UCSF

Background

Evaluation of glenoid bone loss is critical in preoperative planning, as bone loss >13.5% has been associated with worse clinical outcomes. While 3-dimensional computed tomography (3D CT) and the Pico method have been the gold standard in bone loss evaluation, it is unclear how most orthopaedic surgeons evaluate for bone loss in practice.

Purpose

To investigate the techniques used by orthopaedic surgeons to measure glenoid bone loss.

Study design

Cross-sectional study.

Methods

A 12-question survey was sent to members of the AOSSM and Arthroscopy Association of North America. This survey included questions regarding the participants demographic information, typical surgical practice and volume, and glenoid bone loss identification method. Friedman testing with multiple comparisons using Bonferroni correction was used to evaluate the ordinal variable, use frequency, while Kruskal-Wallis testing and Spearman correlations were used to evaluate the role of surgeon demographic factors on method usage.

Results

Overall, 171 orthopaedic surgeons responded to the survey. Participating surgeons were from a variety of locations, practice settings, and years in practice; 91.1% of respondents said that they routinely measure glenoid bone loss. The imaging modality most commonly used for bone loss evaluation was 3D CT, followed by 2-dimensional (2D) magnetic resonance imaging, then 2D CT and radiographs. Percentage diameter loss was the most commonly used method of bone loss evaluation. The intraoperative probe length method was used occasionally, the Pico method was used rarely, and the chord length method was never used. There was no significant effect of time in practice or practice location on bone loss methods used. Surgeons in private practice (P = .022) or other settings (P = .015) had a higher frequency of using the intraoperative probe length method compared with those in the military.

Conclusion

Overall, this study highlights the inconsistency in surgeon evaluation of glenoid bone loss in shoulder instability, despite good evidence of its clinical importance, especially in preventing recurrent instability. This lack of consistency may be mitigated with the establishment of best practice guidelines or accepted algorithms for evaluation and assessment of glenoid bone loss in shoulder instability.