EDITOR'S NOTE: The corresponding author of this article was invited to respond to this letter, but to date, has not done so.
To The Editor:
After reading the article, “Predictors of
Scapular Notching in Patients Managed with the Delta III Reverse Total
Shoulder Replacement"(1), I have some questions I
hope the authors will address. The authors describe in detail that the
glenosphere should be placed in a slightly inferior position on the
glenoid. However, in my experience there are several situations in which,
due to bone loss, the glenosphere may not be able to be placed in the
location the authors describe and achieve adequate fixation. In those
situations one wonders where the author would place the glenosphere, and
if they are unable to place it in this desired position, would that
increase their incidence of scapular notching?
Unfortunately, those excluded from the study were patients with
revision of a previous arthroplasty, treatment of acute fracture,
posttraumatic deformity, or posttraumatic arthritis. It is just this subset of patients in which bone loss may
occur and the glenopshere may not be able to be placed in the optimal
location, and it would have been interesting to see their results of
notching in this population.
Also, moving the glenosphere inferior distally translates the
humerus, and may put tension on the soft tissue envelope around the
shoulder. Have the authors had problems with difficult intraoperative
reductions or post-operative dislocations, and have they had any patients with
traction type nerve injuries after surgery? Were there any acromial
fractures in this group? Displacing the humerus distally would also seem
to increase the dead space around the shoulder joint and implant. Have
the authors had many post-operative hematomas as a result of this?
Lastly, the authors state that with their inclusion criteria there
were 107 shoulders for the study but 30 were removed before the final
evaluation. Possible removal from the study included resection
arthroplasty or revision to a second prosthesis prior to the twenty-four
months. How many of this 30 were removed for this reason, and what was
the mode of early failure in these patients?
The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.
Reference:
1. Simovitch RW, Zumstein MA, Lohri E, Helmy N, Gerber C. Predictors of scapular notching in patients managed with the Delta III reverse total shoulder replacement. J Bone Joint Surg Am. 2007;89:588-600.
Letters to the Editor: ![[Read Letter to the Editor]](/icons/misc/sectionDOWN.gif){kind=icon}
