These authors point out that the effect of 3D planning on surgeon decision making has not been well studied. They conducted a retrospective review of 6,483 total shoulder cases (417 surgeons) for which the glenoid component was planned with a commercially available 3D computed tomography (CT) software program (VIP, Arthrex, Inc.) from 2016 to 2019.
Fifty-six surgeons and their 4,314 planned cases (67%) were included in a high-volume group (>30 cases/surgeon).
The glenoid version (Vtech) and inclination (Itech) of the VIP technician plan as well as the surgeon’s final plan for version (Vsurg) and inclination (Isurg) were extracted. When the version and/or inclination of the surgeon plan matched that of the technician, that variable was defined as “accepted”.
In approximately half of the cases (55%) there was matching of both version and inclination. In 18% neither parameter of the glenoid plan matched that of the technician.
Surgeon acceptance of the initial plan was lower for greater degrees of retroversion.
Surgeon acceptance of the initial plan was lower for surgeons with higher case volumes.
The authors concluded that "Shoulder surgeons should be aware that an initial 3D preoperative plan provided by industry represents a potential source of cognitive bias in shoulder arthroplasty planning."
Comment: This paper suggests that in almost half of the cases, the surgeon selected a plan different than that provided by the technician and that this discordance increased with surgeon experience and glenoid retroversion.
The value of 3D planning with regard to patient outcomes is not provided. In that the cost of 3D planning is substantial* and the effect on the patient is unknown, it is important to asses the value of this technology as suggested here:
Rethinking How We Spend Healthcare Dollars During—and After—the Pandemic
*The cost of this 3D planning appears substantial, "For this 3D planning software, a CT submitted for 3D planning with the VIP system must meet certain FDA requirements and is screened and processed by a VIP Operations team technician trained in the use of the software. The team is comprised of 11 employees (Arthrex, Inc., Naples, FL, USA) trained in the segmentation, thresholding and implant positioning of Arthrex anatomic and reverse total shoulder arthroplasty components in the VIP system."
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To see a YouTube of our technique for a reverse total shoulder arthroplasty without preoperative CT scan or 3D planning software, click on this link.
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