, Eliminating Intraoperative Indecision  As I look back on my career in orthopedics the journey has not been one that I would have ever predicted. I completed a sports medicine/upper extremity fellowship in orthopaedic surgery in 2002 which gave me the tools I needed at the time to better care for my patients but after 19 years in practice, I have found that one of the most fascinating things about time is that it changes you. Hopefully for the better. I love technology and innovation and one of the most profound advancements in my time in practice has been GPS navigation for shoulder arthroplasty.

In the beginning, my practice was primarily sports medicine and therefore I did a small number of shoulder arthroplasties. My upper extremity focus has grown over the years to include shoulder reconstruction. With increasing volume brings increasing complexity of cases, revisions and new challenges. As I started tackling more and more difficult cases I started asking myself the question “should I be doing these cases” and even more importantly, “are these cases even technically feasible to do?”

In my opinion, the fear of the unknown sometimes drives surgeons to make the decision of whether they can help a patient with surgical intervention. I turned to technology to answer many of the technical questions I didn’t know the answer to such as ‘can I get this implant into this patient’s bone and will it perform as it should to accomplish the task at hand?’

The best solution I could find to help navigate the unknown was GPS as it provides me with critical anatomic measurements needed to answer the question “can this case technically be done” and then I must answer the question of “should I do it?” My first GPS case was on a patient whom I told for years that reverse shoulder arthroplasty was not an option due to extensive bone loss. I was wrong and the case was not only technically doable, but GPS made the case simpler. I quickly gained confidence in the system and began helping patients that otherwise wouldn’t have been helped in my practice prior to having access to GPS.

, Eliminating Intraoperative Indecision  The way I think about shoulder arthroplasty has changed as well. I have found that doing a pre-plan for patients can uncover surprises that happen preoperatively not intraoperatively. It’s such a great comfort to know that I can experiment with different possibilities of implants on a computer-generated model and never touch the patient. I feel more prepared and more confident in every case. Intraoperatively, I also have the ability to make minor deviations from the plan as I see fit with real-time feedback. GPS is time neutral in my hands because it eliminates intraoperative indecision. It also assists in cases of difficult exposure by eliminating guides and wires.

The short-term benefits are obvious: great looking radiographs postoperatively and the confidence that I accurately achieved my plan. I find myself saying, “I would have never gotten to this place (on the glenoid) without using GPS.” Do we need to use it on everyone? At this point it is unclear. I would argue that GPS can make any surgeon more accurate while minimizing the potential for complications and give surgeons peace of mind. You don’t know what you are missing until you try it!