The authors of a recent article, Assessment of 3D automated software to predict postoperative impingement free range of motion after reverse total shoulder arthroplasty, found that "In its current state, preoperative Blueprint 3D CT planning software is unable to accurately predict range of motion one year after reverse total shoulder arthroplasty". The authors of Templating in shoulder arthroplasty - A comparison of 2D CT to 3D CT planning software: A systematic review concluded that, "The paucity of evidence exploring clinical parameters makes it difficult to comment on clinical outcomes using different methods of templating. More studies are required to identify how improved radiographic outcomes translate into improvements that are clinically meaningful to patients."
To further assess the value of 3D planning in optimizing shoulder function after a reverse total shoulder, the author of Accuracy of Blueprint in Predicting Range of Motion One Year After Reverse Total Shoulder Arthroplasty sought to test the hypothesis that the mean impingement-free range of motion predicted by Blueprint correlates with the mean actual range of motion one year after reverse total shoulder arthroplasty in 127 shoulders. Interestingly, the surgeon elected to deviate from the Blueprint plan in 30 cases (almost 25%), making intraoperative component modifications.
He found that the actual range of motion and predicted range of motion were statistically significantly different (p<0.0001) for flexion, external rotation, abduction, abduction/ external rotation, and abduction / internal rotation.
As seen below, some predictions were less than what was seen at 1 year (e.g. flexion and abduction). However, actual range of motion was substantially less that predicted for other motions (e.g. abduction/internal rotation). Of note, one of the concerns with reverse total shoulder arthroplasty is the frequent limitation of the ability to regain sufficient internal rotation enabling reach up the back.
The conclusion was that "In its current state, preoperative Blueprint 3D CT planning software is unable to accurately predict range of motion one year after reverse total shoulder arthroplasty."
Comment: Without or with preoperative planning software, the surgeon has the opportunity to evaluate the ranges of motion with different combinations of trial components - seeking to avoid unwanted contact between the humeral component and the scapula inferiorly, anteriorly and posteriorly
as well as taking steps to avoid unwanted contact between the greater tuberosity and the undersurface of the acromion.
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
