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Significant Variability Exists In Preoperative Planning Software Measures Of Glenoid Morphology For Shoulder Arthroplasty

2021 Congress Paper Abstracts

Significant Variability Exists In Preoperative Planning Software Measures Of Glenoid Morphology For Shoulder Arthroplasty

Nicholas C. Laucis, MD, UNITED STATES Alex R. Webb, MD, UNITED STATES David X. Wang, MD, UNITED STATES Daniel M Dean, MD, UNITED STATES Joseph L. Rabe, MD, UNITED STATES David Matthew Lutton, MD, UNITED STATES Steven B Soliman, DO, RMSK, UNITED STATES Blake M. Bodendorfer, MD, UNITED STATES

Georgetown University Medical Center, Washington, DC, UNITED STATES


2021 Congress   Abstract Presentation   5 minutes   rating (1)

 

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Summary: As preoperative planning software and patient-specific instrumentation are both becoming more frequently utilized in an effort to provide better outcomes for patients with glenohumeral arthritis, it is important to consider the accuracy of these software programs as compared to manual measurement; this study shows a high degree of variability among programs for glenoid version and inclination.


Introduction

Three-dimensional imaging and preoperative planning software have become increasingly utilized in an effort to improve component positioning in shoulder arthroplasty. We sought to assess the interrater reliability and concordance with a gold standard comparator of 4 different 3-dimensional preoperative planning programs for shoulder arthroplasty. We hypothesized that that there would be significant variation in measures of glenoid anatomy and these differences would be affected by glenoid deformity.

Methods

A retrospective review of shoulder computed tomography (CT) scans of patients undergoing shoulder arthroplasty was undertaken. An a priori power analysis was performed and it was determined that 76 CT scans were necessary to achieve 80% power. CTs were uploaded to 4 separate templating software systems (VIP, BluePrint, TrueSight, ExactechGPS). Version and inclination of glenoids as measured by each software were extracted for comparison. Interrater reliability was assessed via a 2-way mixed effects intra-class correlation coefficient (ICC). ICC was also calculated when sub-grouping glenoids by Walch classification. Lin’s concordance correlation coefficient (CCC) was calculated for each system with a musculoskeletal-trained radiologist’s measurements used as a gold standard.

Results

Shoulder CT scans for 76 patients were obtained. Measures of glenoid version differed between at least 2 modes of measurement by 5º-10º in 58 (76%) glenoids and >10º in 10 (13%) glenoids. Measures of glenoid inclination differed between at least 2 modes of measurement by 5º-10º in 69 (91%) glenoids and >10º in 36 (47%) glenoids. ICC was good-to-excellent for version but only moderate-to-good for inclination. ICC was significantly higher for Walch A glenoids as compared to Walch B glenoids. VIP had the highest concordance with gold standard while Tornier had the lowest when measuring version CCC. Tornier had the highest concordance with gold standard and ExactechGPS had the lowest when measuring inclination CCC.

Conclusion

There is significant variability in CT-based measures of glenoid version and inclination between 4 different shoulder arthroplasty templating softwares which worsens with glenoid deformity. Concordance with a gold standard comparator is also variable. Further research is needed to better understand how this variability should be accounted for during preoperative planning for shoulder arthroplasty.


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