In shoulder arthroplasty, three-dimensional computed tomography (3D CT) has become the gold standard for preoperative version assessment. Meanwhile, postoperative version is usually evaluated using radiographs (XR), in particular an axillary view, in which the view of the scapular body is often truncated, preventing the scapular plane from being used as a reference.
Forty-six shoulders were studied. Four angles were measured including 3D CT (CT Version), 3D CT PLAC line to glenoid face angle (CT PLAC-GFA), 2) radiographic PLAC line to glenoid face angle (XR PLAC-GFA), and 3) the radiographic glenoid vault line to glenoid face angle (XR GV-GFA). Variation and linear relationship between these angles were calculated.
The key findings of the study were:
• Of the 46 patients, 27 (59%) were male.
• The mean age at the time of surgery was 62.6 years old (IQR = 12.1, 57.1 to 69.3).
• The primary indication for arthroplasty was osteoarthritis (46%). Of the osteoarthritic shoulders, the primary glenoid morphology was Walch B2 (50%)
• The mean difference between CT PLAC-GFA and XR PLAC-GFA was 1.0º (95% CI -0.7 to 2.8) (IQR = 8.5º, -3.0º to 5.4º), with a strong correlation on linear regression (R2 = 0.76, p < 0.001).
• XR PLAC-GFA and XR GV-GFA demonstrated strong correlations with CT measured version (R2 = 0.72 and 0.70, respectively; p < 0.001).
• Inter-rater reliability was excellent for all metrics (ICC ≥ 0.93).
The authors opined – “In conclusion, the PLAC and glenoid vault lines offers reliable references for assessing glenoid orientation on a standard axillary radiograph. Their reliability and reproducibility suggest that they can serve as standalone, cost-effective, and radiation-sparing alternatives for the comparison of pre and postoperative glenoid orientation. Additionally, by establishing the relationship of the patient’s scapular axis and PLAC line on 3D CT, the radiographic measures can be transformed into measures of absolute version, and can provide an accurate estimate of postoperative version without obtaining a postoperative CT. Future studies should focus on validating its clinical utility across broader patient populations and exploring its role in understanding postoperative implant positioning.”
Further reading:
Assessing glenoid orientation on the axillary view: a novel technique using the posterolateral acromion‑to‑coracoid line
Michael Hachadorian et al
International Orthopaedics
https://doi.org/10.1007/s00264-025-06661-7
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