Does bony increased-offset reverse shoulder arthroplasty decrease scapular notching?
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BACKGROUND: The purpose of this cohort study was to compare scapular notching rates, range of motion, and functional outcomes between patients who underwent a standard Grammont-style reverse shoulder arthroplasty (RSA) and patients who underwent bony increased-offset reverse shoulder arthroplasty (BIO-RSA) at a minimum of 2 years' follow-up. We hypothesized that the BIO-RSA cohort would have lower notching rates and improved rotational range of motion; however, validated outcome scores between cohorts would be no different. METHODS: A comparative cohort study was designed after a sample size calculation. A total of 40 patients were studied with 20 in each cohort (RSA vs BIO-RSA). All patients underwent an interview and physical examination. Outcomes included range of motion; shoulder strength; Disabilities of the Arm, Shoulder and Hand (DASH) score; American Shoulder and Elbow Surgeons score; Simple Shoulder Test score; Constant score; and Global Rating of Change scale score. Radiographs were obtained for all patients and examined for scapular notching. RESULTS: When we compared demographic characteristics between the standard RSA and BIO-RSA cohorts, including age, sex, and follow-up duration, there were no significant differences between groups (P > .05). In addition, there were no significant differences between cohorts when we compared forward elevation (P = .418); external rotation (P = .999); internal rotation (P = .071); strength (P > .376); Disabilities of the Arm, Shoulder and Hand score (P = .229); American Shoulder and Elbow Surgeons score (P = .579); Simple Shoulder Test score (P = .522); Constant score (P = .917); or Global Rating of Change scale score (P = .167). The frequency of scapular notching, however, was significantly higher (P = .022) in the RSA cohort than in the BIO-RSA cohort: 75% versus 40%. CONCLUSIONS: Although the scapular notching rate was significantly higher in the standard RSA group, no other outcome measures were statistically different, including range of motion, strength, and validated outcome scores.
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