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General Orthopaedics

Assessment of Scapular Morphology as a Predictor of Notching in Reverse Shoulder Replacements

International Society for Technology in Arthroplasty (ISTA)



Abstract

Background

There has been increased focus on understanding the risk factors associated with scapular notching in reverse shoulder arthroplasty (RSA). The purpose of this study is to evaluate the effect of scapular morphology and surgical technique on the occurrence of scapular notching using the notching index as a comprehensive predictive tool.

Methods

Ninety-one patients treated with a primary RSA were followed for a minimum of 24 months. Using a previously published notching index formula ((PSNA × 0.13) + (PGRD)), a notching index value for all patients was calculated. Radiographic assessment of patients were grouped by Nerot grade of scapular notching, group mean differences for prosthetic scapular neck angle (PSNA), peg glenoid rim distance (PGRD), preoperative scapular neck angle (SNA), notching index and clinical outcomes were compared.

Results

Seventy-five (82%) of the ninety one shoulders in the study developed scapular notching. There was no significant difference in average notching index for group 1, 31.8 ± 4.4, and group 2, 33.1 ± 7.2. No significant difference was demonstrated between the groups for SNA (102.7° vs. 105.4°, p = 0.3), PSNA (125.8° vs. 124.5°, p = 0.82), PGRD (15.4 mm vs. 16.8 mm, p = 0.47) or in clinical outcomes between groups.

Discussion

Our results demonstrated an overall low notch index that lacked specificity in predicting notching for this cohort. These results suggest that perhaps PSNA and prosthetic design are more significant contributors to notching with certain scapular morphology.


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