Scapular Notching After Reverse Total Shoulder Arthroplasty

2018 ◽  
Vol 100 (13) ◽  
pp. 1095-1103 ◽  
Author(s):  
Joel Kolmodin ◽  
Iyooh U. Davidson ◽  
Bong Jae Jun ◽  
Nipun Sodhi ◽  
Naveen Subhas ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Scapular Notching ◽  
Reverse Total Shoulder

scholarly journals Mid-term outcomes of bony increased offset-reverse total shoulder arthroplasty in the Asian population

2021 ◽  
Vol 24 (3) ◽  
pp. 125-134
Author(s):  
Kirtan Tankshali ◽  
Dong-Whan Suh ◽  
Jong-Hun Ji ◽  
Chang-Yeon Kim
Keyword(s):  
Los Angeles ◽  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
Intraoperative Complications ◽  
Total Shoulder Arthroplasty ◽  
Asian Population ◽  
Reverse Total Shoulder Arthroplasty ◽  
Scapular Notching ◽  
Reverse Total Shoulder

Background: To evaluate clinical and radiological outcomes of bony increased offset-reverse total shoulder arthroplasty (BIO-RSA) in the Asian population at mid-term follow-up.Methods: From June 2012 to August 2017 at a single center, 43 patients underwent BIO-RSA, and 38 patients with a minimum of 2 years of follow-up were enrolled. We evaluated the preoperative and postoperative clinical outcomes, radiological outcomes (notching and loosening), and complications of BIO-RSA at the last follow-up. In addition, we divided these patients into notching and not-notching groups and compared the demographics, preoperative, and postoperative characteristics of patients between the two groups.Results: Visual analog scale, American Shoulder and Elbow Surgeons, University of California-Los Angeles, and Simple Shoulder Test scores improved significantly from preoperative (average: 5, 39.43, 16.22, 3.94) to postoperative (average: 1.71, 78.91, 28.34, 7.8; p<0.05) outcomes. All range of motion except internal rotation improved significantly at the final follow-up (p<0.05), and the bone graft was well-incorporated with the native glenoid in all patients (100%). However, scapular notching was observed in 20/38 patients (53%). In the comparison between notching and not-notching groups (18 vs. 20 patients), there were no significant differences in demographics, radiological parameters, and clinical outcomes except acromion-greater tuberosity (AT) distance (p=0.003). Intraoperative complications were three metaphyseal fractures and one inferior screw malposition. Postoperative complications included one heterotopic ossification, one scapula neck stress fracture, one humeral stem loosening, and one late infection.Conclusions: BIO-RSA resulted in improved clinical outcomes at mid-term follow-up in the Asian population. Although better cosmesis and advantages of glenoid lateralization were observed, we observed higher rates of scapular notching compared to previously reported rates in BIO-RSA studies. In addition, adequate glenoid lateralization with appropriate humeral lengthening (AT distance) might reduce scapular notching.

Reverse total shoulder arthroplasty

2021 ◽  
pp. 1-9
Author(s):  
Eleanor G. Burden ◽  
Timothy J. Batten ◽  
Christopher D. Smith ◽  
Jonathan P. Evans
Keyword(s):  
Systematic Review ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Implant Design ◽  
Complication Rates ◽  
Scapular Notching ◽  
Cuff Tear ◽  
Patient Reported ◽  
Reverse Total Shoulder

Aims This systematic review asked which patterns of complications are associated with the three reverse total shoulder arthroplasty (RTSA) prosthetic designs, as classified by Routman et al, in patients undergoing RTSA for the management of cuff tear arthropathy, massive cuff tear, osteoarthritis, and rheumatoid arthritis. The three implant design philosophies investigated were medial glenoid/medial humerus (MGMH), medial glenoid/lateral humerus (MGLH), and lateral glenoid/medial humerus (LGMH). Methods A systematic review of the literature was performed via a search of MEDLINE and Embase. Two reviewers extracted data on complication occurrence and patient-reported outcome measures (PROMs). Meta-analysis was conducted on the reported proportion of complications, weighted by sample size, and PROMs were pooled using the reported standardized mean difference (SMD). Quality of methodology was assessed using Wylde’s non-summative four-point system. The study was registered with PROSPERO (CRD42020193041). Results A total of 42 studies met the inclusion and exclusion criteria. Rates of scapular notching were found to be significantly higher in MGMH implants (52% (95% confidence interval (CI) 40 to 63)) compared with MGLH ((18% (95% CI 6 to 34)) and LGMH (12% (95% CI 3 to 26)). Higher rates of glenoid loosening were seen in MGMH implants (6% (95% CI 3 to 10)) than in MGLH implants (0% (95% CI 0 to 2)). However, strength of evidence for this finding was low. No significant differences were identified in any other complication, and there were no significant differences observed in PROMs between implant philosophies. Conclusion This systematic review has found significant improvement in PROMS and low complication rates across the implant philosophies studied. Scapular notching was the only complication found definitely to have significantly higher prevalence with the MGMH implant design.

Comparison of Methods to Predict Scapular Notching From Radiographs After Reverse Total Shoulder Arthroplasty

2012 ◽  
Author(s):  
Heath B. Henninger ◽  
Michael D. Harris ◽  
Kristen R. Petersen ◽  
Robert T. Burks ◽  
Robert Z. Tashjian
Keyword(s):  
Bone Loss ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
A Priori ◽  
Stress Shielding ◽  
Reverse Total Shoulder Arthroplasty ◽  
Scapular Notching ◽  
Implant Placement ◽  
And Function ◽  
Reverse Total Shoulder

Scapular notching is a complication of reverse total shoulder arthroplasty (rTSA) that results in bone loss on the lateral border of the scapula. Notching has been reported in up to 86% of patients at 5 year follow-up [1], and is graded 1–4 as a function of progressive bone loss [2]. Notching may arise from impingement, erosion, periprosthetic osteolysis, stress shielding or a combination of these [1]. Glenosphere position can mitigate notching by limiting hardware impingement [3–5], but may increase the forces required to abduct the arm [6]. Clinicians might optimize patient range of motion and function via implant placement if susceptibility to notching was known a-priori.

scholarly journals Effect of scapular notching on clinical outcomes after reverse total shoulder arthroplasty

2020 ◽  
Vol 102-B (11) ◽  
pp. 1438-1445
Author(s):  
Young Hoon Jang ◽  
Jeong Hyun Lee ◽  
Sae Hoon Kim
Keyword(s):  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Range Of Movement ◽  
Scapular Notching ◽  
Negative Effect ◽  
Reverse Total Shoulder

Aims Scapular notching is thought to have an adverse effect on the outcome of reverse total shoulder arthroplasty (RTSA). However, the matter is still controversial. The aim of this study was to determine the clinical impact of scapular notching on outcomes after RTSA. Methods Three electronic databases (PubMed, Cochrane Database, and EMBASE) were searched for studies which evaluated the influence of scapular notching on clinical outcome after RTSA. The quality of each study was assessed. Functional outcome scores (the Constant-Murley scores (CMS), and the American Shoulder and Elbow Surgeons (ASES) scores), and postoperative range of movement (forward flexion (FF), abduction, and external rotation (ER)) were extracted and subjected to meta-analysis. Effect sizes were expressed as weighted mean differences (WMD). Results In all, 11 studies (two level III and nine level IV) were included in the meta-analysis. All analyzed variables indicated that scapular notching has a negative effect on the outcome of RTSA . Statistical significance was found for the CMS (WMD –3.11; 95% confidence interval (CI) –4.98 to –1.23), the ASES score (WMD –6.50; 95% CI –10.80 to –2.19), FF (WMD –6.3°; 95% CI –9.9° to –2.6°), and abduction (WMD –9.4°; 95% CI –17.8° to –1.0°), but not for ER (WMD –0.6°; 95% CI –3.7° to 2.5°). Conclusion The current literature suggests that patients with scapular notching after RTSA have significantly worse results when evaluated by the CMS, ASES score, and range of movement in flexion and abduction. Cite this article: Bone Joint J 2020;102-B(11):1438–1445.

Impact of scapular notching on reverse total shoulder arthroplasty outcomes—5 year minimum follow-up

2019 ◽  
Vol 28 (6) ◽  
pp. e204-e205 ◽  
Author(s):  
Ryan W. Simovitch ◽  
Joseph D. Zuckerman ◽  
Thomas W. Wright ◽  
Pierre-Henri Flurin ◽  
Christopher Roche
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Scapular Notching ◽  
Reverse Total Shoulder

scholarly journals Scapular Notching Following Ipsilateral Traumatic Clavicle Fracture in Reverse Total Shoulder Arthroplasty: A Case Report

2021 ◽  
Vol 5 ◽  
pp. 247154922110206
Author(s):  
Jimmy Tat ◽  
Ujash Sheth ◽  
Diane Nam
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Clavicle Fracture ◽  
Open Reduction Internal Fixation ◽  
Reverse Total Shoulder Arthroplasty ◽  
Scapular Notching ◽  
Non Union ◽  
Clavicle Fractures ◽  
And Function ◽  
Reverse Total Shoulder

Introduction Reverse total shoulder arthroplasty (RTSA) procedures are becoming increasingly more common. While the main complications are known, the management of clavicle fractures in patients with an ipsilateral RTSA is not well described. There are three case studies that document clavicular stress fractures following RTSA with an atraumatic etiology, and to our knowledge, no studies have described a traumatic clavicular fracture following RTSA. Case We describe the case of a 75-year-old woman with a traumatic clavicle fracture five years after RTSA for rotator cuff tear arthropathy. With minimal pain and subjective symptoms initially, the patient wished to pursue non-operative treatment. However, she eventually developed a painful non-union and pseudoparalysis of the shoulder with serial radiographs demonstrating progressive superior scapular tilting and scapular notching. Subsequent open reduction internal fixation of her clavicle fracture significantly improved her pain and function. Conclusion We report a traumatic clavicle fracture in the setting of RTSA that not only failed to heal but also resulted in scapular notching and shoulder pseudoparalysis that was improved with surgical stabilization of the fracture. It is possible that the setting of a semi-constrained RTSA, the resulting biomechanical imbalance may predispose to impaired fracture healing and non-union of the clavicle fracture.

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