The Templating Software Spectrum: Unveiling Variations in the 3D Assessment of Glenoid Morphology in Shoulder Arthroplasty Planning

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Introduction Three-dimensional (3D) computed tomography planning improves preoperative quantification of glenoid morphology when planning total shoulder arthroplasty, but measurement reliability across commonly used planning platforms remains uncertain. Methods A retrospective within-subject comparison of 30 shoulders was planned on four systems: Stryker Blueprint (BP), Zimmer Signature (ZS), Exactech Equinoxe (EE), and SurgiCase Materialise (MS). Measurements of retroversion and inclination were analysed to evaluate measurement variability and correlations between systems. Results Retroversion medians (IQR) were BP -6.5 (10.75), ZS -6.0 (7.0), EE -5.5 (7.0), and MS -3.5 (19.5); overall p=0.37. MS showed greater dispersion and weak correlations with other systems (ρ≈0.03-0.07). Inclination means (SD) were BP 5.93 (8.13), ZS 1.28 (7.27), EE 3.53 (7.57), MS 6.00 (5.07); overall p<0.001. All paired contrasts were significant except for BP vs. MS (-0.07, 95% CI -2.14 to 2.01; p=0.948). Inter-system inclination correlations were strong among BP, EE, and ZS (r≈0.80-0.90) and moderate to strong for MS vs. others (r≈0.57-0.75). Conclusion Platforms were not fully interchangeable. Retroversion showed no group-level bias but reduced precision, particularly for MS, while inclination was highly precise yet displayed platform-specific level differences (notably lower with ZS). Based on this, threshold-adjacent decisions (augment selection, baseplate tilt) may vary by platform. Verification of retroversion outliers and confirmation of inclination near boundaries are recommended.

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