Review Question - QID 3510

Inferior scapular notching, a common complication of reverse shoulder arthroplasty occurs most often due to superiorly placed glenoid components on the native glenoid. This allows hinging and notching inferiorly of the humeral component during shoulder movement leading to scapular notching inferiorly. Illustration A shows an example of this radiographic finding.

Simovitch et al demonstrated that superior positioning of the glenoid component as well as superior tilt of the component with respect to the scapula were factors that led to scapular notching. Patients with this radiographic finding also had poorer clinical outcomes.

Gerber et al provide a review on this surgical technique. They describe its biomechanical principles of moving the center of rotation more medial and distal as well as implanting a large glenoid hemisphere to allow increased deltoid function. They also warn of the procedure's high complication rates which are approximately three times that of conventional arthroplasty. Attention to technical detail is needed to reduce high complication rates.