NOTCHING: IS IT THE PATIENT, THE SURGEON OR THE IMPLANT?

BackgroundScapular notching causes glenoid bone loss after a reverse total shoulder arthroplasty (rTSA). The goal of this study was to assess the influence of prosthesis design on notching.MethodsProspective, single surgeon cohort. Two different rTSA designs were consecutively implanted and compared: 25 Delta III rTSAs and 57 Delta Xtend rTSAs in 80 patients. Notching (Nerot 0–4) was assessed at 24 months follow-up. Patient dependent variables, surgical technique and implant geometry were assessed. Multivariate binary logistic regression was used to select the strongest independent predictors of notching.ResultsThe Delta III showed significantly more notching than the Delta Xtend: 72% and 23% respectively, p<0.001. The extent of notching was comparable. One patient (Delta III) needed revision for notching-associated glenoid loosening. Only 3 variables were significantly associated with notching in multivariate analysis: glenosphere overhang (R square 0.65), prosthesis-scapular neck angle (PSNA, R square 0...