Scapular Notching in Revision Reverse Total Shoulder Arthroplasty

The primary goals of this study were to compare notching in revision and primary reverse total shoulder arthroplasty (RTSA) and to evaluate the effect of glenosphere offset in revision RTSA. Sixty-two primary and 21 revision RTSAs performed by a single surgeon with a minimum of 1-year radiographic follow-up were evaluated. Radiographs were evaluated with the Nerot-Sirveaux grading system for notching severity, and the position of glenosphere offset was noted as inferior, standard, or superior. Notching occurred in 11 (18%) primary RTSAs and 9 (43%) revisions (P=0.03). Inferior glenosphere position was associated with notching in 5 of 41 (12%) primary procedures and 5 of 11 (45%) revision procedures (P=0.006). Among the 20 shoulders with radiographic notching, 16 were grade 1, 2 were grade 2, and 2 were grade 3 (both in revisions). Scapular notching is significantly more common in revision than primary RTSA. The more complex pathoanatomy, including soft tissue scarring and glenoid bone loss, that can constrict options for glenosphere placement may contribute to the higher rate of notching in revisions. An inferiorly offset glenosphere reduced the rate of scapular notching in primary RTSA but was not protective in revisions. Most notching was mild in both groups, and more severe notching occurred only in revisions.

Source: Techniques in Shoulder and Elbow Surgery - May 2, 2018 Category: Orthopaedics Tags: Research Articles Source Type: research