Scalise, J Bone Joint Surg Am 2008 - The Influence of Three-Dimensional Computed Tomography Images of the Shoulder in Preoperative Planning for Total Shoulder Arthroplasty - Article Summary

The Influence of Three-Dimensional Computed Tomography Images of the Shoulder in Preoperative Planning for Total Shoulder Arthroplasty

Scalise, Iannotti, et al.·J Bone Joint Surg Am·2008·167 citations·Diagnostic study

Background

Arthritic changes to glenoid morphology can be difficult to fully characterize on both plain radiographs and conventional two-dimensional computer tomography images. We tested the hypothesis that three-dimensional imaging of the shoulder would increase inter-rater agreement for assessing the extent and location of glenoid bone loss and also would improve surgical planning for total shoulder arthroplasty.

Methods

4 shoulder surgeons independently and retrospectively reviewed the preoperative computed tomography scans of 24 arthritic shoulders.
The blinded images were evaluated with conventional 2-dimensional imaging software and then later with novel 3-dimensional imaging software.
Measurements and preoperative judgments were made for each shoulder with use of each imaging modality and then were compared.
The glenoid measurements were glenoid version and bone loss.
The judgments were the zone of maximum glenoid bone loss, glenoid implant fit within the glenoid vault, and how to surgically address abnormal glenoid version and bone loss.
Agreement between observers was evaluated with use of intraclass correlation coefficients and the weighted kappa coefficient (k), and we determined if surgical decisions changed with use of the 3-dimensional data.

Results

The average glenoid version (and standard deviation) measured 217° ± 2.2° on the two-dimensional images and 219° ± 2.4° on the three-dimensional images (p < 0.05).
The average posterior glenoid bone loss measured 9 ± 2.3 mm on the two-dimensional images and 7 ± 2 mm on the three-dimensional images (p < 0.05).
The average anterior bone loss measured 1 mm on both the two-dimensional and the three-dimensional images.
However, the intraclass correlation coefficients for anterior bone loss increased significantly with use of the three-dimensional data (from 0.36 to 0.70; p < 0.05).
Observers were more likely to locate mid-anterior glenoid bone loss on the basis of the three-dimensional data (p < 0.05).
The use of three-dimensional data provided greater agreement among observers with regard to the zone of glenoid bone loss, glenoid prosthetic fit, and surgical decision-making.
Also, when the judgment of implant fit changed, observers more often determined that it would violate the vault walls on the basis of the three-dimensional data (p < 0.05).

Conclusions

The use of three-dimensional imaging can increase inter-rater agreement for the analysis of glenoid morphology and preoperative planning. Important considerations such as the extent and location of glenoid bone loss and the likelihood of implant fit were influenced by the three-dimensional data.

Supplemental

The Influence of Three-Dimensional Computed Tomography Images of the Shoulder in Preoperative Planning for Total Shoulder Arthroplasty.

Scalise, Iannotti, et al.J Bone Joint Surg Am2008167 citationsDiagnostic study