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Variability in preoperative planning software for shoulder arthroplasty
Ana R Senra1,2, Diogo Tomaz1,2, Diogo S Gomes3,4
1Unidade Local de Saúde São João, Porto, Portugal.
JSES International
|May 6, 2026
Summary
Preoperative planning software for shoulder arthroplasty shows significant variability, especially in glenoid inclination measurements. Standardization is crucial for reliable surgical planning and reproducible outcomes in shoulder replacement procedures.
Area of Science:
- Orthopedic surgery
- Biomedical engineering
- Medical imaging analysis
Background:
- Three-dimensional (3D) preoperative planning is vital for optimizing implant selection and component positioning in shoulder arthroplasty.
- Current planning platforms utilize automated best-fit sphere or manual landmark-based methods, which can introduce variability in glenoid morphology assessment.
- Understanding inter-software variability is essential for consistent and accurate surgical planning.
Purpose of the Study:
- To compare the performance of five commercially available 3D preoperative planning platforms for shoulder arthroplasty.
- To determine if differences in analytical algorithms contribute to inter-software variability in glenoid morphology assessment.
- To evaluate the reliability and reproducibility of different planning software in measuring glenoid version, inclination, and humeral head subluxation.
Main Methods:
- Thirty-three patients undergoing shoulder arthroplasty were included in the study.
- Preoperative computed tomography (CT) scans were analyzed using five distinct planning platforms: Blueprint, Equinoxe, Signature ONE, MyShoulder, and LimaCorporate.
- Key glenoid parameters including version, inclination, and humeral head subluxation were assessed, with data analyzed for group and pairwise comparisons between software.
Main Results:
- Significant inter-platform differences were observed for glenoid version (P < .001), inclination (P = .015), and subluxation (P = .032).
- Intraclass correlation coefficients (ICCs) indicated high agreement for subluxation (0.826) and moderate to high agreement for version (0.749), but low agreement for inclination (0.267).
- Pairwise agreement varied widely, with version agreement ranging from 45.5% to 97% and inclination agreement from 30.3% to 90.9%.
Conclusions:
- Substantial variability exists between different preoperative shoulder arthroplasty planning software, particularly impacting glenoid inclination measurements.
- Automated software showed higher concordance for version but lower concordance for subluxation, indicating algorithmic differences influence results.
- Methodological standardization across planning platforms is crucial to enhance the reliability and reproducibility of shoulder arthroplasty planning and surgical outcomes.
