title: The impact of scapular notching on reverse shoulder glenoid fixation.
abstract: BACKGROUND
  Scapular notching is a well-documented complication of reverse shoulder arthroplasty. The effect of scapular notching on glenoid fixation is unknown.
  
  
  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.
authors: Exactech, Gainesville, FL, USA.
authors: Christopher P
authors: CP
authors: Roche
authors: Nicholas J
authors: NJ
authors: Stroud
authors: Brian L
authors: BL
authors: Martin
authors: Cindy A
authors: CA
authors: Steiler
authors: Pierre-Henri
authors: PH
authors: Flurin
authors: Thomas W
authors: TW
authors: Wright
authors: Matthew J
authors: MJ
authors: DiPaola
authors: Joseph D
authors: JD
authors: Zuckerman
mesh_terms: D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000379:methods; D001696:Biomechanical Phenomena; D019245:Compressive Strength; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000517:prevention & control; D007595:Joint Prosthesis; D008953:Models, Anatomic; D017145:Models, Educational; D011474:Prosthesis Design / Q000379:methods*; D011475:Prosthesis Failure; D016059:Range of Motion, Articular / Q000502:physiology; D012540:Scapula / Q000503:physiopathology* / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery*; D013314:Stress, Mechanical