Scapular notching in reverse shoulder arthroplasty. Relationship with surgeon's experience and clinical outcomes / Notching escapular en las prótesis invertidas de hombro. Su relación con la experiencia del cirujano y con los resultados clínicos

Background: Scapular Notching is a problem frequently seen in Reverse shoulder arthroplasties (RSAs), produced by a collision between the humeral component and the scapula. The main objective of this study is to analyze whether this problem decreases with the surgeons experience. As secondary objectives, assessing whether there is a relationship between its appearance and the clinical and functional outcome of patients. Methods: We retrospectively reviewed 101 patients with 105 RSAs; we analyzed complications, focusing on scapular notching. Main follow-up time was 36 month (12-72). The clinical and functional outcomes were evaluated with the Constant scale and the QuickDash questionnaire. Results: Forty-two patients (40%) had some degree of scapular notching. Of these, 25 patients had grade I, 14 had grade II and 3 had grade III notching. The average postoperative Constant score for the entire series was 60.72. A tendency toward a reduced incidence of notching was observed with increasing numbers of operated cases and experience of the surgeon (p=0.04). In the group of patients who had notching, the average postoperative Constant score was 56, and in the group that developed notching, the average score was 63. Patients with notching had significantly lower pain scores (p=0.012). Conclusions: Scapular notching is a common problem of RSA. In RSA, the experience of the surgeon reduces the appearance of problems and complications. Scapular notching is related to poorer clinical outcomes with respect to pain.(AU)

Introducción: La erosión o muesca escapular (notching escapular) es un problema que se observa con frecuencia en las prótesis invertidas de hombro, producido por un choque entre el componente humeral y el cuello de la escápula. El objetivo principal de nuestro trabajo es analizar si disminuye el notching escapular con el aumento de la experiencia del cirujano. Como objetivos secundarios, el valorar si existe una relación entre su aparición y el resultado funcional y clínico en los pacientes. Material y método: Se realiza una revisión retrospectiva de 101 pacientes con 105 prótesis invertidas de hombro, valorando radiográficamente la aparición de notching escapular. El tiempo medio de seguimiento fue de 36 meses (rango, 12-72). Se objetivan los resultados clínico-funcionales con la escala Constant y el cuestionario QuickDash. Resultados: Cuarenta y dos pacientes (40%) presentaron algún grado de notching escapular. De ellos, 25 pacientes tenían un grado I, 14 un grado II y tres un grado III. El Constant postoperatorio medio para toda la serie fue de 60,72. Se observó una tendencia a disminuir la incidencia de notching conforme aumentaba el número de casos intervenidos y la experiencia del cirujano (p = 0,04). En el grupo de los pacientes que presentaban notching escapular, el Constant postoperatorio fue de 56 y en el grupo que no desarrolló notching fue del 63. Los pacientes con notching presentaban puntuaciones inferiores en cuanto al dolor siendo la diferencia estadísticamente significativa (p = 0,012). Conclusiones: El notching escapular es un problema frecuente en las prótesis invertidas de hombro, en las cuales la curva de aprendizaje influye positivamente en la diminución de su aparición. La aparición de notching escapular está relacionado con peores resultados clínicos en cuanto al dolor se refiere.(AU)

Notching escapular en las prótesis invertidas de hombro. Su relación con la experiencia del cirujano y con los resultados clínicos / Scapular notching in reverse shoulder arthroplasty. Relationship with surgeons experience and clinical outcomes

Introducción: La erosión o muesca escapular (notching escapular) es un problema que se observa con frecuencia en las prótesis invertidas de hombro, producido por un choque entre el componente humeral y el cuello de la escápula. El objetivo principal de nuestro trabajo es analizar si disminuye el notching escapular con el aumento de la experiencia del cirujano. Como objetivos secundarios, el valorar si existe una relación entre su aparición y el resultado funcional y clínico en los pacientes. Material y métodos: Se realiza una revisión retrospectiva de 101 pacientes con 105 prótesis invertidas de hombro, valorando radiográficamente la aparición de notching escapular. El tiempo medio de seguimiento fue de 36 meses (rango, 12-72). Se objetivan los resultados clínico-funcionales con la escala Constant y el cuestionario QuickDash. Resultados: Cuarenta y dos pacientes (40%) presentaron algún grado de notching escapular. De ellos, 25 pacientes tenían un grado I, 14 un grado II y tres un grado III. El Constant postoperatorio medio para toda la serie fue de 60,72. Se observó una tendencia a disminuir la incidencia de notching conforme aumentaba el número de casos intervenidos y la experiencia del cirujano (p = 0,04). En el grupo de los pacientes que presentaban notching escapular, el Constant postoperatorio fue de 56 y en el grupo que no desarrolló notching fue del 63. Los pacientes con notching presentaban puntuaciones inferiores en cuanto al dolor siendo la diferencia estadísticamente significativa (p = 0,012). Conclusiones: El notching escapular es un problema frecuente en las prótesis invertidas de hombro, en las cuales la curva de aprendizaje influye positivamente en la diminución de su aparición. La aparición de notching escapular está relacionado con peores resultados clínicos en cuanto al dolor se refiere.(AU)

Background: Scapular Notching is a problem frequently seen in Reverse shoulder arthroplasties (RSAs), produced by a collision between the humeral component and the scapula. The main objective of this study is to analyze whether this problem decreases with the surgeons experience. As secondary objectives, assessing whether there is a relationship between its appearance and the clinical and functional outcome of patients. Methods: We retrospectively reviewed 101 patients with 105 RSAs; we analyzed complications, focusing on scapular notching. Main follow-up time was 36 month (12-72). The clinical and functional outcomes were evaluated with the Constant scale and the QuickDash questionnaire. Results: Forty-two patients (40%) had some degree of scapular notching. Of these, 25 patients had grade I, 14 had grade II and 3 had grade III notching. The average postoperative Constant score for the entire series was 60.72. A tendency toward a reduced incidence of notching was observed with increasing numbers of operated cases and experience of the surgeon (p=0.04). In the group of patients who had notching, the average postoperative Constant score was 56, and in the group that developed notching, the average score was 63. Patients with notching had significantly lower pain scores (p=0.012). Conclusions: Scapular notching is a common problem of RSA. In RSA, the experience of the surgeon reduces the appearance of problems and complications. Scapular notching is related to poorer clinical outcomes with respect to pain.(AU)

Scapular notching in reverse shoulder arthroplasty. Relationship with surgeon̈s experience and clinical outcomes. / Notching escapular en las prótesis invertidas de hombro. Su relación con la experiencia del cirujano y con los resultados clínicos.

BACKGROUND: Scapular Notching is a problem frequently seen in Reverse shoulder arthroplasties (RSAs), produced by a collision between the humeral component and the scapula. The main objective of this study is to analyze whether this problem decreases with the surgeons experience. As secondary objectives, assessing whether there is a relationship between its appearance and the clinical and functional outcome of patients. METHODS: We retrospectively reviewed 101 patients with 105 RSAs; we analyzed complications, focusing on scapular notching. Main follow-up time was 36 month (12-72). The clinical and functional outcomes were evaluated with the Constant scale and the QuickDash questionnaire. RESULTS: Forty-two patients (40%) had some degree of scapular notching. Of these, 25 patients had grade I, 14 had grade II and 3 had grade III notching. The average postoperative Constant score for the entire series was 60.72. A tendency toward a reduced incidence of notching was observed with increasing numbers of operated cases and experience of the surgeon (p=0.04). In the group of patients who had notching, the average postoperative Constant score was 56, and in the group that developed notching, the average score was 63. Patients with notching had significantly lower pain scores (p=0.012). CONCLUSIONS: Scapular notching is a common problem of RSA. In RSA, the experience of the surgeon reduces the appearance of problems and complications. Scapular notching is related to poorer clinical outcomes with respect to pain.