Scapular notching in reverse shoulder arthroplasty. Relationship with surgeon̈s experience and clinical outcomes

Rev Esp Cir Ortop Traumatol. 2022 Jan-Feb;66(1):3-9. doi: 10.1016/j.recot.2021.01.006. Epub 2021 Jun 17.
[Article in English, Spanish]

Abstract

Background: Scapular Notching is a problem frequently seen in Reverse shoulder arthroplasties (RSAs), produced by a collision between the humeral component and the scapula. The main objective of this study is to analyze whether this problem decreases with the surgeons experience. As secondary objectives, assessing whether there is a relationship between its appearance and the clinical and functional outcome of patients.

Methods: We retrospectively reviewed 101 patients with 105 RSAs; we analyzed complications, focusing on scapular notching. Main follow-up time was 36 month (12-72). The clinical and functional outcomes were evaluated with the Constant scale and the QuickDash questionnaire.

Results: Forty-two patients (40%) had some degree of scapular notching. Of these, 25 patients had grade I, 14 had grade II and 3 had grade III notching. The average postoperative Constant score for the entire series was 60.72. A tendency toward a reduced incidence of notching was observed with increasing numbers of operated cases and experience of the surgeon (p=0.04). In the group of patients who had notching, the average postoperative Constant score was 56, and in the group that developed notching, the average score was 63. Patients with notching had significantly lower pain scores (p=0.012).

Conclusions: Scapular notching is a common problem of RSA. In RSA, the experience of the surgeon reduces the appearance of problems and complications. Scapular notching is related to poorer clinical outcomes with respect to pain.

Keywords: Curva de aprendizaje; Dolor; Learning curve; Notching escapular; Outcomes; Pain; Prótesis invertida de hombro; Resultados; Reverse shoulder arthroplasty; Scapular Notching.