Reliability of a novel 3-dimensional computed tomography method for reverse shoulder arthroplasty postoperative evaluation

Gabriel Venne; Michael Pickell; Randy E Ellis; Ryan T Bicknell

doi:10.1016/j.jses.2019.05.001

Reliability of a novel 3-dimensional computed tomography method for reverse shoulder arthroplasty postoperative evaluation

JSES Open Access. 2019 Jun 27;3(3):168-173. doi: 10.1016/j.jses.2019.05.001. eCollection 2019 Oct.

Authors

Gabriel Venne¹, Michael Pickell^{2

3}, Randy E Ellis^{2

3

4

5

6}, Ryan T Bicknell^{2

3

5}

Affiliations

¹ Department of Anatomy and Cell Biology, McGill University, Montréal, QC, Canada.
² Department of Surgery, Queen's University, Kingston, ON, Canada.
³ Kinston General Hospital, Kingston, ON, Canada.
⁴ Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.
⁵ Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada.
⁶ School of Computing, Queen's University, Kingston, ON, Canada.

Abstract

Background: Long-term function and survival of reverse shoulder arthroplasties (RSAs) are reliant on component positioning and fixation. Conventional postoperative analysis is performed using plain radiographs or 2-dimensional (2D) computed tomography (CT) images. Although 3-dimensional (3D) CT would be preferred, its use is limited by metal artifacts. This study proposes a new 3D CT method for postoperative RSA evaluation and compares its interobserver reliability with conventional methods.

Materials and methods: Preoperative and postoperative CT scans, as well as postoperative radiographs, were obtained from 18 patients who underwent RSA implantation; the scapula, implant, and screws were reconstructed as 3D CT models. The postoperative 3D scapula and implant were imported into preoperative coordinates and matched to the preoperative scapula. Standardized scapula coordinates were defined, in which the glenoid baseplate version and inclination angle were measured. The percentage of screw volume in bone was measured from a Boolean intersection operation between the preoperative scapula and screw models. Four independent reviewers performed the measurements using 3D CT and conventional 2D methods. Intraclass correlation coefficients (ICCs) were used to compare the reliability of the methods.

Results: The 3D CT method showed excellent reliability (ICC > 0.75) in baseplate inclination (ICC = 0.92), version (ICC = 0.97), and screw volume in bone (ICC = 0.99). Conventional 2D methods demonstrated poor reliability (ICC < 0.4). For radiographs, inclination showed poor reliability (ICC = 0.09) and the screw percentage in bone showed fair reliability (ICC = 0.54). Version was not measured with plain radiographs. For 2D CT slice measurements, inclination showed poor reliability (ICC = 0.02), version showed excellent reliability (ICC = 0.81), and the screw percentage in bone showed poor reliability (ICC = 0.28).

Conclusion: The new 3D CT-based method for evaluating RSA glenoid implant positioning and screw volume in bone showed excellent reliability and overcame the metal-artifact limitation of postoperative CT and 3D CT reconstruction.

Keywords: 2D imaging; 3D CT reconstruction; Postoperative evaluation; intraclass correlation coefficient; metal artifacts; reverse shoulder arthroplasty.