Assessment of surgeon variability in preoperative planning of reverse total shoulder arthroplasty: a quantitative comparison of 49 cases planned by 9 surgeons

J Shoulder Elbow Surg. 2020 Oct;29(10):2080-2088. doi: 10.1016/j.jse.2020.02.023. Epub 2020 May 26.


Background: Preoperative planning software is gaining utility in reverse total shoulder arthroplasty (RTSA), particularly when addressing pathologic glenoid wear. The purpose of this study was to quantify inter- and intrasurgeon variability in preoperative planning a series of RTSA cases to identify differences in how surgeons consider optimal implant placement. This may help identify opportunities to establish consensus when correlating plan differences with clinical data.

Methods: A total of 49 computed tomography scans from actual RTSA cases were planned for RTSA by 9 fellowship-trained shoulder surgeons using the same platform (Exactech GPS, Exactech Inc., Gainesville, FL, USA). Each case was planned a second time 6-12 weeks later. Variability within and between surgeons was measured for implant selection, version correction, inclination correction, and implant face position. Interclass correlation coefficients, and Pearson and Light's kappa coefficient were used for statistical analysis.

Results: There was considerable variation in the frequency of augmented baseplate selection between surgeons and between rounds for the same surgeon. Thresholds for augment use also varied between surgeons. Interclass correlation coefficients for intersurgeon variability ranged from 0.43 for version, 0.42 for inclination, and 0.25 for baseplate type. Pearson coefficients for intrasurgeon variability were 0.34 for version and 0.30 for inclination. Light's kappa coefficient for baseplate type was 0.61.

Conclusions: This study demonstrates substantial variability both between surgeons and between rounds for individual surgeons when planning RTSA. Although average differences between plans were relatively small, there were large differences in specific cases suggesting little consensus on optimal planning parameters and opportunities to establish guidelines based on glenoid pathoanatomy. The correlation of preoperative planning with clinical outcomes will help to establish such guidelines.

Keywords: Reverse total shoulder; augmented glenoid; glenoid inclination; glenoid retroversion; intersurgeon variability; intrasurgeon variability; preoperative planning.

Publication types

  • Comparative Study

MeSH terms

  • Arthroplasty, Replacement, Shoulder / instrumentation
  • Arthroplasty, Replacement, Shoulder / methods*
  • Glenoid Cavity / diagnostic imaging
  • Glenoid Cavity / surgery
  • Humans
  • Practice Patterns, Physicians'*
  • Preoperative Period
  • Scapula / surgery
  • Shoulder Joint / diagnostic imaging*
  • Shoulder Joint / surgery*
  • Shoulder Prosthesis
  • Software
  • Surgeons*
  • Tomography, X-Ray Computed