Impact of scapular notching on clinical outcomes after reverse total shoulder arthroplasty: an analysis of 476 shoulders

Mollon, Brent; Mahure, Siddharth A.; Roche, Christopher P.; Zuckerman, Joseph D.

doi:10.1016/j.jse.2016.11.043

Cited by 137 publications

(92 citation statements)

References 33 publications

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“…Scapular notching results from repetitive impaction of the humeral component upon the inferior scapular neck, leading to focal osseous erosion in this area. Though early studies concluded that notching bore no clinical consequence, one long term study observed poorer clinical outcomes in patients with notching 48 . Patients with reverse total shoulder arthroplasties are also at elevated risk for stress fractures of the scapular spine and acromion, due to increased stress in this region and osseous insufficiency related to implant design 49 (Figure 11).…”

Section: Evaluating Synovial Reactionsmentioning

confidence: 99%

Clinical magnetic resonance imaging of arthroplasty at 1.5 T

Koff

Burge

Potter

2020

Journal Orthopaedic Research

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Magnetic resonance imaging (MRI) has historically been avoided for the routine clinical evaluation of metal implants at many clinical centers due to the presence of artifact that creates in‐plane and through‐plane distortions and signal intensity voids in generated images. However, when the image acquisition parameters are appropriately modified and advanced multi‐spectral pulse sequences are used, high‐quality diagnostic images can be generated and may be used for diagnosing patients with suspected periprosthetic pathology. MRI provides superior soft‐tissue contrast and excellent sensitivity for mobile water and is, therefore, a valuable tool in the evaluation of these patients, given the increasing prevalence of arthroplasty within the general population. Knowledge of expected normal postoperative appearance in patients with total hip arthroplasty, total knee arthroplasty, and total shoulder arthroplasty facilitates the detection of abnormal findings in this population, as does familiarity with common pathologic conditions encountered in the periprosthetic region. This review article will provide background information regarding the presence of image artifacts, methods to reduce the artifacts, and application of MRI at 1.5 T for evaluating common complications in subjects with total knee arthroplasty, total hip arthroplasty, and total shoulder arthroplasty.

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Section: Evaluating Synovial Reactionsmentioning

confidence: 99%

Clinical magnetic resonance imaging of arthroplasty at 1.5 T

Koff

Burge

Potter

2020

Journal Orthopaedic Research

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“…However, inverted design and particularly the shift of the center of rotation was not without consequences. Reported complication rates for RSA are as high as 68% (Wierks, ; Ackland et al, ; Mollon et al, ). Of these complications, scapular notching, gleno‐humeral dislocation, component loosening, and infection are some of the most common (Ackland et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…Despite the range of reported incidence of scapular notching being from 10% to 96% (Sirveaux, ; Werner et al, ; Boileau et al, ; Simovitch et al, ; Levigne et al, ; Stechel et al, ; Levigne et al, ; Sadoghi et al, ; Torrens et al, ; Mollon et al, ), its clinical relevance remains controversial. Some researchers associate the occurrence of scapular notching with poorer clinical outcomes (Sirveaux, ; Simovitch et al, ; Levigne et al, ; Sadoghi et al, ; Torrens et al, ; Mollon et al, ) and, in some patients, with implant failure (Nyffeler, ). Others report no impact on postoperative function (Werner et al, ; Boileau et al, ; Levigne et al, ).…”

Section: Introductionmentioning

confidence: 99%

3D image‐based morphometric analysis of the scapular neck length in subjects undergoing reverse shoulder arthroplasty

et al. 2017

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Scapular notching after RSA may, in part, be related to a patient's scapular morphology. The purpose of this study was to develop a novel 3 D measurement technique to describe infraglenoid tubercle morphometry. We hypothesize that the parameters describing infraglenoid tubercle would be normally distributed and would correlate with individual's demographics and glenoid morphometry. A group of 110 subjects treated with RSA were evaluated. Scapular geometry was obtained from pre-operative CT scans. The scapular neck length was defined in anterior and posterior view as the orthogonal distance between the glenoid surface and (a) the point of most significant change of curvature on lateral pillar; (b) the most lateral portion of the infraglenoid tubercle. Scapular neck angle, maximum anatomical adduction angle, glenoid width, height and version were also measured. Scapular neck length measured in the anterior and posterior view were normally distributed with mean values of 17.6 6 2.8 mm and 7.9 6 2.5 mm, respectively. Scapular neck angle was on average 112.4 6 10.68 and maximal adduction angle was 17.6 6 2.88. No significant associations between infraglenoid tubercle morphometric parameters, demographic, glenoid size or version were identified. Improved understanding of the patient-specific risk factors for scapular notching will help surgeons with pre-surgical planning and implant selection. Parametrization of the infraglenoid tubercle presented in this study showed normal distribution in the population unrelated to gender, side or demographics. The size of the infraglenoid tubercle is a unique trait, pre-operative evaluation of the scapular neck should be always warranted to decrease the incidence of post-operative notching. Clin. Anat. 31:43-55,

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“…Despite increasing popularity and a broadening range of indications, implant stability of reverse total shoulder arthroplasty (RTSA) has not been previously investigated. The glenoid component is of particular concern due to a significant number of patients presenting with notching , radiological signs of erosion of the inferior scapular neck caused by implant impingement . RTSA causes major biomechanical changes in the shoulder, and aseptic loosening of the glenoid component has represented a significant cause of failure in earlier models of the implant .…”

mentioning

confidence: 99%

“…RTSA causes major biomechanical changes in the shoulder, and aseptic loosening of the glenoid component has represented a significant cause of failure in earlier models of the implant . Modern RTSA designs favor a more distal positioning of the glenoid component to avoid scapular notching . This may prove effective to avoid notching, but the question of glenoid component stability remains unanswered.…”

mentioning

confidence: 99%

Model‐based RSA is suitable for clinical trials on the glenoid component of reverse total shoulder arthroplasty

Fraser¹,

Tsukanaka

Fjalestad

et al. 2018

Journal Orthopaedic Research

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This study aims to validate model-based radiostereometric analysis (RSA) on the glenoid component of reversed total shoulder arthroplasty. We compared two different modalities of model-based RSA, elementary geometrical shapes and reversed engineering. We also explored two different ways to position the patient to obtain different projections of the implant, the hip-position (transversal) and shoulder-position (sagittal). Phantom accuracy was determined by performing nine translations (x, y, z) and five rotations (x, y, z), and expressed as the mean difference between RSA measurements and micrometer values. Precision was measured using 12 double examinations of the phantom and 19 in patients, and expressed as1.96 × standard deviations of the paired differences between double examinations. The accuracy was high for both modalities, but rotation around the symmetrical axis of the implant could not be measured using reversed engineering. Clinical precision ranged from 0.13 to 0.25 mm for translations, and 0.4° to 0.7° for rotations, using reversed engineering. For elementary geometrical shapes, the precision ranged from 0.18 to 0.34 mm for translations, and 0.8° to 1.8° for rotations. The hip-position was abandoned due to poor implant visualization. Model-based RSA on the glenoid component of reversed total shoulder arthroplasty has a high precision and accuracy, comparable to RSA results on hips and knees. Patient positioning is vital for obtaining adequate results. We found that reversed engineering was the more reliable method, and recommend reversed engineering as the method of choice for further clinical RSA investigation of the glenoid component of reversed total shoulder arthroplasty. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

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Impact of scapular notching on clinical outcomes after reverse total shoulder arthroplasty: an analysis of 476 shoulders

Cited by 137 publications

References 33 publications

Clinical magnetic resonance imaging of arthroplasty at 1.5 T

Clinical magnetic resonance imaging of arthroplasty at 1.5 T

3D image‐based morphometric analysis of the scapular neck length in subjects undergoing reverse shoulder arthroplasty

Model‐based RSA is suitable for clinical trials on the glenoid component of reverse total shoulder arthroplasty

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