Surgeon variation in the use of pre-operative imaging, 3D-based planning, and enabling technologies in shoulder arthroplasty

Background: 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. Methods: 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 pre-operative advanced imaging (computed tomography [CT], magnetic resonance imaging), 3D CT-based planning for primary and revision arthroplasty, and intraoperative enabling technologies (patient-specific instrumentation, navigation, mixed/augmented reality, robotics). Routine use was defined as ≥75% of cases. Associations between surgeon characteristics and low use of 3D planning (