In the absence of reliable evidence, it is the opinion of the work group that patients with glenohumeral osteoarthritis undergoing arthroplasty should be imaged with axillary and true AP (Grashey view) radiographs, with advanced imaging performed at the discretion of the clinician


Pre-operative evaluation of patients undergoing shoulder arthroplasty helps to define osseous anatomy, pathology and potential component positioning. In addition to other radiographic projections, well-positioned True AP (Grashey) and axillary radiographs will evaluate glenohumeral cartilage space narrowing, joint congruity and joint subluxation. Axillary radiographs will also provide information on glenoid morphology and bone stock. If there are clinical concerns for rotator cuff compromise, MRI, ultrasound or CT arthrogram could be considered. While utilization of pre-operative planning with 3D CT imaging with or without patient-specific instrumentation has been shown to improve accuracy of desired implant position, there is inadequate data to determine how this affects long term clinical outcomes.


Strength of Evidence (evidence quality): No reliable evidence


Benefits & Harms:

Ordering physicians should be mindful of radiation doses associated with pre-operative planning CT examinations.


Future Research:

High quality evidence is needed to evaluate if improved clinical outcomes are associated with more accurate arthroplasty component positioning.


The Future of OrthoGuidelines


The OrthoGuidelines Process