Which statement describes the most common complication of RTSA that can lead to re-operation?

• A. Infection
• B. Dislocation
• C. Loosening
• D. Scapular Notching

Answer: (D)

Scapular notching reflects a mechanical problem that can translate into failure of the reverse total shoulder arthroplasty over time. It happens when the humeral cup contacts the inferior scapular neck, causing erosion of the scapular surface. This notching is very commonly seen on imaging after RTSA, and while many cases are asymptomatic, progression can worsen impingement, increase polyethylene wear, and contribute to loosening of the glenoid baseplate or other components. When notching progresses or is associated with functional decline and pain, revision surgery may be required. This potential for progression to a mechanical failure that necessitates intervention makes it a prominent reason for re-operation in many patient series.

Infection, while serious, is less common as a cause for revision; dislocation occurs more frequently but is often reducible and does not always require re-operation; loosening is a significant late complication but not as consistently linked to the need for revision across cohorts as notching.