The impact of scapular notching on reverse shoulder glenoid fixation

• Published in: Journal of shoulder and elbow surgery 2013-07, Vol.22 (7), p.963-970
• Main Authors: Roche, Christopher P., MS, Stroud, Nicholas J., MS, Martin, Brian L., BS, Steiler, Cindy A., AA, Flurin, Pierre-Henri, MD, Wright, Thomas W., MD, DiPaola, Matthew J., MD, Zuckerman, Joseph D., MD
• Format: Article
• Language: English
• Subjects: Arthroplasty, Replacement - adverse effects; Arthroplasty, Replacement - methods; Biomechanical Phenomena; Compressive Strength; glenoid fixation; Humans; Joint Instability - etiology; Joint Instability - prevention & control; Joint Prosthesis; Models, Anatomic; Models, Educational; Orthopedics; Prosthesis Design - methods; Prosthesis Failure; Range of Motion, Articular - physiology; Reverse shoulder arthroplasty; Scapula - physiopathology; Scapula - surgery; Shoulder Joint - surgery; Stress, Mechanical
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2012.10.035

Background Scapular notching is a well-documented complication of reverse shoulder arthroplasty. The effect of scapular notching on glenoid fixation is unknown. Materials and methods This study dynamically evaluated reverse shoulder glenoid baseplate fixation and assessed the effect of scapular notching on fixation in composite scapulae. A cyclic test was conducted to simulate 55° of humeral abduction in the scapular plane as a 750-N axial load was continuously applied to induce a variable shear and compressive load. Before and after cyclic loading, a displacement test was conducted to measure glenoid baseplate displacement in the directions of the applied static shear and compressive loads. Results For the scapulae without a scapular notch, glenoid baseplate displacement did not exceed the generally accepted 150-μm threshold for osseous integration before or after cyclic loading in any component tested. For the scapulae with a scapular notch, glenoid baseplate displacement exceeded 150 μm in 2 of the 7 samples before cyclic loading and in 3 of the 7 samples after cyclic loading. The average pre-cyclic glenoid baseplate displacement in the direction of the shear load was significantly greater in scapulae with a scapular notch than those without a scapular notch both before ( P  = .003) and after ( P  = .023) cyclic loading. Conclusions Adequate glenoid baseplate fixation was achievable in most cases in scapulae with a severe scapular notch; however, the fact that this micromotion threshold was not met in all scapulae with a notch is concerning and implies that severe notching may play a role in initial glenoid baseplate stability.