Preoperative Planning for Anatomic Total Shoulder Arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Radiology

Background:

• Total shoulder arthroplasty (TSA) success relies on precise patient selection and anatomical restoration.
• Preoperative planning is vital for selecting appropriate implants to correct deformities and optimize soft-tissue tension.

Purpose of the Study:

• To evaluate the effectiveness of advanced imaging and planning techniques in improving TSA outcomes.
• To compare the accuracy of patient-specific instrumentation (PSI) with standard instrumentation for glenoid implant placement.

Main Methods:

• Review of imaging modalities including plain radiographs, CT scans, and 3D reconstructions for glenohumeral joint assessment.
• Analysis of commercial software for calculating anatomical parameters like version.
• Comparison of PSI with standard instrumentation regarding version error, inclination error, and positional offset.
• Consideration of intraoperative navigation systems for real-time feedback.

Main Results:

• Plain radiographs offer limited accuracy for complex 3D glenohumeral anatomy.
• CT and 3D reconstructions provide better assessment of version, subluxation, and allow virtual implantation.
• Commercial software shows variability in parameter calculation compared to surgeon measurements.
• PSI demonstrated improved measurements over 2D imaging but no significant difference in version error, inclination error, or positional offset compared to standard instrumentation.

Conclusions:

• While advanced imaging aids in preoperative planning for TSA, current PSI techniques do not offer superior accuracy in glenoid implant positioning over standard methods.
• Further research is needed to fully assess the benefits of intraoperative navigation in TSA.