These authors sought to compare the use of axillary radiographs and midglenoid axial CT scans to identify glenoid wear.
Five independent examiners with differing levels of experience characterized the glenoid morphology as either concentric or eccentric on preoperative axillary radiographs and mid-glenoid axial CT scans for 330 patients who underwent anatomic total shoulder arthroplasty.
Intraobserver consistency averaged 75% for radiographs and 73% for CT scans. There was significant interobserver consistency, as higher levels of training corresponded with greater consistency between imaging analyses (p < 0.001).
Comment: Especially in these times with huge strains on the nation's medical budget, we need to be thoughtful about how our health care dollars are spent.
As the authors state, "Although CT scans are associated with greater financial cost and exposure to radiation than radiographs, the literature has yet to describe the additional clinical value and/or potential cost-value benefit as a result of improved outcomes provided by the use of CT scans in patients undergoing total shoulder arthroplasty, even when integrated with virtual planning software and generation of patient specific instrumentation."
We agree that CT scans without or with 3D reconstructions can provide additional detail regarding glenohumeral pathoanatomy in comparison to plain radiographs, it remains to be seen whether this increment in information leads to significantly better clinical outcomes for the patient. Any benefit would need to be balanced against the increased costs and the 200 to 1,000 fold increase in radiation exposure of the CT scans (2.06 mSV)75 (10.83 mSV)76 in comparison to plain radiographs (0.01 mSV). In addition to the cost, physicians are increasingly concerned about the relationship between radiation dosage and the risk of the patient developing cancer.
Further research is needed to show that preoperative CT scans contribute to improved outcomes for the patient.
Meanwhile, standardized preoperative views can provide the information needed to evaluate and manage the arthritic shoulder (see article below).
Prearthroplasty glenohumeral pathoanatomy and its relationship to patient’s sex, age, diagnosis, and self-assessed shoulder comfort and function
These authors examined 544 patients within 6 weeks before shoulder joint replacement arthroplasty with the goals of characterizing the radiographic characteristics of the arthritic joint and the relationship of these pathologic changes to the patients' age, sex and diagnosis. They also studied the inter-relationships among glenoid type, glenoid version, and amount of decentering of the humeral head on the glenoid; as well as the relationships of the pathoanatomy to the patient’s self-assessed shoulder comfort and function.
Examples of the different types of glenoid pathoanatomy are shown below.
They found that male patients had a higher frequency of type B2 glenoids and a lower frequency of A2 glenoids.
The arthritic shoulders of men were more retroverted and had greater amounts of posterior decentering.
Patients with types A1 and C glenoids were younger than those with other glenoid types.
Shoulders with osteoarthritis were more likely to be type B2 and to be retroverted.
Types B2 and C had the greatest degree of retroversion, whereas types B1 and B2 had the greatest amounts of posterior decentering.
Shoulders with glenoid types B1 and B2 and those with more decentering did not have worse preoperative self-assessed shoulder comfort and function.
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