Automated three-dimensional measurements of version, inclination, and subluxation

Abstract

Background: Preoperative planning software has been developed to measure glenoid version, glenoid inclination, and humeral head subluxation on computed tomography (CT) for shoulder arthroplasty. However, most studies analyzing the effect of glenoid positioning on outcome were done prior to the introduction of planning software. Thus, measurements obtained from the software can only be extrapolated to predict failure provided they are similar to classic measurements. The purpose of this study was to compare measurements obtained using classic manual measuring techniques and measurements generated from automated image analysis software.

Methods: Ninety-five two-dimensional computed tomography scans of shoulders with primary glenohumeral osteoarthritis were measured for version according to Friedman method, inclination according to Maurer method, and subluxation according to Walch method. DICOM files were loaded into an image analysis software (Blueprint, Wright Medical) and the output was compared with values obtained manually using a paired sample t-test.

Results: Average manual measurements included 13.8° version, 13.2° inclination, and 56.2% subluxation. Average image analysis software values included 17.4° version (3.5° difference, p < 0.0001), 9.2° inclination (3.9° difference, p < 0.001), and 74.2% for subluxation (18% difference, p < 0.0001).

Conclusions: Glenoid version and inclination values from the software and manual measurement on two-dimensional computed tomography were relatively similar, within approximately 4°. However, subluxation measurements differed by approximately 20%.

Keywords: Walch classification; glenohumeral arthritis; glenoid inclination; glenoid version; humeral head subluxation; shoulder arthroplasty.

Figure 1.

Lines and angles used for measurements of glenoid version (a), glenoid inclination (b), and humeral head subluxation (c).

Figure 2.

Representative example of the values provided by the automated software analysis software investigated in this study (Blueprint, Wright Medical, Memphis, TN).