JAAOS - 2026-03-15 - Journal Article; Review
Custom Implants and Patient-Specific Instrumentation in Total Shoulder Arthroplasty.
Kurowicki J, Harkin WE, Moran TE, Garrigues GE
Topics
Key Takeaway
Custom implants and patient-specific instrumentation (PSI) in TSA improve glenoid component positioning accuracy in complex anatomy, though clinical outcome superiority over standard implants remains unproven in controlled studies.
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Summary
This narrative review examines indications, principles, and clinical outcomes of 3D-printed custom implants and PSI in primary and revision TSA for patients with complex osseous anatomy. PSI improves glenoid guide pin placement accuracy and reduces version error compared to standard instrumentation, particularly in Walch B2/B3 and Favard E3/E4 glenoid morphologies. Clinical outcome data remain limited by small series and short follow-up, precluding definitive conclusions about functional superiority.
Key Limitation
No controlled comparative outcome data exist demonstrating that PSI- or custom implant-achieved improvements in component positioning translate to superior long-term functional outcomes or reduced revision rates versus standard instrumentation.
Original Abstract
Patients with complex anatomy and osseous deformity undergoing primary and revision total shoulder arthroplasty can pose challenges to surgeons and render off-the-shelf implants insufficient. The advent of three-dimensional printing has enabled the emergence of patient-specific instrumentation and custom implants which offer tailored solutions to address each patient's unique anatomy. This article examines the principles, indications, and clinical outcomes of patient-specific instrumentation and custom implants in total shoulder arthroplasty.