Impact of incidental findings in preoperative advanced imaging for total shoulder arthroplasty

Abstract

BackgroundThe volume of shoulder arthroplasty continues to rise. Computed tomography (CT) is a valuable tool for preoperative planning and has been linked to decreased revision rates in patients undergoing anatomic or reverse total shoulder arthroplasty (TSA). As more patients undergo CT imaging prior to planned arthroplasty, the number of incidental findings (IFs) will likely increase. The purpose of this study was to quantify the frequency of IFs on preoperative shoulder CT scans prior to TSA, describe common IFs, and report the incidence of further medical or imaging evaluation of those findings. A secondary aim was to identify patient characteristics associated with the identification of IFs on preoperative CT imaging prior to TSA. MethodsA retrospective, single-center cohort study of 385 patients undergoing planned TSA between 2018 and 2022 was performed. Patients who underwent a preoperative CT were included. Data were extracted from the electronic medical records for each included patient. Patient factors associated with increased IFs on CT were identified using univariate logistic regression model. A total of 385 patients who underwent 416 anatomic or reverse TSA procedures were included in analysis. Overall, 208 (50.0%) patients were found to have IFs on CT. Pulmonary IFs were the most common type of IF (58.2%). ResultsA total of 57 IFs (27.9%) were deemed actionable and required further evaluation. The most common action performed was a chest CT scan (47.4%). Three patients (5.3%) required further biopsy of IFs, and 4 patients (7.0%) required surgical intervention. Smoking history was significantly associated with both identification of IFs (P = .017) and with that finding being actionable (P = .037). Male gender was associated with a decreased likelihood of actionable IFs (OR = 0.41, P = .004). ConclusionsIFs on preoperative imaging for TSA are common and may require further evaluation. Most IFs are related to pulmonary pathology, and a concern for lung cancer prompted further work-up in some patients. For high-volume TSA centers, it may be beneficial to establish protocols for care based on common IFs.