Scapular notching in reverse shoulder arthroplasty

Lévigne, Christophe; Boileau, Pascal; Favard, Luc; Garaud, P.; Molé, Daniel; Sirveaux, François; Walch, Gilles

doi:10.1016/j.jse.2008.02.010

Cited by 477 publications

(401 citation statements)

References 19 publications

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“…It may be argued the prevalence and severity of inferior scapular notching increase over time. Experience to date with our current technique is that notches are typically evident on imaging studies at 6 months postoperatively and do not show progression, at least at a minimum followup of 2 years [13,21]. A potential argument is that inferior placement of the glenosphere prevents scapular notching with standard RSA [17,27].…”

Section: Discussionmentioning

confidence: 99%

“…We made no attempt to determine the reliability of the observations; when differences in assessments were noted, the two observers reached a consensus. Postoperative plain radiographic assessment was performed using fluoroscopy and magnification control, according to the recommendations of Lévigne et al [21], to align the central radiographic beam and be tangent to the posterior surface of the baseplate. Analysis of CT scans was performed using the Osirix 1 software (Pixmeo, Geneva, Switzerland).…”

Section: Patients and Materialsmentioning

confidence: 99%

“…Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. [5,6,13,16,21,22,27,29,37,40,41]. Inferomedial impingement of the humeral insert against the pillar of the scapula during adduction and rotation of the arm is responsible for bone erosion and polyethylene wear (known as ''inferior scapular notching'') and has been observed in 50% to 96% of postoperative radiographs [6,7,27,29,30,32,36,41].…”

Section: Introductionmentioning

confidence: 99%

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Bony Increased-offset Reversed Shoulder Arthroplasty: Minimizing Scapular Impingement While Maximizing Glenoid Fixation

Boileau

Moineau

Roussanne

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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413

326

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Background Scapular notching, prosthetic instability, limited shoulder rotation and loss of shoulder contour are associated with conventional medialized design reverse shoulder arthroplasty. Prosthetic (ie, metallic) lateralization increases torque at the baseplate-glenoid interface potentially leading to failure. Questions/purposes We asked whether bony lateralization of reverse shoulder arthroplasty would avoid the problems caused by humeral medialization without increasing torque or shear force applied to the glenoid component. Patients and Methods We prospectively followed 42 patients with rotator cuff deficiency treated with bony increased-offset reverse shoulder arthroplasty. A cylinder of autologous cancellous bone graft, harvested from the humeral head, was placed between the reamed glenoid surface and baseplate. Graft and baseplate fixation was achieved using a lengthened central peg (25 mm) and four screws. Patients underwent clinical, radiographic, and CT assessment at a minimum of 2 years after surgery. ResultsThe humeral graft incorporated completely in 98% of cases (41 of 42) and partially in one. At a mean of 28 months postoperatively, no graft resorption, glenoid loosening, or postoperative instability was observed. Inferior scapular notching occurred in 19% (eight of 42). The absolute Constant-Murley score improved from 31 to 67. Thirty-six patients (86%) were able to internally rotate sufficiently to reach their back over the sacrum. Conclusions Grafting of the glenoid surface during reverse shoulder arthroplasty effectively creates a long-necked scapula, providing the benefits of lateralization. Bony increased-offset reverse shoulder arthroplasty is associated with low rates of inferior scapular notching, improved shoulder rotation, no prosthetic instability and improved shoulder contour. In contrast to metallic lateralization, bony lateralization has the advantage of maintaining the prosthetic center of rotation at the prosthesis-bone interface, thus minimizing torque on the glenoid component.

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Section: Discussionmentioning

confidence: 99%

Section: Patients and Materialsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bony Increased-offset Reversed Shoulder Arthroplasty: Minimizing Scapular Impingement While Maximizing Glenoid Fixation

Boileau

Moineau

Roussanne

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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413

326

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“…The variables in the current prostheses have been developed to address concerns that have arisen with reverse shoulder arthroplasty. The persistent problems and high complication rate with this procedure have been described extensively in the current literature, with complications including hematoma formation [48], infection [5,15,18,45,48,49], scapular notching [28,44,45,49], instability [18,48,49], acromial insufficiency [15,48], and glenoid component failures [14,17,42,45]. Additionally, complications and patient satisfaction vary among primary cuff tear arthroplasty, revision cases, and fractures [5,15,18,45,48,49].…”

Section: Discussionmentioning

confidence: 99%

A History of Reverse Total Shoulder Arthroplasty

Flatow

Harrison

2011

Clinical Orthopaedics &Amp; Related Research

189

108

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Background Management of the cuff-deficient arthritic shoulder has long been challenging. Early unconstrained shoulder arthroplasty systems were associated with high complication and implant failure rates. The evolution toward the modern reverse shoulder arthroplasty includes many variables of constrained shoulder arthroplasty designs. Questions/purposes This review explores the development of reverse shoulder arthroplasty, specifically describing (1) the evolution of reverse shoulder arthroplasty designs, (2) the biomechanical variations in the evolution of this arthroplasty, and (3) the current issues relevant to reverse shoulder arthroplasty today. Methods Using a PubMed search, the literature was explored for articles addressing reverse shoulder arthroplasty, focusing on those papers with historical context. Results Results of the early designs were apparently poor, although they were not subjected to rigorous clinical research and usually reported only in secondary literature. We identified a trend of glenoid component failure in the early reverse designs. This trend was recognized and reported by authors as the reverse shoulder evolved.Authors reported greater pain relief and better function in reverse shoulder arthroplasty with the fundamental change of Grammont's design (moving the center of rotation medially and distally). However, current reports suggest lingering concerns and challenges with today's designs. Conclusions The history of reverse shoulder arthroplasty involves the designs of many forward-thinking surgeons. Many of these highly constrained systems failed, although more recent designs have demonstrated improved longevity and implant performance. Reverse shoulder arthroplasty requires ongoing study, with challenges and controversies remaining around present-day designs.

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“…Incorrect placement of the glenosphere can lead to early catastrophic baseplate failure, instability, and scapular notching which may be a cause secondary implant loosening and functional decline [34]. The incidence of these complications can be mitigated by placing the glenoid baseplate on the inferior aspect on the glenoid, centered in the anterior/posterior sagittal plane, as close to neutral tilt as possible with avoidance of superior tilt [35]. Glenosphere placement too superior or in excessive anteversion or retroversion can predispose the component to scapular notching or impingement.…”

Section: Common Failure Mechanisms Of and Difficulties In Shoulder Armentioning

confidence: 99%

Planning software and patient-specific instruments in shoulder arthroplasty

Wylie

Tashjian

2016

Curr Rev Musculoskelet Med

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Computer planning software and patient-specific instrumentation have been investigated in multiple subspecialties of orthopedics with mixed results. Shoulder arthroplasty has evolved over the last decade with improvements in implant design and surgical instrumentation. Despite these advances, glenoid positioning in shoulder arthroplasty continues to be a difficult problem. Recent advances in threedimensional imaging techniques and the use of computer planning software may potentially address some of the common difficulties encountered by surgeons. The addition of patient-specific instrumentation and guides provide an option for patients with significant glenoid deformity that may allow improved accuracy of glenoid component implantation compared to using standard instrumentation. Studies have reported improved positioning of the glenoid component in both anatomic and reverse total shoulder arthroplasty with patientspecific instrumentation and guides. More research is needed to determine whether these improvements lead to better patient-reported outcomes or implant survival. In addition, further studies will be needed to address whether this technology is cost effective for large-scale implementation in the orthopedic community.

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Scapular notching in reverse shoulder arthroplasty

Cited by 477 publications

References 19 publications

Bony Increased-offset Reversed Shoulder Arthroplasty: Minimizing Scapular Impingement While Maximizing Glenoid Fixation

Bony Increased-offset Reversed Shoulder Arthroplasty: Minimizing Scapular Impingement While Maximizing Glenoid Fixation

A History of Reverse Total Shoulder Arthroplasty

Planning software and patient-specific instruments in shoulder arthroplasty

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