Intersurgeon and intrasurgeon variability in preoperative planning of anatomic total shoulder arthroplasty: a quantitative comparison of 49 cases planned by 9 surgeons

J Shoulder Elbow Surg. 2020 Dec;29(12):2610-2618. doi: 10.1016/j.jse.2020.04.010. Epub 2020 Jun 9.


Background: Preoperative planning software is widely available for most anatomic total shoulder arthroplasty (ATSA) systems. It can be most useful in determining implant selection and placement with advanced glenoid wear. The purpose of this study was to quantify inter- and intrasurgeon variability in preoperative planning of a series of ATSA cases.

Methods: Forty-nine computed tomography scans were planned for ATSA by 9 fellowship-trained shoulder surgeons using the ExactechGPS platform (Exactech Inc., Gainesville, FL, USA). Each case was planned a second time between 4 and 12 weeks later. Variability within and between surgeons was measured for implant type, size, version and inclination correction, and implant face position. Interclass correlation coefficients, Pearson, and Light's kappa coefficients were used for statistical analysis.

Results: There was considerable variation in the frequency of augment use between surgeons and between rounds for the same surgeon. Thresholds for augment use also varied between surgeons. Interclass correlation coefficients for intersurgeon variability were 0.37 for version, 0.80 for inclination, 0.36 for implant type, and 0.36 for implant size. Pearson coefficients for intrasurgeon variability were 0.17 for version and 0.53 for inclination. Light's kappa coefficient for implant type was 0.64.

Conclusions: This study demonstrates substantial inter- and intrasurgeon variability in preoperative planning of ATSA. Although the magnitude of differences in correction was small, surgeons differed significantly in the use of augments to achieve the resultant plan. Surgeons differed from each other on thresholds for augment use and maximum allowable residual retroversion. This suggests that there may a range of acceptable corrections for each shoulder rather than a single optimal plan.

Keywords: Anatomic total shoulder arthroplasty; glenoid inclination; glenoid version; intersurgeon variability; intrasurgeon variability; preoperative planning.

Publication types

  • Comparative Study

MeSH terms

  • Arthroplasty, Replacement, Shoulder* / methods
  • Bone Malalignment / diagnostic imaging*
  • Bone Malalignment / prevention & control
  • Bone Malalignment / surgery
  • Humans
  • Imaging, Three-Dimensional
  • Observer Variation
  • Preoperative Care / methods*
  • Scapula / diagnostic imaging
  • Scapula / surgery
  • Shoulder Joint* / diagnostic imaging
  • Shoulder Joint* / surgery
  • Shoulder Prosthesis*
  • Software
  • Surgery, Computer-Assisted / methods*
  • Surgery, Computer-Assisted / standards
  • Tomography, X-Ray Computed