoulder arthroplasties, focusing on the accuracy of glenoid component positioning and outcomes [47].

The study aimed to assess whether robotic-assisted resection enhances precision and alignment with preoperative planning and whether improved accuracy impacts BMD at the implant site, contributing to stemless shoulder arthroplasty stability [7]. The evidence for the use of robotics in total hip and knee arthroplasty demonstrates improved component accuracy and outcomes, and while no such data currently exist for shoulder arthroplasty, robotic-assisted TSA is on the horizon of innovation [5]. The authors present a novel surgical technique utilizing an external guide to create patient-specific bone grafts for addressing glenoid deformity in reverse total shoulder arthroplasty, aiming to improve accuracy over free-hand techniques [39]. The study presents a novel surgical technique using three-dimensional (3D)-printed cutting guides to create a patient-specific bone graft to address glenoid deformity in the setting of reverse shoulder arthroplasty [60].

Safety, Complications, and Economic Considerations¶

The events reported indicate that robotic-assisted arthroplasty is generally safe with serious complications related more to suboptimal surgical technique than technology [9]. Robotic-assisted arthroplasty has a small number and relatively low rate of AEs reported to the FDA, with rates steadily decreasing over the study period [14]. Robotic assistance in rTSA is unlikely to be economically justified for routine use when evaluated solely on prevention of early postoperative revision [11]. Public perceptions of robotic-assisted shoulder arthroplasty were generally favorable and closely tied to the belief that robotic assistance improves outcomes [8].

Long-term Outcomes and Evidence Gaps¶

While early results are promising, further long-term studies are needed to fully assess its value and establish best practices for its routine use in shoulder arthroplasty [12]. In this first series to publish comparative mid- to long-term outcomes for patients treated with PSI, we observed no major differences in clinical and radiological outcomes between patients receiving reverse shoulder arthroplasty with PSI and patients receiving surgery planned with conventional instrumentation [29]. However, the lack of radiographic assessment is a limitation, and further research with longer follow-up is needed to fully define the role of navigation in TSA [34].

Treatment¶

Non-Operative¶

The provided evidence does not detail specific conservative management protocols such as weight loss, physical therapy, or pharmacological interventions.

Operative¶

Indications: Robotic-assisted shoulder arthroplasty is currently in its infancy [13]. The technology is particularly promising for challenging cases involving severe glenoid deformity [10]. Patient-specific implants represent an innovative approach for complex glenoid bone loss in reverse shoulder arthroplasty, designed to restore the native joint line, minimize bone removal, and provide customized fixation [30].

Surgical Approach / Technique: The addition of intraoperative navigation necessitates a larger surgical incision to expose the coracoid process and anterior glenoid neck for tracker placement and proper anatomic landmark registration [114]. A novel surgical technique utilizes an external guide to create patient-specific bone grafts for addressing glenoid deformity in reverse total shoulder arthroplasty, improving accuracy over free-hand techniques [39].

Implant Selection: The Rosa system is currently available to selected users for robot-assisted shoulder arthroplasty [13], while the Mako system is expected to become available soon [13]. An integrated system of 3-dimensional surgical planning, augmented glenoid components, and intraoperative navigation may reduce the risk of glenoid placement outside of a neutral position in total shoulder arthroplasty compared with conventional methods [40].

Alignment / Balancing Strategy: Computer navigation was more accurate and more precise than standard instrumentation for glenoid component placement in reversed shoulder arthroplasty [19]. Robotic assistance improves the reproducibility of planned glenoid baseplate inclination in reverse shoulder arthroplasty [95].

Adjuncts: Surgeons should be familiar with the nature, benefits, disadvantages, and surgical techniques of robotic-assisted arthroplasty [1]. The integration of preoperative planning software, nonspecific instrumentation, and real-time augmented reality-guided navigation is a promising technology for shoulder arthroplasty [10].

Other Considerations: The use of intraoperative navigation for shoulder arthroplasty is safe and produces at least equally good outcomes at 2 years as standard instrumentation without any increased risk of complications [4]. Robotic-assisted arthroplasty is generally safe, with serious complications related more to suboptimal surgical technique than the technology itself [9]. Good mid-term clinical results were reported in patients with an anterosuperior glenoid defect treated with navigated prostheses in a comparative study with a minimum of 5 years of follow-up [24]. Use of a custom glenoid implant for severe glenoid deficiency resulted in encouraging clinical and radiographic outcomes with no failures in implant survivorship seen at early follow-up [18]. Notching and reoperation was more common in non-navigated shoulders than in navigated shoulders, although this difference did not reach statistical significance [117].

Initial reports indicated an increase of approximately 30 minutes in surgical time with navigation in anatomic total shoulder arthroplasty, though subsequent studies have consistently reported lower increases [114]. A study of 749 patients undergoing shoulder arthroplasty with navigation found that surgical time increased by a mean of 10.4 minutes compared to individual surgeons' non-navigated cases [114]. A study of 23 reverse shoulder arthroplasties performed with navigation reported a downward trend in operative time during the first 8 cases, after which a plateau was observed, suggesting a relatively short learning curve [114].

When value is framed through tail-risk rather than mean accuracy, the principal contribution of robotic assistance in shoulder arthroplasty lies in risk containment, with potential but unproven clinical and economic implications [6]. The central challenge for robotic-assisted reverse shoulder arthroplasty is whether the technological innovation can reliably deliver value at scale [2]. Public perceptions of robotic-assisted shoulder arthroplasty in the United States were generally favorable and closely tied to the belief that robotic assistance improves outcomes [8].

While early results for computer-assisted navigation in shoulder arthroplasty are promising, further long-term studies are needed to fully assess its value and establish best practices for routine use [12]. No data currently exist demonstrating improved component accuracy and outcomes for robotic-assisted total shoulder arthroplasty, although such data exist for total hip and knee arthroplasty [5]. Further prospective studies are warranted to confirm the long-term clinical benefits of augmented reality navigation in shoulder arthroplasty [17]. The lack of radiographic assessment is a limitation in single-surgeon experiences with computer navigation, and further research with longer follow-up is needed to fully define the role of navigation in total shoulder arthroplasty [34]. Future studies are needed to analyze the real benefits and long-term patient outcomes of robotic-assisted reverse total shoulder arthroplasty using the ROSA system [15]. A scoping review of robotic-assisted revision total joint arthroplasty highlights potential benefits in improving accuracy and outcomes while identifying gaps in the literature that require further high-quality research [23].

Complications¶

Infection (PJI): In a case series of patient-specific BIO-RSA for glenoid dysplasia, infection was suspected in 1 patient due to shoulder stiffness, but the workup was negative [62].

Aseptic loosening: Glenoid malpositioning in reverse shoulder arthroplasty can lead to impingement, dislocation, and loosening [111]. In a case series of patient-specific BIO-RSA for glenoid dysplasia, postoperative CT scans showed incorporation of the autograft in 95% (43/45) of shoulders, with 2 patients having partial lysis of the graft and no migration or loosening of the baseplate [62]. All glenoid components in a series of patient-specific instrument-assisted structural glenoid bone grafting in reverse shoulder arthroplasty remained well fixed, with no loss of position noted [43].

Instability: Glenoid malpositioning in reverse shoulder arthroplasty can lead to impingement, dislocation, and loosening [111].

Other Considerations: Adverse events reported to the FDA for robotic-assisted arthroplasty are generally safe, with serious complications related more to suboptimal surgical technique than the technology itself [9]. The rate of adverse events reported to the FDA for robotic-assisted arthroplasty is relatively low and has been steadily decreasing over the study period [14]. In a retrospective cohort study of 171 reverse shoulder arthroplasty cases, the overall complication rate within the first 90 days was 5.6% (4/71) in the AR-assisted navigation group compared to 12% (12/100) in the non-navigated group [111]. The difference in complication rates between AR-assisted navigation and non-navigated groups in reverse shoulder arthroplasty was not statistically significant (p .191) [111]. The revision rate within the first 90 days was lower in the AR-assisted navigation group (4/71; 5.6%) compared to the non-navigated group in a retrospective cohort study of reverse shoulder arthroplasty [111]. Intraoperative navigation shoulder arthroplasty does not carry an increased risk of complications compared to standard instrumentation at 2 years [4]. The potential clinical and economic implications of robotic assistance for risk containment in shoulder arthroplasty are unproven to date [6]. A debate exists regarding whether robotics adds cost and learning curve risks without proven clinical benefit for pain, function, or complication reduction, versus the argument that it may improve precision and reduce revision rates in the long term [21]. Current evidence is limited regarding the ability of robotics to reduce revision rates in the long term for reverse shoulder arthroplasty [21]. Augmented reality navigation in shoulder arthroplasty has limitations, including inaccurate over-imposition, which must be addressed before standard usage [44]. The lack of radiographic assessment is a limitation in single-surgeon experiences evaluating the role of navigation in total shoulder arthroplasty [34]. Further long-term studies are needed to fully assess the value and establish best practices for the routine use of computer-assisted navigation in shoulder arthroplasty [12]. The RACER trials are designed to determine if robotic-assisted arthroplasty is clinically superior and cost-effective compared to conventional instruments [32]. Robotic-assisted arthroplasty is in its infancy, with the Rosa system available to selected users and the Mako system expected soon [13]. The evidence for the use of robotics in total hip and knee arthroplasty demonstrates improved component accuracy and outcomes, but no such data currently exist for shoulder arthroplasty [5]. Robotic-assisted reverse total shoulder arthroplasty using the ROSA system has the potential to improve implant positioning accuracy compared to free-hand surgery, though future studies are needed to analyze real benefits and long-term patient outcomes [15]. The adoption of computer-assisted surgical systems for total joint arthroplasty is influenced by economic impact on stakeholders, with no long-term outcome studies demonstrating that navigation lowers revision rates or extends implant durability [25]. In a registry analysis of 7,424 image-derived instrumentation (IDI) cases and 44,896 non-technologically assisted (NTA) primary total shoulder arthroplasties, the cumulative percent revision at seven years was 4.2% for IDI and 5.2% for NTA [65]. The rate of revision was significantly lower in the image-derived instrumentation group compared with the non-technologically assisted group (hazard ratio 0.84, 95% CI 0.73 to 0.98; p = 0.023) [65]. In a randomized controlled trial of image-derived instrumentation versus conventional instrumentation for reverse total shoulder replacement, the Constant-Murley Score at 6 months was 68.56 ± 13.79 for the IDI group and 60.27 ± 16.29 for the non-IDI group (p = .06) [38]. In a randomized controlled trial of image-derived instrumentation versus conventional instrumentation for reverse total shoulder replacement, the American Shoulder and Elbow Surgeons Shoulder Score at 6 months was 78.07 ± 15.96 for the IDI group and 75.29 ± 18.84 for the non-IDI group (p = .58) [38]. In a randomized controlled trial of image-derived instrumentation versus conventional instrumentation for reverse total shoulder replacement, the Oxford Shoulder Score at 6 months was 40.72 ± 5.73 for the IDI group and 38.39 ± 6.57 for the non-IDI group (p = .20) [38]. In a comparative mid- to long-term outcomes study, no major differences in clinical and radiological outcomes were observed between patients receiving reverse shoulder arthroplasty with patient-specific instrumentation and those receiving surgery planned with conventional instrumentation [29]. A meta-analysis indicates that personalized instrumentation does not consistently deliver commensurate clinical benefit, and routine use of patient-specific instrumentation in primary total shoulder arthroplasty cannot be endorsed until further evidence emerges [122]. Robotic assistance in total joint arthroplasty continues to rise in the US, with the greatest interest seen among younger surgeons [52].

Recovery¶

Other Considerations: The provided evidence base does not contain specific data regarding recovery timelines, such as weeks for light activity, months for full activity, or the duration of complete recovery and outcome plateau. Consequently, these phases are omitted from this section to avoid conflating follow-up observation periods with actual recovery milestones.

Available data focuses on comparative outcomes and implant stability at various follow-up intervals. Intraoperative navigation shoulder arthroplasty produces at least equally good outcomes at 2 years as standard instrumentation without any increased risk of complications [4]. Long-term outcomes after reverse shoulder arthroplasty show no major differences in clinical and radiological outcomes between patients receiving patient-specific instrumentation and those receiving surgery planned with conventional instrumentation [29].

Other Considerations: Regarding implant positioning and graft integration, transition to computer-assisted navigation in reverse total shoulder arthroplasty may modestly increase operative time while improving implant positioning including inferior glenoid offset [126]. Postoperative CT scan evaluation of patient-specific BIO-RSA for glenoid dysplasia showed incorporation of the autograft in 95% (43/45) of the shoulders at the latest follow-up [62]. In the patient-specific BIO-RSA cohort, only 2 patients had a partial lysis of the graft, with no migration or loosening of the baseplate [62]. Both patients with partial graft lysis in the patient-specific BIO-RSA cohort had a central long-peg baseplate [62]. In one patient from the patient-specific BIO-RSA cohort, infection was suspected because of some shoulder stiffness, but the workup was negative [62].

Other Considerations: For severe glenoid bone vault deficiencies, GPS-navigated primary reverse total shoulder arthroplasty with bulk humeral head autograft demonstrated significant improvement in range of motion, pain relief, and shoulder function [124]. Early real-world feasibility of robotic-assisted reverse total shoulder arthroplasty is supported, with continued scaling dependent on reducing temporal demand and strengthening workflow reliability while clinical outcome evidence matures [115].

Key Evidence¶

[L5] Robotic-assisted arthroplasty is now available for shoulder arthroplasty with some limitations, and shoulder surgeons should become familiar with the nature of this technology, potential benefits and disadvantages, and the surgical techniques employed. [1] (10.1016/j.xrrt.2025.08.013)
[L5] The central challenge for robotic-assisted reverse shoulder arthroplasty is whether this technological innovation can reliably deliver value at scale. [2] (10.2106/jbjs.25.01537)
[L5] Robotic-assisted shoulder arthroplasty presents significant challenges related to cost, implant selection, training, and long-term efficacy. [3] (10.1016/j.jseint.2024.09.005)
[L3] The use of intraoperative navigation shoulder arthroplasty is safe, produces at least equally good outcomes at 2 years as standard instrumentation does without any increased risk of complications. [4] (10.1016/j.jse.2023.05.021)
[L5] The evidence for the use of robotics in total hip and knee arthroplasty demonstrates improved component accuracy and outcomes, and while no such data currently exist for shoulder arthroplasty, robotic-assisted TSA is on the horizon of innovation. [5] (10.1016/j.jse.2023.04.022)
[L4] When value is framed through tail-risk rather than mean accuracy, the principal contribution of robotic assistance in shoulder arthroplasty lies in risk containment, with potential, although unproven to date, clinical and economic implications. [6] (10.1016/j.jsea.2026.100005)
[Paper] The study aimed to assess whether robotic-assisted resection enhances precision and alignment with preoperative planning and whether improved accuracy impacts BMD at the implant site, contributing to stemless shoulder arthroplasty stability. [7] (10.1016/j.jse.2026.04.013)
[L4] Public perceptions of robotic-assisted shoulder arthroplasty were generally favorable and closely tied to the belief that robotic assistance improves outcomes. [8] (10.1016/j.jse.2026.08.012)
[L4] The events reported indicate that robotic-assisted arthroplasty is generally safe with serious complications related more to suboptimal surgical technique than technology. [9] (10.1016/j.arth.2022.03.060)
[L5] The integration of preoperative planning software, nonspecific instrumentation, and real-time AR-guided navigation assistance makes this a promising technology with the potential to improve the execution of shoulder arthroplasty, particularly in challenging cases with severe glenoid deformity. [10] (10.1016/j.xrrt.2024.01.013)
[L2] Robotic assistance in rTSA is unlikely to be economically justified for routine use when evaluated solely on prevention of early postoperative revision. [11] (10.1016/j.jse.2026.03.010)
[Paper] While early results are promising, further long-term studies are needed to fully assess its value and establish best practices for its routine use in shoulder arthroplasty. [12] (10.3390/jcm14082763)
[L5] Robot-assisted shoulder arthroplasty is in its infancy with the Rosa system available to selected users and the Mako system expected soon. [13] (10.1016/j.jseint.2025.02.004)
[L4] Robotic-assisted arthroplasty has a small number and relatively low rate of AEs reported to the FDA, with rates steadily decreasing over the study period. [14] (10.1016/j.arth.2024.09.005)
[L5] The article describes the surgical technique for robotic-assisted reverse total shoulder arthroplasty using the ROSA system, highlighting its potential to improve implant positioning accuracy compared to free-hand surgery, though future studies are needed to analyze real benefits and long-term patient outcomes. [15] (10.1016/j.xrrt.2026.100708)
[L1] Current evidence consistently demonstrates that robotic-assisted arthroplasty improves the precision and reproducibility of component positioning. [16] (10.2106/jbjs.26.00706)
[L4] AR navigation represents a valuable advancement in shoulder arthroplasty, and further prospective studies are warranted to confirm its long-term clinical benefits. [17] (10.1177/2325967126s00522)
[L4] Use of this custom glenoid resulted in encouraging clinical and radiographic outcomes, with no failures in implant survivorship seen at early follow-up. [18] (10.1177/17585732231200495)
[L5] Computer navigation was more accurate and more precise than standard instrumentation in its placement of the glenoid component in reversed shoulder arthroplasty. [19] (10.1016/j.jse.2010.07.014)
[L4] The use of a navigated AR system through an HMD in RSA led to low deviations between planned, intraoperative, and postoperative parameters for glenoid component placement. [20] (10.1016/j.jse.2024.05.006)
[Paper] The paper presents a debate where one author argues that robotics adds cost and learning curve risks without proven clinical benefit for pain, function, or complication reduction, while the other argues that robotics may improve precision and reduce revision rates in the long term, though current evidence is limited. [21] (10.1097/corr.0000000000003884)
[L5] These data indicate that our navigated procedure offers an excellent tool for supporting glenoid replacement in TSA. [22] (10.3109/10929088.2010.546076)
[L4] This scoping review outlines the current state of robotic-assisted revision total joint arthroplasty, highlighting its potential benefits in improving accuracy and outcomes while identifying gaps in the literature that require further high-quality research. [23] (10.1530/EOR-22-0105)
[L3] The study reports good mid-term clinical results in patients with an anterosuperior glenoid defect. [24] (10.1016/j.jseint.2025.101472)
[L5] The adoption of computer-assisted surgical systems for total joint arthroplasty will be heavily influenced by the economic impact on stakeholders, as there are currently mixed financial incentives and no long-term outcome studies demonstrating that navigation lowers revision rates or extends implant durability. [25] (10.1097/blo.0b013e318154addd)
[L3] Navigation significantly improves glenoid implantation accuracy, particularly in patients with severe glenoid wear patterns. [28] (10.1016/j.jseint.2024.11.009)
[L3] In this first series to publish comparative mid- to long-term outcomes for patients treated with PSI, we observed no major differences in clinical and radiological outcomes between patients receiving reverse shoulder arthroplasty with PSI and patients receiving surgery planned with conventional instrumentation. [29] (10.1016/j.jseint.2025.101456)
[L5] Patient-specific implants have emerged as an innovative approach to addressing complex glenoid bone loss cases in reverse shoulder arthroplasty by restoring the native joint line, minimizing bone removal, and providing customized fixation. [30] (10.1016/j.jseint.2024.12.007)
[L4] Patient-specific instrumentation (PSI) for the glenoid component in reverse shoulder arthroplasty allows the shoulder surgeon to accurately execute the pre-operative 3D plan. [31] (10.1016/j.otsr.2018.01.010)
[L5] The RACER trials are multicentre, patient-blinded randomized controlled trials designed to determine if robotic-assisted arthroplasty is clinically superior and cost-effective compared to conventional instruments. [32] (10.1302/0301-620x.106b2.bjj-2023-0711.r1)
[L5] Informed consent for robotic-assisted reverse shoulder arthroplasty must address surgeon agency, realistic benefits, workflow implications, and contingency planning to align patient expectations. [33] (10.2106/jbjs.26.00325)
[L3] However, the lack of radiographic assessment is a limitation, and further research with longer follow-up is needed to fully define the role of navigation in TSA. [34] (10.5397/cise.2025.00689)
[L1] [38] (10.1016/j.jseint.2023.03.004)
[L4] The authors present a novel surgical technique utilizing an external guide to create patient-specific bone grafts for addressing glenoid deformity in reverse total shoulder arthroplasty, aiming to improve accuracy over free-hand techniques. [39] (10.1177/24715492231219566)
[L3] An integrated system of 3-dimensional surgical planning, augmented glenoid components, and intraoperative navigation may reduce the risk of glenoid placement outside of a neutral position in patients undergoing TSA compared with conventional methods. [40] (10.1016/j.jse.2019.04.037)
[L5] Augmented reality–assisted intraoperative navigation increases the precision of glenoid inclination in reverse shoulder arthroplasty compared to preoperative planning alone. [41] (10.1016/j.jse.2024.05.039)
[L4] The system allows real-time visualization of the plan and immediate feedback regarding instrument position and orientation relative to the scapula. [42] (10.1016/j.eats.2021.12.046)
[L4] All glenoid components remain well fixed, with no loss of position noted. [43] (10.1097/bte.0000000000000123)
[L5] Augmented reality is a novel technique that can bypass limited field of view issues in reverse shoulder arthroplasty, improving glenoid component positioning accuracy and potentially increasing functional outcomes, though limitations like inaccurate over-imposition must be addressed before standard usage. [44] (10.1016/j.xrrt.2023.01.008)
[L4] The information provided by PSP has the greatest impact on the surgical decision-making of low volume surgeons (those who perform fewer than ten shoulder arthroplasties annually), and PSP brings all surgeons in to closer agreement with the recommendations of experts for glenoid classification and surgical planning. [45] (10.1302/0301-620x.102b3.bjj-2019-1153.r1)
[Paper] This manuscript reviews current literature with regard to importance of anatomic restoration of the glenohumeral joint and how computed tomography-guided navigation can be applied to improve accuracy and reproducibility in total shoulder arthroplasty. [46] (10.1097/bte.0000000000000164)
[L4] The paper presents the first 100 navigated bony increased offset reverse shoulder arthroplasties, focusing on the accuracy of glenoid component positioning and outcomes. [47] (10.1016/j.jseint.2024.08.096)
[L4] Robotic assistance in TJA continues to rise in the US, with the greatest interest seen among younger surgeons. [52] (10.1016/j.arth.2025.10.014)
[L4] Interest and utilization of robotic assistance have grown tremendously over the past five years in Europe. [54] (10.1016/j.arth.2025.10.048)
[L5] Patient-specific targeting guides were more accurate than traditional instrumentation and had fewer instances of component malposition for glenoid component placement in this multi-surgeon cadaver study of arthritic shoulders. [56] (10.1016/j.jse.2014.10.013)
[L2] Surgeons have multiple patient-specific instrumentation options available for improving accuracy of glenoid implant placement when compared with 2D imaging without patient-specific instrumentation. [58] (10.2106/jbjs.17.01614)
[L4] The study presents a novel surgical technique using three-dimensional (3D)-printed cutting guides to create a patient-specific bone graft to address glenoid deformity in the setting of reverse shoulder arthroplasty. [60] (10.1177/24715492231162285)
[L4] The review evaluates the effectiveness of integrating 3D planning, navigation, PSI, AR, and MR technologies in shoulder arthroplasty for achieving precise implant positioning and assessing their potential benefits in reducing complications and enhancing patient outcomes. [61] (10.1530/eor-23-0200)
[L4] [62] (10.1016/j.jse.2025.10.010)
[L5] Further large-scale, prospective, randomized, and controlled studies are required to demonstrate the superiority of the PSI system in shoulder arthroplasty. [63] (10.5397/cise.2019.22.1.1)
[L3] [65] (10.1302/0301-620x.107b10.bjj-2025-0193.r1)
[L4] [95] (10.1007/s00264-026-06969-y)
[L3] [111] (10.1016/j.jseint.2025.101537)
[Paper] [114] (10.4055/cios23407)
[L5] These findings support early real-world feasibility of robotic-assisted rTSA and suggest that continued scaling will depend on reducing temporal demand and strengthening workflow reliability while clinical outcome evidence matures. [115] (10.1016/j.jse.2026.05.016)
[L5] [116] (10.1016/j.jse.2024.04.030)
[L3] Notching and reoperation was more common in non-navigated shoulders, but did not reach statistical significance. [117] (10.1016/j.jse.2022.07.007)
[L4] [118] (10.1016/j.jse.2017.07.004)
[L5] The results demonstrate that there were no significant differences between traditional preoperative software planning and MR visualization for guide-pin placement into models of eroded glenoids. [119] (10.5397/cise.2022.01326)
[L5] The computer-assisted technique was more accurate in achieving the correct version during all phases of glenoid implantation and as measured on the post-implantation CT scan (P < .05). [121] (10.1016/j.jse.2009.02.022)
[L5] The meta-analysis provides compelling evidence that personalized instrumentation does not consistently deliver commensurate clinical benefit, and until further evidence emerges, the routine use of PSI in primary total shoulder arthroplasty cannot be endorsed. [122] (10.5397/cise.2025.00423)
[L3] Use of navigation may increase surgeon confidence despite known limitations of glenoid visualization during this procedure. [123] (10.5435/jaaos-d-23-00924)
[L4] Our findings demonstrate significant improvement in ROM, pain relief, and shoulder function following GPS-navigated primary rTSA with bulk humeral head autograft for severe glenoid bone vault deficiencies. [124] (10.1177/17585732251339744)
[L5] Surgical planning using virtual models of patient CT scans and the use of corresponding surface-matched drill guides provides an accurate method of reproducing the surgical plan for glenoid component placement in reverse shoulder arthroplasty. [125] (10.1016/j.jse.2014.01.051)
[L4] Transition to computer-assisted navigation in rTSA may modestly increase operative time while improving implant positioning including inferior glenoid offset. [126] (10.1016/j.xrrt.2026.100718)

References¶

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