Preoperative planning and its role in anatomic total shoulder arthroplasty

As the utilization of total shoulder arthroplasty continues to grow, surgeons are facing increasingly complex reconstructive challenges both in the primary and revision settings. Proper implant positioning, particularly of the glenoid, is paramount to achieving a good result and avoiding devastating complications and early failure. Historically, surgeons have been able to use plain radiographs and 2-dimensional computed tomography (CT) for preoperative planning. Recently, preoperative planning software based on 3-dimensional CT (3D CT) has revolutionized the surgeons’ ability to visualize glenoid deformity and bone stock, plan corrective procedures for abnormal version, and visualize component position. Commercially available preoperative templating software based on 3D CT has been shown to be more accurate and reliable than 2D CT in calculating glenoid version and inclination, and accurately predicts implant size. Patient-specific instrumentation can be developed from the 3D reconstruction, allowing surgeons to accurately execute the preoperative plan and implant the prosthesis to match a patient’s unique anatomy. Robotic-assisted surgery, intraoperative navigation, and augmented reality technology show promise in providing real-time intraoperative feedback in order to maximize surgical accuracy and efficiency while ultimately improving patient-reported outcomes.