When daily life is put into the plan: what motion-simulation evidence suggests about CORIOGRAPH◊ Pre-Op Planning and Modeling Services for TSA

Key takeaways

• CORIOGRAPH Pre-Op Planning is positioned as the first TSA planner to assess impingement risk during activities of daily living (ADLs) while accounting for scapulothoracic mechanics.^1–6
• Full-body motion simulation highlights activities ADLs and scapulothoracic mechanics as clinically relevant considerations for TSA planning.^7,8
• Most current TSA planners focus on glenohumeral motion and may miss scapulothoracic contributions to impingement risk.⁹
• Impingement is implicated in two leading causes of TSA revision: instability and glenoid loosening.^10–12
• Registry data cited in the Evidence in Focus (EIF) indicate ~16–29% of revisions are due to loosening and ~22–35% due to instability (across anatomic and reverse TSA).¹²
  
  CORIOGRAPH Pre-Op Planning interface showing motion simulation and shoulder measurements

Planning has become exceptionally good at reading bone on CT. But patients are not static anatomy—they function through complex, everyday movements such as brushing their hair or fastening a seatbelt. Motion-simulation evidence suggests these activities of daily living, along with the scapulothoracic mechanics that support them, can influence when and whether impingement occurs.

What’s the planning gap today?

3D pre-op planning has advanced TSA by enabling precise analysis of bony anatomy. Yet the EIF highlights a key limitation: many current planning systems do not consider shoulder motion required for ADLs and may therefore provide a partial picture of post-op impingement risk. In reverse TSA planning specifically, the EIF notes most planners consider only glenohumeral motion and do not incorporate scapulothoracic orientation and motion.⁹

Evidence in focus: motion simulation at a glance

Study 1 (reverse TSA): In this simulation study, scapular-plane elevation was evaluated in reverse TSA virtual plans to examine how scapular orientation may influence impingement-free motion. The key takeaway is that scapulothoracic mechanics may materially affect the available range before impingement, reinforcing the value of assessing motion beyond static implant positioning.⁸

Key finding: greater scapular protraction angle correlated with impingement at lower humeral elevation (r = -0.5, p = 0.017), suggesting scapulothoracic posture can meaningfully shift the impingement threshold.⁸

Study 2 (anatomic + reverse TSA): CT scans from 10 patients were used to evaluate 20 virtual plans (10 anatomic, 10 reverse) across 240 ADL simulations. The study reported no single universal trend: impingement risk was impacted differently by common ADLs for anatomic versus reverse TSA.⁷

What this means in practice

Two implications stand out. First, scapulothoracic mechanics are not “noise”—they can be a driver. A moderate negative correlation between scapular protraction and attainable humeral elevation before impingement underscores how posture and scapular orientation can move the boundary of safe motion.⁸

Second, ADL-driven impingement is heterogeneous. The ADL simulation work suggests there isn’t one activity that predicts everything, and the same ADL can affect anatomic and reverse TSA differently. That nudges planning away from a single arc of motion and toward a portfolio of “real-life” tasks that matter to patients.⁷

Where CORIOGRAPH Pre-Op Planning fits

The EIF describes CORIOGRAPH Pre-Op Planning and Modeling Services as the first TSA planner to assess impingement risk during ADLs while accounting for scapulothoracic mechanics. It also describes support for both anatomic and reverse TSA cases and customization to surgeon-specific preferences, enabled by advanced planning tools and patient-level personalization.^1–6

Take-home question

Before you finalize the plan, ask: “Have I tested this construct in the movements my patient needs, accounting for the scapula, not just the glenohumeral joint?” If the answer is no, you may be optimizing alignment without stress-testing impingement risk where it actually shows up: in daily life.

About the CORIOGRAPH Pre-Op Planning and Modeling Services for Shoulder TSA

CORIOGRAPH Pre-Op Planning and Modeling uses biomechanical simulation to help evaluate impingement risk during ADLs, accounting for scapulothoracic mechanics. It supports planning for both anatomic and reverse TSA and provides outputs aligned to surgeon preferences.^1–6

Find out more about the AETOS^◊ Shoulder System:

AETOS System for healthcare professionals:

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