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.