Abstract
INTRODUCTION
3D preoperative planning software for anatomic and reverse total shoulder arthroplasty (ATSA and RTSA) provides additional insight for surgeons regarding implant selection and placement. Interestingly, the advent of such software has brought previously unconsidered questions to light on the optimal way to plan a case. In this study, a survey of shoulder specialists from the American Shoulder and Elbow Society (ASES) was conducted to examine thought patterns in current glenoid implant selection and placement.
METHODS
172 ASES members completed an 18-question survey on their thought process for how they select and place a glenoid implant for both ATSA and RTSA procedures. Data was collected using a custom online Survey Monkey survey. Surgeon answers were split into three cohorts based on their responses to usage of 3D preoperative planning software: high users, seldom users, and non-users. Data was analyzed for each cohort to examine differences in thought patterns, implant selection, and implant placement.
RESULTS
76 surgeons were grouped into the high user cohort, 66 into the seldom user cohort, and 30 into the non-user cohort. 61.9% of high users and 74.1% of seldom users performed >75 shoulder arthroplasties per year, whereas only 19.9% of non-users performed >75 arthroplasties per year (Figure 1). When questioned on glenoid implant type selection (augmented vs. non-augmented components), 80.3% of high users reported augment usage for both ATSA and RTSA, with using augments >45% of the time in 18.4% of ATSA cases and in 22.3% of RTSA cases. For seldom users, 80.3% reported augment usage in ATSA cases, and 70.3% in RTSA cases. Seldom users reported augment usage >45% of the time in 4.5% of ATSA cases and in 1.6% of RTSA cases. For non-preoperative planning users, 53.3% reported using augments in ATSA cases, and 48.3% for RTSA cases. Non-users used augmented glenoid components >45% of the time in 6.6% of ATSA cases and in 6.8% of RTSA cases. For resultant implant superior inclination in RTSA, 40.8% of high users aim for 0° of inclination, followed by 31.8% for seldom users and 16.7% of non-users (Figure 2).
CONCLUSION
The results of this study show that 3D preoperative planning software has an influence on the decision making process when planning a shoulder arthroplasty. High volume shoulder arthroplasty surgeons report higher preoperative planning software usage than low volume surgeons, suggesting the utility of such software. Augmented glenoid component usage for both ATSA and RTSA is also higher for surgeons that use preoperative planning software, which either suggests the utility of augmented glenoid components, or that the use of such software creates the perceived need for augmented glenoid components. Lastly, surgeons who preoperatively plan tend to orient their glenoid components differently, which could suggest either a better understanding of the anatomy through the use of the software, or an influence on mindset regarding implant orientation resulting from software usage. This highlights an area for future work that could correlate clinical outcome data to implant selection and placement to prove what is the optimal plan for a given patient.
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