3D preoperative planning for reverse total shoulder.

Assessment of surgeon variability in preoperative planning of reverse total shoulder arthroplasty: a quantitative comparison of 49 cases planned by 9 surgeons

These authors point out that there is limited agreement on the optimal type of glenoid implant and on the optimal placement of the implant for each individual patient having a reverse total shoulder.

They sought to determine the degree to which 9 experienced surgeons agreed on implant choice and position in 49 RTSA cases planned using the Exactech GPS system. A second round of planning was repeated 6-12 weeks later by each surgeon.

There was considerable variation in the frequency of augmented baseplate selection between surgeons and between rounds for the same surgeon. 

Thresholds for augment use also varied between surgeons. Interclass correlation coefficients (ICC) for intersurgeon variability ranged from 0.43 for version, 0.42 for inclination, and 0.25 for baseplate type (ICC less than 0.40 - poor; between 0.40 and 0.59 - fair; between 0.5 and 0.75 - moderate; between 0.75 and 0.90 - good; above 0.9 - excellent).

Pearson coefficients for intrasurgeon variability were 0.34 for version and 0.30 for inclination. Light’s kappa coefficient for baseplate type was 0.61.

These authors concluded that there was substantial variability both between surgeons and between rounds for individual surgeons when planning RTSA. They suggest that there was little consensus among the surgeons on optimal planning parameters.

Comment: Substantial time and resources are required for preoperative 3D planning. The improvement in patient outcomes resulting from this approach has yet to be demonstrated, i.e. do patients having reverse total shoulders with 3D planning fare better than those having reverse total shoulders without 3D planning? 

This study study points to the variability in the 3D plans developed by 9 experienced surgeons and in the variability between 3D plans developed by the same surgeon on two different occasions.

To see our technique for reverse total shoulder, click on this link.

To subscribe to this blog, enter your email in the box to your right

=====
How you can support research in shoulder surgery Click on this link.

To see our new series of youtube videos on important shoulder surgeries and how they are done, click here.

Be sure to visit "Ream and Run - the state of the art"  regarding this radically conservative approach to shoulder arthritis at this link and this link. Also see the essentials of the ream and run.

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages   arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery