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

Abstract

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.

Is reverse total shoulder arthroplasty (rTSA) more advantageous than anatomic TSA (aTSA) for osteoarthritis with intact cuff tendon? A systematic review and meta-analysis

“…However, in some studies regarding aTSA, early baseplate loosening found on a radiological exam did not deteriorate in the long-term follow-up [ 2 , 5 , 9 , 12 , 26 ]. In cases of rTSA, scapular notching did not improve in the long-term follow-up, resulting in a significantly negative effect on the clinical outcomes [ 14 ]. Since our study did not have a long-term follow-up, further research will be needed to confirm the long-term prognosis of each treatment.…”

The Evolution of Reverse Total Shoulder Arthroplasty—From the First Steps to Novel Implant Designs and Surgical Techniques

“…A mechanical impingement between the humeral component and the inferior scapular neck and the glenoid were discussed to be responsible for scapular notching [ 3 , 6 , 41 ]. This mechanical impingement can lead to wear of the polyethylene insert of the humeral component and subsequently cause osteolysis of the surrounding bone [ 3 , 42 ]. However, the clinical significance of scapular notching is still a controversial topic.…”

Implant selection for successful reverse total shoulder arthroplasty

“…There has been some debate regarding the inferior tilt of the glenoid baseplate. However, considering the normal anatomy of the glenoid with a 5° superior tilt and the superior wear of cuff tear arthropathy, a 10° inferior tilt of the baseplate is recommended to prevent scapular notching [32,33]. A glenosphere with an inferior offset (inferiorly overhanging glenosphere) can also be used for inferior translation of the glenoid component [34][35][36][37].…”