Abstract
INTRODUCTION
The advent of CT based 3D preoperative planning software for reverse total shoulder arthroplasty (RTSA) provides surgeons with more data than ever before to prepare for a case. Interestingly, as the usage of such software has increased, further questions have appeared over the optimal way to plan and place a glenoid implant for RTSA. In this study, a survey of shoulder specialists from the American Shoulder and Elbow Society (ASES) was conducted to examine thought patterns in current RTSA implant selection and placement.
METHODS
172 ASES members completed an 18-question survey on their thought process for how they select and place a RTSA glenoid implant. Data was collected using a custom online Survey Monkey survey. Surgeon answers were split into two cohorts based on number of arthroplasties performed per year: between 0–75 was considered low volume (LV), and between 75–200+ was considered high volume (HV). Data was analyzed for each cohort to examine differences in thought patterns, implant selection, and implant placement.
RESULTS
70 surgeons were grouped into the LV cohort, and 102 surgeons were grouped into the HV cohort. 46.1% of surgeons in the HV cohort reported using a preoperative planning software for the majority of cases, 48% reported seldom use, and 5.9% reported no use. In the LV cohort, 41.4% reported use for the majority of cases, 24.3% reported seldom use, and 34.3% reported no use (Figure 1). When questioned on what percentage of RTSA cases do surgeons use augmented glenoid implants, 26.7% in the HV cohort responded never using augments vs. 32.4% in the LV cohort, 32.7% responded using augments <15% of the time in the HV cohort vs. 30.9% in the LV cohort, 26.7% responded using augments between 15–45% of the time in the HV cohort vs. 27.9% in the LV cohort, and 13.8% responded using augments >45% of the time in the HV cohort vs. 8.8% in the LV cohort (Figure 2). When asked what the maximum allowable superior inclination for a RTSA glenoid implant is, surgeons answered 10° 20.6% of the time in the HV cohort vs. 30% in the LV cohort, 5° 18.6% of the time in the HV cohort vs. 25.7% in the LV cohort, 0° 38.2% of the time in the HV cohort vs. 25.7% in the LV cohort, and no fixed degree 22.5% of the time in the HV cohort vs. 18.6% in the LV cohort (Figure 3).
CONCLUSION
The results of this study show that even within a group of highly trained surgeons, there are widely varying opinions on how to plan the optimal RTSA case. Variation between high and low volume surgeons reveals even greater differences, suggesting that experience affects thought pattern. Despite these differences, there is no way to prove the optimal implant selection and placement without consistent data collection and long-term clinical outcomes. Machine learning on large preoperative planning databases combined with clinical outcomes data may provide further clarity on optimal implant placement and selection.
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