Concordance of Preoperative 3D Templating in Stemless Anatomic Total Shoulder Arthroplasty

Rechenmacher, Albert J.; Goltz, Daniel E.; Wickman, John R.; Levin, Jay M.; Schappe, Tyler; Green, Cynthia L.; Klifto, Christopher S.; Lassiter, Tally; Anakwenze, Oke

doi:10.5435/jaaos-d-22-00309

Cited by 5 publications

(8 citation statements)

References 31 publications

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“…We found that only 61.2% of surgeons’ predictions matched with surgical data, though decision concordance for glenoid-related parameters was significantly higher than for the humeral side. Our findings were considerably lower than previously reported for aTSA [ 10 - 12 , 14 ]. Raiss et al, in a study examining concordance between preoperative planning and implanted glenoid components, reported 85% complete concordance between planned and implanted glenoids [ 10 ].…”

Section: Discussioncontrasting

confidence: 99%

“…Regarding glenoid size, 61% were concordant with a plan in our study with all discordant cases within one size. The range of deviation of the discordant glenoid sizes in our study was similar to that of Rechenmacher et al [ 12 ]. Our study differed from that of Raiss et al in that we re-planned our cases at least six months following the actual procedure to minimize the bias inherent in performing the surgery based on adhering to the surgical plan.…”

Section: Discussionsupporting

confidence: 91%

“…Computerized planning software that utilizes a preoperative CT scan has recently become popularized for both aTSA and rTSA [9][10][11][12]17]. Posteriorly augmented glenoid components are used to correct glenoid retroversion or erosion while preserving the native bone without the need for extensive eccentric reaming.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the improved accuracy of preoperative planning using CT, surgeons still often modify the predetermined implant sizes and placement according to intraoperative findings. The concordance between the implant selected using the preoperative planning software and the implant placed during surgery has not been well-defined in the existing literature [10][11][12][13][14]. Reschenbacher et al retrospectively reviewed 50 cases of stemless aTSA performed by two surgeons and found that there was perfect concordance between the preoperative plan and the actual implants in only 11 cases (22%).…”

Section: Introductionmentioning

confidence: 99%

“…Reschenbacher et al retrospectively reviewed 50 cases of stemless aTSA performed by two surgeons and found that there was perfect concordance between the preoperative plan and the actual implants in only 11 cases (22%). They found that the glenoid component demonstrated the highest concordance when compared to the humeral head and nucleus [ 12 ]. Similarly, Raiss et al reported an 85% complete concordance between the size, backside radius, and need for augments in the surgically implanted glenoid compared with the preoperatively planned implant [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Accuracy and Reliability of Computerized Surgical Planning Software in Anatomic Total Shoulder Arthroplasty

Bedeir¹,

Tabeayo²,

Chou³

et al. 2023

Cureus

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Purpose: The primary purpose of this study was to assess the concordance between preoperatively determined implant parameters using CT-based planning software and surgically implanted prostheses. Secondarily, we sought to evaluate the agreement between preoperative plans performed by surgeons at different levels of training.Methods: Patients with primary glenohumeral osteoarthritis who underwent anatomic total shoulder arthroplasty (aTSA) and had a preoperative CT scan according to Blueprint (Stryker, Mahwah, NJ) protocol to be used for preoperative planning were included. A cohort of short-stemmed (SS) and stemless cases performed between October 2017 and December 2018 was randomly selected from an institutional database for the study. Planning was performed separately by four observers at different levels of orthopedic training at a minimum of six months following the actual surgery. Concordance between the surgical decisions during planning and the actually utilized implants was calculated. Additionally, inter-rater agreement was analyzed using the intra-class correlation coefficient (ICC). Implant parameters assessed were glenoid size, backside radius of curvature, and the need for posterior augment, in addition to humeral stem/nucleus size, head size, head height, and head eccentricity.Results: Twenty-one patients were included (10 stemmed and 11 stemless) with a cohort comprising 12 (57%) females with a median age of 62 years (IQR 59.5,67). There was a total of 544 decision possibilities based on the above parameters. The total number of decisions that matched surgical data was 333 (61.2%). Prediction of glenoid component augmentation need and size was the variable that matched most with surgical data (83.3%), whereas nucleus/stem size was the worst (42.9%). Interobserver agreement was excellent in one variable, good in three variables, moderate in one, and poor in two. The best interobserver agreement was with regard to head height. Conclusion: Preoperative planning using CT-based software may be more accurate for the glenoid component when compared to humeral-sided parameters. Specifically, planning may be most helpful in determining the need and the size of glenoid component augmentation. Utilizing computerized software demonstrates high reliability, even among surgeons early in their orthopedic training.

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