Postoperative x-rays - accuracy and reliability

Accuracy and reliability of postoperative radiographic measurements of glenoid anatomy and relationships in patients with total shoulder arthroplasty.

The authors examined thirty-two x-ray images and computed tomography scans were taken within 1 month of each other in patients who had undergone total shoulder arthroplasty with an all-polyethylene glenoid component.

They found fair-moderate agreement between x-ray images and CT scans for coronal superior-inferior plane and version measurements, but poor agreement for humeral scapular alignment in the axial plane. They noted an average difference of overestimating coronal superior-inferior plane by 0.06% ± 7.7% and overestimating version by -4.2° ± 5.1°.

It is important to recognize, however, that the position of the arm and scapula were quite different for axillary radiographs and the axial CT scans, so it not at all clear that the differences are indicative of a lack of accuracy of the axillary view.

The authors recommend the use of postoperative Grashey radiographs for measurement of coronal superior-inferior plane and axillary radiographs for measurement of glenoid retroversion.

We have not found that the increased cost and radiation exposure of a CT scan are merited to assess glenohumeral anatomy in the great majority of cases.

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