Long-term impact of scapular notching after reverse shoulder arthroplasty

Background Primary anatomic total shoulder arthroplasty can be challenging in patients with complex glenoid wear patterns and bone loss. Severe retroversion (>15°) or significant bone loss may require bone grafting. This review summarizes the rate of revision and long-term outcomes of anatomic total shoulder arthroplasty with bone graft. Methods A systematic search of MEDLINE, Embase, PubMed, and CENTRAL databases was conducted from the date of inception to 23 October 2018. Two reviewers independently screened articles for eligibility and extracted data for analysis. The primary outcome was rate of revision. The secondary outcomes were rate of component loosening, functional outcome, and range of motion. Results Of the 1056 articles identified in the search, 26 underwent full-text screening and 7 articles were included in the analysis. All procedures were one-stage anatomic total shoulder arthroplasties. The rate of revision was 5.4% with component loosening and infection listed as indications over a weighted mean follow-up period of 6.3 years. Complications occurred in 12.6% of patients. Conclusion Glenoid bone grafting in anatomic total shoulder arthroplasty results in comparable revision rates and improvement in pain compared to augmented glenoid components and reverse shoulder arthroplasty. Due to the low quality of evidence, further prospective studies should be conducted. Level of evidence IV

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Glenosphere design affects range of movement and risk of friction-type scapular impingement in reverse shoulder arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.100b9.bjj-2018-0264.r1 ◽

2018 ◽

Vol 100-B (9) ◽

pp. 1182-1186 ◽

Cited By ~ 21

Author(s):

B. S. Werner ◽

J. Chaoui ◽

G. Walch

Keyword(s):

Internal Rotation ◽

Shoulder Arthroplasty ◽

External Rotation ◽

Reverse Shoulder Arthroplasty ◽

Large Diameter ◽

Glenoid Component ◽

Range Of Movement ◽

Scapular Notching ◽

Component Size ◽

Centre Of Rotation

Aims Scapular notching is a frequently observed radiographic phenomenon in reverse shoulder arthroplasty (RSA), signifying impingement of components. The purposes of this study were to evaluate the effect of glenoid component size and glenosphere type on impingement-free range of movement (ROM) for extension and internal and external rotation in a virtual RSA model, and to determine the optimal configuration to reduce the incidence of friction-type scapular notching. Materials and Methods Preoperative CT scans obtained in 21 patients (three male, 18 female) with primary osteoarthritis were analyzed using modelling software. Two concurrent factors were tested for impingement-free ROM and translation of the centre of rotation: glenosphere diameter (36 mm vs 39 mm) and type (centred, 2 mm inferior eccentric offset, 10° inferior tilt). Results Glenosphere size was most predictive of increased extension and external rotation, whereas lateralization of the centre of rotation was the most predictive factor for internal rotation. A larger diameter of glenosphere combined with a 10° tilted configuration demonstrated superior values for extension and external rotation, whereas the eccentric component improved internal rotation by a mean 8.9° (standard deviation 2.7°) compared with a standard concentric glenosphere. Conclusion Glenosphere configuration can be modified to increase range of movement in RSA. Friction-type scapular notching was most effectively reduced by use of a large-diameter glenosphere with 10° inferior tilt. Cite this article: Bone Joint J 2018;100-B:1182–6.

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Cadaveric validation of a finite element modeling approach for studying scapular notching in reverse shoulder arthroplasty

Journal of Biomechanics ◽

10.1016/j.jbiomech.2016.07.007 ◽

2016 ◽

Vol 49 (13) ◽

pp. 3069-3073 ◽

Cited By ~ 4

Author(s):

Vijay N. Permeswaran ◽

Jessica E. Goetz ◽

M. James Rudert ◽

Carolyn M. Hettrich ◽

Donald D. Anderson

Keyword(s):

Finite Element ◽

Finite Element Modeling ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Scapular Notching ◽

Element Modeling ◽

Modeling Approach

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Evaluation of the role of glenosphere design and humeral component retroversion in avoiding scapular notching during reverse shoulder arthroplasty

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2013.05.009 ◽

2014 ◽

Vol 23 (2) ◽

pp. 151-158 ◽

Cited By ~ 87

Author(s):

Julien Berhouet ◽

Pascal Garaud ◽

Luc Favard

Keyword(s):

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Scapular Notching ◽

Humeral Component

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Bipolar lateralization in reverse shoulder arthroplasty for avoidance of scapular notching

Obere Extremität ◽

10.1007/s11678-020-00594-w ◽

2020 ◽

Vol 15 (3) ◽

pp. 207-212

Author(s):

Patric Raiss ◽

Rainer Neumann

Keyword(s):

Shoulder Arthroplasty ◽

External Rotation ◽

Constant Score ◽

Reverse Shoulder Arthroplasty ◽

Complication Rates ◽

Level Of Evidence ◽

Scapular Notching ◽

Neck Shaft Angle ◽

Shoulder Flexion

Abstract Introduction Reverse shoulder arthroplasty (RSA) has become a well-established treatment option for multiple disorders of the shoulder joint. In recent years, implant designs and configurations have been modified in order to improve function and avoid complications. Lateralization on the glenoid and the humeral side has been described to improve function and decrease radiographic scapular notching. Data on the clinical and radiographic results of bipolar lateralization in RSA are lacking. Methods In 38 cases, RSA was performed using an uncemented humeral short-stem component with a 145° neck–shaft angle in combination with bone lateralization on the glenoid side (Bony Increased-Offset Reversed Shoulder Arthroplasty, BIO-RSA; Wright Medical Inc., Memphis, TN, USA). Mean follow-up was 19 months (range 12–34 months). Patients were followed clinically using the Constant score as well as range of motion for shoulder flexion and external rotation. Radiographs in two different plains were analyzed for implant seating and the occurrence of scapular notching. Results There was a significant increase in all measured clinical parameters. Forward flexion increased from a mean of 75° preoperatively to 151° postoperatively, and mean Constant score increased from 21 to 71 points postoperatively (p < 0.001). Glenoid notching of grade 1 according to Sirveuax was observed in 3 out of 35 cases (9%); no grade 2, 3, or 4 notching was present. Revision surgery was necessary in one case (3%). Conclusion RSA with bipolar lateralization leads to excellent clinical outcomes, low complication rates, and low rates of radiographic scapular notching. Longer follow-up and prospective randomized trials are needed. Level of evidence Level IV.

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Case Report: Watching and Waiting? A Case of Incomplete Glenosphere Seating With Spontaneous Reversal in Reverse Shoulder Arthroplasty

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/2471549220949147 ◽

2020 ◽

Vol 4 ◽

pp. 247154922094914

Author(s):

Micah L MacAskill ◽

Rachel J Thomas ◽

Leslie A Barnes

Keyword(s):

Conservative Management ◽

Revision Surgery ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Glenoid Component ◽

Viable Option ◽

Scapular Notching ◽

Spontaneous Reversal ◽

No Gold Standard ◽

Design Factors

Introduction: Reverse shoulder arthroplasty is a useful procedure with broadening applications, but it has the best outcomes when used for rotator cuff tear arthropathy. However, this procedure is not without complications. While scapular notching and aseptic loosening are more common complications that have been extensively studied in the literature, dissociation of the glenoid component and incomplete glenosphere seating has not received much attention. Specifically, little research has explored appropriate management of incomplete seating of the glenosphere component, and no gold standard for treatment of this complication has emerged. Methods: In the case described here, an elderly patient with an incompletely seated glenosphere component post-operatively opted to pursue conservative management in order to avoid revision surgery if possible. Results: The partially engaged, superiorly directed components in this case exhibited spontaneous complete and symmetric seating of the glenosphere between six and twelve months post-operatively, indicating that conservative management of this complication in low-demand patients may be a viable option to avoid the risks associated with revision surgery. Conclusion: Further research should be pursued to explore what patient and prosthesis design factors may be suited to observation with serial radiographs when incomplete seating of the glenosphere component occurs.

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Onlay versus inlay humeral components in reverse shoulder arthroplasty: A systematic review and meta-analysis

Shoulder & Elbow ◽

10.1177/17585732211067171 ◽

2021 ◽

pp. 175857322110671

Author(s):

Garrett R Jackson ◽

Joshua Meade ◽

Bradley L Young ◽

David P Trofa ◽

Shadley C Schiffern ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

External Rotation ◽

Meta Analysis ◽

Reverse Shoulder Arthroplasty ◽

Scapular Notching ◽

Forward Flexion ◽

Scapular Fractures ◽

Humeral Component ◽

Significant Difference ◽

Vas Scores

Background Advances have been made to the traditional inlay Grammont Reverse Shoulder Arthroplasty (RSA) design such as the onlay humeral component prosthesis. Currently, there is no agreement in the literature regarding the best option for the humeral component when comparing inlay and onlay designs. This review compares the outcomes and complications between onlay versus inlay humeral components for RSA. Methods A literature search was conducted using PubMed and Embase. Only studies reporting outcomes comparing onlay versus inlay RSA humeral components were included. Results Four studies with 298 patients (306 shoulders) were included. Onlay humeral components were associated with better external rotation (ER) ( p < 0.0001). No significant difference in forward flexion (FF) or abduction was found. Constant scores (CS) and VAS scores did not differ. Increased scapular notching was found in the inlay group (23.18%) versus the onlay group (7.74%) ( p = 0.02). Postoperative scapular fractures and acromial fractures did not differ. Conclusion Onlay and inlay RSA designs are associated with improved postoperative range of motion (ROM). Onlay humeral designs may be associated with greater ER and lower rate of scapular notching; however, no difference was found in Constant and VAS scores, so further studies are required to assess the clinical significance of these differences.

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