Introduction: The use of three-dimensional (3-D) preoperative planning and patient specific surgical instrumentation (PSI) have been shown to improve surgeon accuracy in achieving desired glenoid implant position during total shoulder arthroplasty (TSA). While a number of PSI tools are currently available for glenoid guide pin placement in TSA, no studies to date have compared technologies against each other. The purpose of this study is to evaluate the use of 3-D preoperative planning with and without the use of different PSI tools in TSA to compare the accuracy of glenoid component placement across groups and to historical controls using standard two-dimensional (2-D) imaging and standard instrumentation. We hypothesize that the use of PSI technology will improve accuracy compared to standard instrumentation with standard 2-D imaging or 3-D preoperative planning alone, particularly in cases with more severe preoperative glenoid pathology.