A radiographic analysis of the effects of prosthesis design on scapular notching following reverse total shoulder arthroplasty

Decreased scapular notching with lateralization and inferior baseplate placement in reverse shoulder arthroplasty with high humeral inclination

“…similarly found a lower incidence of notching in a prosthesis with a lower neck-shaft angle and a lateralized center of rotation in a recent study. [23] Based on our data and other recent studies, it appears that both humeral inclination angle and lateralized center of rotation may decrease the presence of any notching, and in particular decrease the presence of clinically significant advanced scapular notching.…”

Elucidating trends in revision reverse total shoulder arthroplasty procedures: a retrieval study evaluating clinical, radiographic, and functional outcomes data

“…20 Scapular notching, a frequent radiographic finding in RTSA with a reported incidence as high as 92%, 13,42 is the result of mechanical impingement between the medial rim of the humerosocket and the lateral border of the scapula during adduction, which has been associated with factors related to implant design, surgical technique, and patient characteristics. 2,30,32,36,53 Despite the suspected causal relationship between mechanical impingement, PE wear, and osteolysis with notch progression, as proposed by Nyffeler et al, 46 clinical studies have failed to convincingly correlate scapular notching, especially lower grade notching (Sirveaux 54 grades 1 and 2), with significant pain or dramatic changes in functional outcomes 30,36,65 ; however, in advanced cases of notching, component loosening has been reported. 53 A positive correlation between the term of implantation of the RTSA device and the severity of scapular notching was found in our study, suggesting a progressive phenomenon similar to that reported by Levigne et al 35 in their series of 337 shoulders.…”

Reverse total shoulder arthroplasty: a biomechanical evaluation of humeral and glenosphere hardware configuration

“…4,33,43 Surgical/implant factors affecting outcomes include both technical factors (e.g., glenosphere positioning and tilt, humeral and glenosphere version) and implant-related factors (e.g., glenosphere diameter and lateral offset, humeral offset and rotation, polyethylene insert eccentricity, constraint and thickness). 3,9,16,[20][21][22][25][26][27][31][32][33] Surgeons should consider the effect of hardware selection and placement because excessive tension or offset after reverse arthroplasty may be associated with deltoid-related pain, restriction in motion, or acromial fractures. 8,14,34,42,50 To the contrary, insufficient tension or offset may be associated with instability or increased risk for scapular notching.…”