Shoulder Arthroplasty Planning Technologies

Innovations in shoulder arthroplasty seek to improve clinical outcomes for patients, Three-dimensional computer tomographic (CT) scans provide a more detailed depiction of glenoid pathoanatomy than traditional two-dimensional CT scans or plain films. Preoperative planning software enables the surgeon to visualize different reconstruction strategies. Patient specific instrumentation and computer assisted navigation strive to optimize implant positioning.  These technologies can add time and cost to the conduct of shoulder arthroplasty (data on average selling price (ASP) below from Orthopaedic Network News 2023). 

Certain questions about these technologies need to be answered by clinical research:

(1) Do these technologies improve the outcomes for patients in terms of improvement in comfort and function along with a reduction in complications and revisions?
(2) If these technologies are of value, in which cases should they be used - what are the "appropriate use criteria" for them?
(3) Are there potential adverse effects associated with the use of the technologies, such as increased rates of infection from prolonged operative time?
(4) Do these planning systems lead to the use of more complex implants (e.g. augmented baseplates for reverses and augmented poly for anatomic glenoid components) that may not be necessary.
(5) Do the different planning technologies results in similar measures, for example of glenoid inclination and version?

(6) How do the results reported by authors with financial conflicts of interest compare to those reported by authors without such conflicts?

Some recent articles bear on these questions:

In 3D preoperative planning for shoulder arthroplasty: an evaluation of different planning software systems it was found that the wide variety of methods used by different companies and institutions results in significantly differing glenoid inclination and version measurements.

In Does commercially available shoulder arthroplasty preoperative planning software agree with surgeon measurements of version, inclination, and subluxation? Preoperative planning software for shoulder arthroplasty had limited agreement in measures of version, inclination, and subluxation measurements.

In The Impact of Preoperative Three- Dimensional Planning and Intraoperative Navigation of Shoulder Arthroplasty on Implant Selection and Operative Time. Using 3D planning increased the likelihood that the surgeon selected an augmented glenoid component compared with 2D planning. Because 3D planning and intraoperative navigation is more costly than 2D planning, and augmented glenoid components are more costly than standard glenoid components, the cost-benefit of these changes with respect to mid- and long-term clinical outcomes and implant survival has not been ascertained.

In Patient-specific Instrumentation Versus Standard Surgical Instruments in Primary Reverse Total Shoulder Arthroplasty: A Retrospective Comparative Clinical Study patients having reverse total shoulder arthroplasty using patient specific instrumentation did not achieve significantly better clinical or radiographic outcomes than those performed without PSI.

As would be expected, authors advocating these technologies are often involved with their development and have financial ties to the companies providing them.Financial support is necessary for the research, development, application, and advocacy of new technologies. In Novel Shoulder Arthroplasty Planning Technologies and Potential Conflicts of Interest most publications on these innovations were found to be authored by those with financial conflicts of interest. Such conflicts can be associated with the results of the studies (Conflict of interest in orthopaedic research. An association between findings and funding in scientific presentations)(Conflict of interest in orthopaedic research)(Demographics of disclosure of conflicts of interest at the 2011 annual meeting of the American Academy of Orthopaedic Surgeons)(Scope and impact of financial conflicts of interest in biomedical research: a systematic review).

Clinical research, including carefully controlled clinical trials, are needed to establish the value of these technologies to the patient having arthroplasty for glenohumeral arthritis.

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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).