This retrospective multicenter study examined the causes and consequences of scapular notching after reverse shoulder arthroplasty. It reviewed 337 shoulders in 326 patients over an average 47-month follow-up. The goal was to identify preoperative, intraoperative, and technical factors that predispose to notching and to propose ways to prevent it.
When you plan a reverse shoulder, the single most controllable driver of notching is baseplate position. Place the baseplate flush with the inferior glenoid rim so the glenosphere overhangs about 4 mm inferiorly, and avoid superior tilt. Superior tilt causes the humeral cup to underlap the glenosphere and crowd the scapular neck.
Read the preoperative glenoid: a superiorly eroded E2 glenoid tempts you into high, valgus placement (81% notching), so ream preferentially inferiorly to restore vertical inclination. An inferiorly eroded E4 glenoid naturally sits in safe inferior tilt (30% notching).
The deltopectoral approach gives better access for that inferior preparation, which is one reason it produced far less notching than the anterosuperior approach.
Clinically, notching did not hurt Constant scores at 47 months, but its correlation with glenoid lucency is why the authors reserved this implant for patients over 70. Adapt your technique to glenoid morphology rather than treating every case identically.
This retrospective multicenter study examined the causes and consequences of scapular notching after reverse shoulder arthroplasty. It reviewed 337 shoulders in 326 patients over an average 47-month follow-up. The goal was to identify preoperative, intraoperative, and technical factors that predispose to notching and to propose ways to prevent it.
When you plan a reverse shoulder, the single most controllable driver of notching is baseplate position. Place the baseplate flush with the inferior glenoid rim so the glenosphere overhangs about 4 mm inferiorly, and avoid superior tilt. Superior tilt causes the humeral cup to underlap the glenosphere and crowd the scapular neck.
Read the preoperative glenoid: a superiorly eroded E2 glenoid tempts you into high, valgus placement (81% notching), so ream preferentially inferiorly to restore vertical inclination. An inferiorly eroded E4 glenoid naturally sits in safe inferior tilt (30% notching).
The deltopectoral approach gives better access for that inferior preparation, which is one reason it produced far less notching than the anterosuperior approach.
Clinically, notching did not hurt Constant scores at 47 months, but its correlation with glenoid lucency is why the authors reserved this implant for patients over 70. Adapt your technique to glenoid morphology rather than treating every case identically.