Technological advancements for surgical planning and intraoperative navigation in elbow arthroplasty: a systematic review

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Background: Due to the complex load transmission across the elbow and the limited systems available for total elbow arthroplasty (TEA), optimal implant positioning, which is crucial for achieving satisfactory functional outcomes and longstanding implant survival, remains challenging. Technological advancements in orthopedic surgery are rapidly evolving, with some of the main goals including improving implant positioning. In contrast to more common arthroplasties, these techniques are rarely described for TEA. The purpose of this review is to assess the current technologies available for TEA and investigate whether these are beneficial for surgical accuracy, functional outcomes, and implant survival. Methods: A systematic search using Embase, Medline, Web of Science, Cochrane, and Google Scholar was used to identify articles investigating the use of novel technologies in surgical planning for TEA. Results: A total of 16 articles, published between 2007 and 2022, were included in this systematic review. Augmented reality, robotic tracking systems, patient-specific instrumentation, and 3-dimensional planning or printing were investigated in a total of 89 patients and 55 cadaver elbows. Compared to conventional methods, implant positioning was significantly improved using these novel technologies with similar short-term functional outcomes. Conclusion: Despite being sparsely investigated, several novel technologies are nowadays available for TEA. These technologies show improved implant positioning following TEA when compared to conventional planning methods. Although superior implant positioning did not directly translate into significantly better clinical outcomes, further investigation of the effect on long-term outcomes and implant survival is needed to assess the potential benefit of these techniques in future TEA.

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