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

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.