Commercial 3-dimensional imaging programs are not created equal: version and inclination measurement positions vary among preoperative planning software

Waltz, CDR. Robert A.; Peebles, Annalise M.; Ernat, Justin J.; Eble, Stephanie K.; Denard, Patrick J.; Romeo, Anthony A.; Golijanin, Petar; Liegel, Scott M.; Provencher, Matthew T.

doi:10.1016/j.jseint.2022.01.006

Cited by 9 publications

(3 citation statements)

References 26 publications

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“…Cabarcas et al 23 performed a meta-analysis that revealed no significant differences in accuracy between PSI and standard instrumentation, concluding that further investigations regarding long-term outcomes, impact on operating room time, and cost-effectiveness are warranted before PSI can be routinely recommended. Furthermore, a recent study comparing 3D imaging programs found variance according to the region of the glenoid from which version and inclination are measured 24 .…”

Section: Discussionmentioning

confidence: 99%

Use of Preoperative CT Scans and Patient-Specific Instrumentation May Not Improve Short-Term Adverse Events After Shoulder Arthroplasty

Navarro,

Chan,

Prentice

et al. 2023

JBJS Open Access

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Background: Ongoing innovation leads to a continuous influx of new technologies related to shoulder arthroplasty. These are made available to surgeons and marketed to both health-care providers and patients with the hope of improving outcomes. We sought to evaluate how preoperative planning technologies for shoulder arthroplasty affect outcomes. Methods: This was a retrospective cohort study conducted using data from an integrated health-care system’s shoulder arthroplasty registry. Adult patients who underwent primary elective anatomic or reverse total shoulder arthroplasty (2015 to 2020) were identified. Preoperative planning technologies were identified as (1) a computed tomography (CT) scan and (2) patient-specific instrumentation (PSI). Multivariable Cox regression and logistic regression were used to compare the risk of aseptic revision and 90-day adverse events, respectively, between procedures for which technologies were and were not used. Results: The study sample included 8,117 procedures (in 7,372 patients) with an average follow-up of 2.9 years (maximum, 6 years). No reduction in the risk of aseptic revision was observed for patients having either preoperative CT scans (hazard ratio [HR] = 1.22; 95% confidence interval [CI] = 0.87 to 1.72) or PSI (HR = 1.44; 95% CI = 0.71 to 2.92). Patients having CT scans had a lower likelihood of 90-day emergency department visits (odds ratio [OR] = 0.84; 95% CI = 0.73 to 0.97) but a higher likelihood of 90-day venous thromboembolic events (OR = 1.79; 95% CI = 1.18 to 2.74). Patients with PSI use had a higher likelihood of 90-day deep infection (OR = 7.74; 95% CI = 1.11 to 53.94). Conclusions: We found no reduction in the risk of aseptic revision with the use of these technologies. Patients having CT scans and PSI use had a higher likelihood of venous thromboembolism and deep infection, respectively. Ongoing research with extended follow-up is being conducted to further examine the effects of these technologies on patient outcomes. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Use of Preoperative CT Scans and Patient-Specific Instrumentation May Not Improve Short-Term Adverse Events After Shoulder Arthroplasty

Navarro,

Chan,

Prentice

et al. 2023

JBJS Open Access

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“…Additionally, the outcomes of this study may not be generalizable to all commercially available shoulder arthroplasty implants, as only the Blueprint planning software and one implant system were used for all cases. Waltz et al recently demonstrated that the region of the glenoid from which version and inclination were measured differed among two widely used preoperative planning software systems [ 21 ]. Moreover, one of the participating observers was the main surgeon who actually operated on these patients.…”

Section: Discussionmentioning

confidence: 99%

Accuracy and Reliability of Computerized Surgical Planning Software in Anatomic Total Shoulder Arthroplasty

Bedeir¹,

Tabeayo²,

Chou³

et al. 2023

Cureus

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Purpose: The primary purpose of this study was to assess the concordance between preoperatively determined implant parameters using CT-based planning software and surgically implanted prostheses. Secondarily, we sought to evaluate the agreement between preoperative plans performed by surgeons at different levels of training.Methods: Patients with primary glenohumeral osteoarthritis who underwent anatomic total shoulder arthroplasty (aTSA) and had a preoperative CT scan according to Blueprint (Stryker, Mahwah, NJ) protocol to be used for preoperative planning were included. A cohort of short-stemmed (SS) and stemless cases performed between October 2017 and December 2018 was randomly selected from an institutional database for the study. Planning was performed separately by four observers at different levels of orthopedic training at a minimum of six months following the actual surgery. Concordance between the surgical decisions during planning and the actually utilized implants was calculated. Additionally, inter-rater agreement was analyzed using the intra-class correlation coefficient (ICC). Implant parameters assessed were glenoid size, backside radius of curvature, and the need for posterior augment, in addition to humeral stem/nucleus size, head size, head height, and head eccentricity.Results: Twenty-one patients were included (10 stemmed and 11 stemless) with a cohort comprising 12 (57%) females with a median age of 62 years (IQR 59.5,67). There was a total of 544 decision possibilities based on the above parameters. The total number of decisions that matched surgical data was 333 (61.2%). Prediction of glenoid component augmentation need and size was the variable that matched most with surgical data (83.3%), whereas nucleus/stem size was the worst (42.9%). Interobserver agreement was excellent in one variable, good in three variables, moderate in one, and poor in two. The best interobserver agreement was with regard to head height. Conclusion: Preoperative planning using CT-based software may be more accurate for the glenoid component when compared to humeral-sided parameters. Specifically, planning may be most helpful in determining the need and the size of glenoid component augmentation. Utilizing computerized software demonstrates high reliability, even among surgeons early in their orthopedic training.

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“…The integration of patient-specific morphological and functional data into computer model-based planning devices is one of the major challenges and could still improve postoperative results. 9,10 The extraction of patient anatomical data is based on static threedimentional (3D) imaging in the supine position. 11 However, the scapula may have a different position depending on the position of the patient.…”

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confidence: 99%

Orientation of the Scapula in the Standing Position

Andro,

Garraud,

Deransart

et al. 2023

J of Ultrasound Medicine

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ObjectivesA new ultrasound‐based device is proposed to non‐invasively measure the orientation of the scapula in the standing position to consider this parameter for Total Shoulder Arthroplasty. The aim of this study was to assess the accuracy and reliability of this device.MethodsAccuracy was assessed by comparing measurements made with the ultrasound device to those acquired with a three‐dimensional (3D) optical localization system (Northern Digital, Canada) on a dedicated mechanical phantom. Three users performed 10 measurements on three healthy volunteers with different body mass (BMI) indices to analyze the reliability of the device by measuring the intra and interobserver variabilities.ResultsThe mean accuracy of the device was 0.9°± 0.7 (0.01–3.03), 1.3°± 0.8 (0.03–4.55), 1.9°± 1.5 (0.05–5.76), respectively, in the axial, coronal, and sagittal planes. The interobserver and intraobserver variabilities were excellent whatever the BMI and the users experience.ConclusionsThe device is accurate and reliable enough for the measurement of the scapula orientation in the standing position.

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Commercial 3-dimensional imaging programs are not created equal: version and inclination measurement positions vary among preoperative planning software

Cited by 9 publications

References 26 publications

Use of Preoperative CT Scans and Patient-Specific Instrumentation May Not Improve Short-Term Adverse Events After Shoulder Arthroplasty

Use of Preoperative CT Scans and Patient-Specific Instrumentation May Not Improve Short-Term Adverse Events After Shoulder Arthroplasty

Accuracy and Reliability of Computerized Surgical Planning Software in Anatomic Total Shoulder Arthroplasty

Orientation of the Scapula in the Standing Position

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