Arthroplasty iSAWE 7

Question

A 74 year old man has new pain over the top of the shoulder six months after a reverse shoulder arthroplasty.

Arthroplasty iSAWE 7, radiograph of the shoulder
Radiograph of the shoulder. Image by Georg Mattiassich, Lucian Lior Marcovici, Rolf Michael Krifter, Reinhold Ortmaier, Peter Wegerer, Albert Kroepfl, Wikimedia Commons, CC BY 2.0.
  1. List the complications of reverse shoulder arthroplasty.
  2. Describe scapular notching and its grading.
  3. How would you investigate and treat his new pain?

Answer

Complications

  • Scapular notching
  • Acromial and scapular spine stress fracture
  • Instability and dislocation
  • Infection, Cutibacterium acnes in men
  • Baseplate loosening
  • Periprosthetic humeral fracture
  • Axillary nerve injury and neuropraxia
  • Haematoma

Scapular notching

  • Mechanical impingement of the humeral component on the inferior scapular neck in adduction
  • Polyethylene wear and osteolysis
  • Reduced by inferior baseplate placement, inferior tilt, larger glenosphere and lateralisation

Sirveaux grading

GradeExtent
1Limited to the pillar
2Reaches the lower baseplate screw
3Over the lower screw
4Reaches the baseplate peg

New acromial pain

  • Acromial or scapular spine stress fracture, about 3 to 5%
  • Point tenderness over the acromion, loss of elevation
  • CT if radiographs are normal
  • Most treated in a sling with activity restriction
  • Fixation for displaced spine fractures (Levy type III)
  • Excess lateralisation and distalisation increase risk

Related pages

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.