Scapular Notching in Reverse Total Shoulder Arthroplasty

Friedman, Richard J.; Barcel, D. Anthony; Eichinger, Josef K.

doi:10.5435/jaaos-d-17-00026

Cited by 106 publications

(91 citation statements)

References 38 publications

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“…Athwal et al [18] have reported 62% notching rate with 25 mm glenoid base plate (without bony increased offset) in their series which is near to our rate of notching (60.5%). Many studies have shown reduction in notching and higher impingement free adduction with larger glenosphere of diameter 42 or 44 mm rather than 36 or 38 mm diameter glenosphere which may also explain the notching rate in our study [19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 77%

Clinical and Radiological Outcomes of Bony Increased Offset-Reverse Total Shoulder Arthroplasty in the Asian Population

Tankshali¹,

Ji²,

Park³

et al. 2020

Preprint

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Background: Bony increased offset-reverse total shoulder arthroplasty (BIO-RSA) was proposed which uses autograft harvested from the patient’s humeral head to lateralize the glenoid baseplate. This technique provided the lateralization of the center of rotation and the reduction of the scapular notching. Few studies have reported outcomes of BIO-RSA in the Asian population. We reported the first report of clinical and radiological outcomes of BIO-RSA in the Asian population at mid-term follow-up. Methods: From June 2012 to August 2017, a total 38 patients with average age of 73±6 years operated by the BIO-RSA technique with minimum two-year follow-up (average 36.7±16 months) were enrolled in our study. Indications of the BIO-RSA were rotator cuff tear arthropathy, massive irreparable cuff tear without osteoarthritis, primary osteoarthritis with glenoid defect, recurrent shoulder dislocation with massive cuff tear, and glenoid fracture sequela. We excluded patients with acute proximal humerus fracture, avascular necrosis and revision RSA performed using allo- or autograft. We evaluated clinical and radiological outcomes of BIO-RSA at the last follow-up. Results: VAS, ASES, UCLA, and SST scores improved significantly from preoperative (average-5, 39.4, 16.2, 3.9) to postoperative (average- 1.7, 78.9, 28.3, 7.8, p-value < 0.05). All range of motion except internal rotation improved significantly at the last follow-up (p-value <0.05) and the bone graft was incorporated with the native glenoid in all the cases (100%). However, scapular notching was observed in 23/38 (60.5%) of patients. Intraoperative complications were three metaphyseal fractures and one inferior screw malpositioning. Postoperative complications included one heterotropic ossification, one scapula neck stress fracture, one humeral stem loosening, and one late infection. Conclusions: BIO-RSA results in improved clinical outcomes at mid-term follow-up in the Asian population. Although better cosmesis and advantage of glenoid lateralization were observed in our study along with similar complications rates as compared to conventional RTSA, we observed higher rates of scapular notching to previously reported rates in BIO-RSA studies.

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Section: Discussionmentioning

confidence: 77%

Clinical and Radiological Outcomes of Bony Increased Offset-Reverse Total Shoulder Arthroplasty in the Asian Population

Tankshali¹,

Ji²,

Park³

et al. 2020

Preprint

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“…The main cause of scapular notching is that repeated impingement of the humeral prosthesis against the inferior scapular neck during arm abduction, which might be attributed to the relatively centred position of the glenoid component. [39][40][41] To minimize the risk of notching, a 3D-printed guiding baseplate was used to determine the optimal position of the glenoid prosthesis. In our patients, no scapular notching was observed.…”

Section: Discussionmentioning

confidence: 99%

<p>The Personalized Shoulder Reconstruction Assisted by 3D Printing Technology After Resection of the Proximal Humerus Tumours</p>

Liu

Zeng

et al. 2019

CMAR

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These authors contributed equally to this work Background: The reverse shoulder arthroplasty (RSA) may be a promising alternative for proximal humerus tumours because of good postoperative shoulder function. However, the conventional reverse shoulder prosthesis can not meet individual needs and RSA has been associated with a relatively high complication rate. Therefore, implant design and surgical reconstruction technique warrant further study. Methods: Between September 2015 and May 2018, 7 patients were treated via RSA after enbloc resection of the proximal humerus tumours. A 3D-printed guiding baseplate was used to assist the implant of the 3D-printed glenoid prosthesis; a personalized humerus prosthesis was used to reconstruct the proximal humerus. The functional outcomes were assessed by range of motion (ROM) of the shoulder joint, Musculoskeletal Tumour Society (MSTS) functional score, and Toronto Extremity Salvage Score (TESS). We also analyzed tumour recurrence, metastases, and complications associated with the reconstruction procedure. Results: All patients were observed for 14 to 36 months, with an average of 23.6 months. At the final follow-up, the mean MSTS score was 85.7% (range, 73.3-93.3%), and the mean TESS score was 90.0% (range, 84.1-95.9%). No instability, infection, scapular notching, loosening or fracture were observed in this series. One patient with GCT suffered from pulmonary metastasis, while one with osteosarcoma died because of pulmonary metastasis. Conclusion: The 3D-printed guiding baseplate facilitated the accurate implantation of the glenoid prosthesis. The RSA based on a 3D-printed glenoid prosthesis and a personalized custom-made humerus prosthesis significantly improved the shoulder function and decreased the complication rate. Further studies of a larger scale with longer follow-up are required to validate this technology.

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“…Scapular notching is a unique complication of RSA resulting from changes in the glenohumeral anatomical structure [55]. It is usually observed 6 months postoperatively on plain radiography, and the reported incidence of scapular notching ranges from 4.6% to 96% [6,8,11,56,57]. Scapular notching is the most commonly observed complication; hence, Zumstein et al [6] classified this as a postoperative problem rather than a complication.…”

Section: Scapular Notchingmentioning

confidence: 99%

Complications of Reverse Shoulder Arthroplasty: A Concise Review

Kim

Jang

et al. 2021

Clin Shoulder Elbow

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Reverse shoulder arthroplasty is an ideal treatment for glenohumeral dysfunction due to cuff tear arthropathy. As the number of patients treated with reverse shoulder arthroplasty is increasing, the incidence of complications after this procedure also is increasing. The rate of complications in reverse shoulder arthroplasty was reported to be 15%–24%. Recently, the following complications have been reported in order of frequency: periprosthetic infection, dislocation, periprosthetic fracture, neurologic injury, scapular notching, acromion or scapular spine fracture, and aseptic loosening of prosthesis. However, the overall complication rate has varied across studies because of different prosthesis used, improvement of implant and surgical skills, and different definitions of complications. Some authors included complications that affect the clinical outcomes of the surgery, while others reported minor complications that do not affect the clinical outcomes such as minor reversible neurologic deficit or minimal scapular notching. This review article summarizes the processes related to diagnosis and treatment of complications after reverse shoulder arthroplasty with the aim of helping clinicians reduce complications and perform appropriate procedures if/when complications occur.

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Scapular Notching in Reverse Total Shoulder Arthroplasty

Cited by 106 publications

References 38 publications

Clinical and Radiological Outcomes of Bony Increased Offset-Reverse Total Shoulder Arthroplasty in the Asian Population

Clinical and Radiological Outcomes of Bony Increased Offset-Reverse Total Shoulder Arthroplasty in the Asian Population

<p>The Personalized Shoulder Reconstruction Assisted by 3D Printing Technology After Resection of the Proximal Humerus Tumours</p>

Complications of Reverse Shoulder Arthroplasty: A Concise Review

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