Scapular notching yields worse outcomes with reverse TSA

CHICAGO — Patients who received scapular notching while undergoing reverse total shoulder arthroplasty showed worse outcome measures compared with no scapular notching, according to results presented at the American Shoulder and Elbow Surgeons Annual Meeting.

Ryan W. Simovitch, MD, and colleagues stratified 271 patients undergoing reverse total shoulder arthroplasty with the Equinoxe system (Exactech Inc.) into a group that received scapular notching (n = 41) or a group that did not (n = 230). The investigators evaluated outcomes using the Simple Shoulder Test, University of California Los Angeles (UCLA), American Shoulder and Elbow Surgeons, Shoulder Pain and Disability Index and Constant scores, as well as range of motion, strength and patient satisfaction.

“The scapular notching rate overall was 15.1%, an average grade of 1.7 and there were no notches that exceeded grade 3,” Simovitch said in his presentation.

Although the notching and no notching groups started with no statistically significant differences, Simovitch noted clinical metrics and strength were statistically significantly better postoperatively among patients who did not have notching.

“When asked whether patients thought that they were much better, better, unchanged or worse, we found that there was a trend toward patients rating themselves to being much better when they were in a no notching group,” Simovitch said.

He added that patients in the notching group had a statistically significant increase in saying that their shoulder was worse in follow-up. Patients had an overall complication rate of 11.1% and a revision rate of 2.2%, according to Simovitch.

“When we stratified those patients according to no notching as well as notching, we found the complication rate was a twofold increase in the notching group and we saw the revision rate was almost five-fold increase in the notching group, both of which were statistically significant,” Simovitch said. – by Casey Tingle

Reference:

Simovitch RW, et al. Paper 13. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 12-14, 2018; Chicago.

Disclosure: Simovitch reports he received IP royalties and is a paid consultant and paid presenter or speaker for Exactech Inc.