Iannotti (2015) — Three-dimensional imaging and templating improve glenoid implant positioning.

Three-Dimensional Imaging and Templating Improve Glenoid Implant Positioning.

·J Bone Joint Surg Am·2015·202 citations·Shoulder & Elbow

Randomized controlled trial (Level III) comparing glenoid component positioning accuracy in anatomic total shoulder arthroplasty across three planning strategies: 3D CT templating with standard instrumentation, 3D CT templating with patient-specific instrumentation, and historical 2D CT planning with standard instrumentation. Postoperative 3D CT with metal artifact reduction was used to measure actual versus planned implant position in all 63 patients.

Study Snapshot

Design

RCT + historical cohort

Blinding: Single-blind

Setting: Single center, Cleveland Clinic

Funding: State of Ohio; industry

Objective

Determine whether 3D CT templating improves glenoid component positioning in total shoulder arthroplasty

Outcome(s)

Glenoid implant deviation from plan in inclination and version

Subjects

63 patients: 46 randomized + 17 historical controls

253D imaging + patient-specific instrument
213D imaging + standard instrumentation
172D imaging + standard instrumentation, historical controls

Inclusion

End-stage primary glenohumeral osteoarthritis
Anatomic total shoulder arthroplasty

Follow-up

Postoperative CT within 3 weeks

Statistics

Fisher's exact testWelch two-sample t-testIntraclass correlation coefficientHolm correction

Key Findings

Three-dimensional planning cut inclination error by roughly two-thirds compared to 2D imaging — mean deviation 11.1° in the 2D group versus ~3–4° in both 3D groups (p < 0.001), a difference large enough to meaningfully affect implant seating and long-term fixation
Surgeons using 2D imaging were significantly more likely to miss the target by a clinically important margin:
–
5° in inclination (p = 0.001)
–
10° in version or inclination (p = 0.002)
Adding patient-specific instrumentation to 3D templating offered no significant accuracy benefit over 3D templating with standard instruments (inclination difference −0.98°, p = 0.67) — the planning model drives precision, not the physical guides
Five of 17 patients in the 2D group retrospectively required an augmented glenoid component that was never identified intraoperatively; 3D templating correctly guided augmented component selection in both 3D groups before the case began
Inter-rater reliability for postoperative implant measurement was excellent (ICC ≥ 0.96), confirming the outcome methodology was robust enough to trust the between-group differences

Clinical Relevance

When planning anatomic total shoulder arthroplasty — especially with Walch B2 or C glenoids.

Use 3D CT templating: it cuts inclination error by roughly two-thirds compared to 2D planning and helps you correctly identify when an augmented glenoid component is needed before you're in the OR. If your institution has 3D planning software but not patient-specific guides, the data here show the software alone drives the accuracy benefit.

Supplemental

Three-Dimensional Imaging and Templating Improve Glenoid Implant Positioning.

Iannotti, Ricchetti, et al.·J Bone Joint Surg Am·2015·202 citations·Shoulder & Elbow

Three-Dimensional Imaging and Templating Improve Glenoid Implant Positioning.

Study Snapshot

Key Findings

Clinical Relevance

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Three-Dimensional Imaging and Templating Improve Glenoid Implant Positioning.

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Key Findings

Clinical Relevance

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Three-Dimensional Imaging and Templating Improve Glenoid Implant Positioning.

Study Snapshot

Key Findings

Clinical Relevance

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Three-Dimensional Imaging and Templating Improve Glenoid Implant Positioning.

Study Snapshot

Key Findings

Clinical Relevance

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