Use of preoperative advanced imaging for reverse total shoulder arthroplasty

Abstract

BackgroundIn order to avoid implant related complications related to glenosphere malposition, there has been an increased interest in the use of advanced imaging, including computed tomography (CT) and magnetic resonance imaging (MRI) for preoperative planning and patient-specific instrumentation for reverse shoulder arthroplasty (RSA). While recent literature has demonstrated improved component position when this technology is applied, the clinical benefits remain largely hypothetical and unproven. Thus, the goals of the current study were to utilize a national database to describe current trends in the use of preoperative advanced imaging and investigate the relationship between such imaging and postoperative complications compared to matched controls without any preoperative imaging. MethodsPatients undergoing RSA for non-fracture indications were identified within the Mariner dataset within the PearlDiver database from 2010 to 2018Q2. Patients who underwent preoperative advanced imaging (MRI and/or CT) within a year prior to surgery were then identified as study cohorts. A matched cohort undergoing RSA without preoperative advanced imaging was created for comparison purposes. The incidence of imaging over time and rates of loosening/osteolysis, periprosthetic fracture, prosthetic dislocation, and revision shoulder arthroplasty of all groups were compared using a regression analysis. ResultsThe percentage of patients who underwent preoperative CT (141% increase, P < .0001), and either MRI or CT (107% increase, P = .002) increased significantly during the study period, while there was no significant increase in MRI utilization (P = .122). Patients who underwent preoperative CT experienced significantly lower rates of revision shoulder arthroplasty (2.4% vs. 3.3%, OR = 0.72, P = .004) and periprosthetic dislocation (2.8% vs. 3.3%, OR 0.80, P = .039) within 2 years of RSA compared to patients who did not undergo preoperative CT, while preoperative MRI was associated with significantly lower rates of periprosthetic fracture (0.2% vs. 0.4%, OR 0.44, P = .005), revision shoulder arthroplasty (2.1% vs. 2.6%, OR = 0.75, P = .006), and periprosthetic dislocation (2.5% vs. 3.2%, OR 0.78, P = .003) within 2 years of RSA compared to patients without an MRI. ConclusionThere has been a significant increase in the utilization of preoperative CT as compared to MRI for RSA during the time period studied. The utilization of preoperative advanced imaging may be associated with a statistically significant reduction in multiple implant related complications following RSA for non-fracture indications, although these findings are of unclear clinical significance given limitations of the database and low percentage difference in complication rates.Level of Evidence: Level III