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Surgeon Variation in the Use of Preoperative Imaging, 3D-Based Planning, and Enabling Technologies in Shoulder Arthroplasty
Journal article   Open access   Peer reviewed

Surgeon Variation in the Use of Preoperative Imaging, 3D-Based Planning, and Enabling Technologies in Shoulder Arthroplasty

Mariano E. Menendez, George S. Athwal, Evan Lederman, Patrick J. Denard, Frederick A. Matsen, John G. Costouros, Brett M. Andres, Michael A. Stone, Anshuman Singh, Christopher L. Sheu, …
Journal of shoulder and elbow arthroplasty, 100009
02/27/2026
DOI: 10.1016/j.jsea.2026.100009
PMCID: PMC13058280
PMID: 41960150
url
https://doi.org/10.1016/j.jsea.2026.100009View
Published (Version of record) Open Access

Abstract

Conference narratives and publications frequently portray widespread utilization of advanced imaging, 3D-based planning, and enabling technologies in shoulder arthroplasty, but surgeon adoption in day-to-day practice is not well characterized. This study sought to characterize surgeon variation in the use of these tools, delineate perceived benefits and barriers to 3D planning, and identify surgeon characteristics associated with lower utilization. A 16-question survey was created using Google Forms and distributed to 161 shoulder surgeons members of the PacWest Shoulder and Elbow Society. The survey asked questions regarding fellowship training, years in practice, practice type, surgical volume, and patterns of preoperative advanced imaging (computed tomography [CT], magnetic resonance imaging [MRI]), 3D CT–based planning for primary and revision arthroplasty, and intraoperative enabling technologies (patient-specific instrumentation [PSI], navigation, mixed/augmented reality, robotics). Routine use was defined as ≥75% of cases. Associations between surgeon characteristics and low use of 3D planning (<25% of cases) were evaluated. In total, 53% of surgeons completed the survey (85 of 161). Preoperative CT was routinely obtained by 71% of surgeons. Routine acquisition of both CT and MRI was uncommon (9.5%). Routine 3D planning was reported by 60% for primary arthroplasty, with 25% never or rarely using it. Routine 3D planning for revision cases was reported by 47%. Routine use of PSI guides was infrequent (15%), and there was low adoption of navigation (13%), mixed reality (7%), and robotics (6%). Interest in robotics was high (62%), most often motivated by perceived gains in implant accuracy. There was no consensus on whether 3D planning is standard of practice (55% yes, 45% no). Reported benefits of 3D planning included implant accuracy (91%), fewer outliers (67%), education (33%), and operative time savings (32%). Barriers included imaging acquisition/protocol issues (68%) and time required to plan (47%). Surgeons in practice >10 years were more likely to report low utilization of 3D planning (p=0.034). Preoperative CT and 3D–based planning are common but not universal—with about 30% and 40% of surgeons not routinely using them, respectively—highlighting practice heterogeneity and a disconnect between scholarly discourse and day-to-day practice. Use of CT-based enabling technology is low, but there is interest in the nascent field of robotics. Practice variation appears shaped by workflow constraints, evidentiary uncertainty, and surgeon-specific beliefs and experience. Research that connects planning and its execution to patient outcomes is warranted as it may change the value proposition. IV, survey.
 Computed Tomography Advanced Imaging Planning Practice Variation Shoulder Arthroplasty Shoulder Replacement

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