Can We Completely Trust in Automated Software for Preoperative Planning of Shoulder Arthroplasty? Software Update May Modify Glenoid Version, Glenoid Inclination and Humeral Head Subluxation Values

Abstract

Background: The purpose of this study was to evaluate the impact of software updating on measurements of the glenoid inclination and version, along with humeral head subluxation performed by an automated 3D planning program. The hypothesis was that the software update could significantly modify the values of the glenoid inclination and version, as well as of the humeral head subluxation. Methods: A comprehensive pool of 76 shoulder computed tomography (CT) scans of patients who underwent total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA) were analyzed with the automated program Blueprint in 2018 and again in 2020 after a software update. Results: A statistically significant difference of 8.1 ± 8.2 and 5.4 ± 7.8 (mean difference of −2.8 ± 5.0, p < 0.001) was indeed reached when comparing the mean glenoid inclination achieved with Blueprint 2018 and Blueprint 2020, respectively. The glenoid version, as well as the humeral head subluxation evaluations, were not significantly different between the two software versions, with mean values being −9.4 ± 8.9 and −9.0 ± 7.4 and 60.1 ± 12.6 and 61.8 ± 12.0, respectively (p = 0.708 and p = 0.115, respectively). In 22% of CT scans, the software update determined a variation of the glenoid inclination of more than 5° or 10°. Conclusion: The present study shows the software update of an automated preoperative planning program may significantly modify the values of glenoid inclination. Even though without a significant difference, variations were also found for the glenoid version and humeral head subluxation. Accordingly, these results should further advise surgeons to carefully and critically evaluate data acquired with automated software.

Three-dimensional planning, navigation, patient-specific instrumentation and mixed reality in shoulder arthroplasty: a digital orthopedic renaissance

“…Despite the advantages, 3D planning in shoulder arthroplasty has limitations. Its accuracy heavily relies on preoperative imaging quality, and unexpected intraoperative anatomical variations may compromise the precision of the planned procedure ( 18 , 27 ). Additionally, the learning curve for surgeons adopting 3D planning may influence its widespread adoption ( 18 , 20 ).…”

“…The hypothesis was that the software update would significantly alter these measurements. The results revealed a statistically significant difference in mean glenoid inclination values between Blueprint 2018 and Blueprint 2020, indicating that a software update can indeed affect this parameter ( 27 ). While variations between two software versions were also observed for glenoid version and humeral head subluxation, they were not statistically significant.…”

“…Despite illustrated potential benefits of preoperative 3D planning, surgeons should always question data from automated software. A recent study aimed to assess the impact of a software update on measurements of glenoid inclination, version, and humeral head subluxation performed by the automated 3D planning program Blueprint (Stryker) ( 27 ). The hypothesis was that the software update would significantly alter these measurements.…”

“…Despite having access to 3D planning, they may prefer visual estimation (eyeballing) over relying solely on accurate measurements when positioning the implants during surgery. This highlights the need to carefully consider and combine both automated tools and visual assessments for a well-rounded approach to making surgical decisions ( 27 ).…”