Scapular Notching in Reverse Shoulder Arthroplasty: Is It Important to Avoid It and How?

Lévigne, Christophe; Garret, Jérôme; Boileau, Pascal; Alami, Ghassan B.; Favard, Luc; Walch, Gilles

doi:10.1007/s11999-010-1695-8

Cited by 245 publications

(164 citation statements)

References 14 publications

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“…In our series, patients who had a better pre-operative ROM and therefore a greater post-operative ROM were more at risk for developing a scapular notch [30]. This was also true for patients with a BMI <30, which is in agreement with previous studies [14,29].…”

Section: Discussionsupporting

confidence: 92%

“…Except for a lower risk of notching in obese patients, BMI did not influence the rate of complications in our series as opposed to results reported by Gupta et al [21]. However, as opposed to reports in previous publications [30,38,40], we found no influence of scapular notching on postoperative active ROM or on complication rates; however, as with Favard et al [15], our results confirmed the deleterious effect of superior tilt.…”

Section: Discussioncontrasting

confidence: 54%

“…This approach induces medialisation of the centre of rotation (COR) and a lowering of the humerus, leading to an increase of the deltoid-moment arm, which restored good elevation in pseudoparalytic shoulders. This Grammont design yields satisfactory functional results, but numerous publications demonstrated that this improvement in elevation comes at a price [2,13,27,29,30,33,38,40,43,44,48]: loss of medial and lateral rotation [23,25], loss of shoulder contour, risk of instability and a high percentage of scapular notching. The latter complication is reported in around 75 % of cases [2,15,43] and up to 96 % in some series [48], and it can be observed as early as three to six months postoperatively [34,40,43].…”

Section: Introductionmentioning

confidence: 99%

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Does lateralisation of the centre of rotation in reverse shoulder arthroplasty avoid scapular notching? Clinical and radiological review of one hundred and forty cases with forty five months of follow-up

Katz¹,

Valenti²,

Kany³

et al. 2015

International Orthopaedics (SICOT)

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Purpose Our purpose was to evaluate the influence of metallic lateralisation of the centre of rotation (COR) in reverse shoulder arthroplasty (RSA) on the incidence of scapular notching and its eventual clinical and radiological consequences. Methods We analysed 140 RSAs with a lateralised design (Arrow, FH Orthopedics, Mulhouse, France) implanted for massive rotator cuff tear with/without arthritis. Mean followup was 45 months (range 24-120, standard deviation 20). Patients were evaluated clinically using the Constant and Murley (Clin Orthop Relat Res 214:160-164, 1987) score and active range of motion (ROM) and radiologically using standard anteroposterior and axillary view. Scapular notching was assessed according to Sirveaux classification Simovitch et al. (J Bone Joint Surg Am, 89:588-600, 2007), and patients were separated into two groups (scapular notch/no scapular notch) and compared. Results Forty-one notches (29 %) were found: 20 grade 1, 18 grade 2, and three grade 3. The latter three patients had a follow-up of 44, 70 and 84 months, respectively, and the scapular notch did not evolve in the final two years. Better preoperative function was significantly associated with scapular notching (p<0,05 for flexion and abduction), but no final clinical differences in ROM and Constant score were found between groups. A body mass index (BMI) <30 increased the risk of scapular notching, which was observed in 43 % of patients with a BMI<30 and 30 % of patients with a BMI> 30 p=0,048). Pre-operative narrowing of the subacromial space increased the risk of scapular notching, but age or gender showed no influence. However, there was a significantly greater number of scapular notches in patients operated on the dominant side (p=0,04). No significant difference in lateral offset was found between groups (p=0,99). Glenoid implantation in an excessively high position (p=0,033) and absence of inferior tilt (p=0,0029) were significantly associated with scapular notching. Conclusions In this series, metallic lateralisation of the COR in RSA did not impair clinical results, with patients achieving good flexion recovery ROM increase in rotations. Metallic lateralisation of the COR in RSA leads to a lower incidence of scapular notching (29 %) compared with previously reported results using other arthroplastic systems with a more medialised COR. However, although scapular notching was not totally eliminated, those that were found did not evolve over time. Several factors increased the incidence of scapular notching: BMI <30, better preoperative ROM, an excessively high glenoid implant and absence of inferior tilt.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

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Does lateralisation of the centre of rotation in reverse shoulder arthroplasty avoid scapular notching? Clinical and radiological review of one hundred and forty cases with forty five months of follow-up

Katz¹,

Valenti²,

Kany³

et al. 2015

International Orthopaedics (SICOT)

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“…However, SN did not influence the clinical or the radiological outcome. This concurs with the findings of Lévigne et al [10]. On the other hand, Simovitch et al [8] found that SN resulted in poorer outcome.…”

Section: Discussionsupporting

confidence: 90%

“…The distance between the two lines was calculated and values more than 0 mm were regarded as overhang. Glenoid baseplate inclination was described as the angle between the baseplate and a horizontal line drawn from the upper margin of the glenoid as recommended by Lévigne et al [10] (Fig. 1c).…”

Section: Methodsmentioning

confidence: 99%

Clinical and radiological outcome of the Total Evolutive Shoulder System (TESS®) reverse shoulder arthroplasty: a prospective comparative non-randomised study

Kadum

Mukka

Englund

et al. 2014

International Orthopaedics (SICOT)

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Purpose The aims of this study were to assess the function and quality of life after the Total Evolutive Shoulder System (TESS) reverse shoulder arthroplasty (RSA), to evaluate the radiological stability of the stemless version and to address the effect of arm lengthening and scapular notching (SN) on the outcome. Methods This was a prospective comparative nonrandomised study. A total of 37 consecutive patients (40 shoulders) underwent TESS RSA between October 2007 and January 2012; 16 were stemless and 26 were stemmed. At a mean follow-up of 39 months (15-66), we evaluated range of motion (ROM), pain and functional outcome with QuickDASH and quality of life with EQ-5D score. Radiologically, component positioning, signs of loosening, SN and arm length difference were documented. Results We found a significant improvement in functional outcome and reduction of pain in both stemmed and stemless groups. No humeral loosening was evident, but there were four glenoid loosenings. In 12 shoulders that developed SN, seven already had scapular bone impression (SBI) evident on initial post-operative radiographs. Glenoid overhang seemed to decrease the risk of SN. Arm lengthening was associated with better EQ-5D but did not influence ROM or functional outcome.Conclusions Reverse shoulder arthroplasty markedly improved shoulder function. SN is of concern in RSA, but proper positioning of the glenoid component may prevent its development.

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3D image‐based morphometric analysis of the scapular neck length in subjects undergoing reverse shoulder arthroplasty

et al. 2017

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Scapular notching after RSA may, in part, be related to a patient's scapular morphology. The purpose of this study was to develop a novel 3 D measurement technique to describe infraglenoid tubercle morphometry. We hypothesize that the parameters describing infraglenoid tubercle would be normally distributed and would correlate with individual's demographics and glenoid morphometry. A group of 110 subjects treated with RSA were evaluated. Scapular geometry was obtained from pre-operative CT scans. The scapular neck length was defined in anterior and posterior view as the orthogonal distance between the glenoid surface and (a) the point of most significant change of curvature on lateral pillar; (b) the most lateral portion of the infraglenoid tubercle. Scapular neck angle, maximum anatomical adduction angle, glenoid width, height and version were also measured. Scapular neck length measured in the anterior and posterior view were normally distributed with mean values of 17.6 6 2.8 mm and 7.9 6 2.5 mm, respectively. Scapular neck angle was on average 112.4 6 10.68 and maximal adduction angle was 17.6 6 2.88. No significant associations between infraglenoid tubercle morphometric parameters, demographic, glenoid size or version were identified. Improved understanding of the patient-specific risk factors for scapular notching will help surgeons with pre-surgical planning and implant selection. Parametrization of the infraglenoid tubercle presented in this study showed normal distribution in the population unrelated to gender, side or demographics. The size of the infraglenoid tubercle is a unique trait, pre-operative evaluation of the scapular neck should be always warranted to decrease the incidence of post-operative notching. Clin. Anat. 31:43-55,

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Scapular Notching in Reverse Shoulder Arthroplasty: Is It Important to Avoid It and How?

Abstract: Level IV, Therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 245 publications

References 14 publications

Does lateralisation of the centre of rotation in reverse shoulder arthroplasty avoid scapular notching? Clinical and radiological review of one hundred and forty cases with forty five months of follow-up

Does lateralisation of the centre of rotation in reverse shoulder arthroplasty avoid scapular notching? Clinical and radiological review of one hundred and forty cases with forty five months of follow-up

Clinical and radiological outcome of the Total Evolutive Shoulder System (TESS®) reverse shoulder arthroplasty: a prospective comparative non-randomised study

3D image‐based morphometric analysis of the scapular neck length in subjects undergoing reverse shoulder arthroplasty

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