📌 RTSA Glenoid Complications: The Essentials

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How to Differentiate Normal Remodeling from True Mechanical Failure

Radiographic and CT follow-up are the backbone of evaluating glenoid-sided complications after Reverse Total Shoulder Arthroplasty (RTSA).
A few key imaging patterns reliably separate benign postoperative changes from worrisome loosening or migration.

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1. Glenoid Loosening – The Red Flags

What to look for:

• Progressive radiolucent lines >2 mm at the baseplate–bone or screw–bone interface
  
  
• Circumferential lucency or interval increase on follow-up
  
  
• Screw haloing or breakage
  
  
• Positional change of the baseplate (tilt, subsidence)
  
  
• Periprosthetic osteolysis
  
  

Best modalities:
Serial radiographs → CT for lucent rims & bone loss → SPECT/CT for painful prostheses

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2. Scapular Notching – Expected vs. Problematic

Definition:
Inferomedial cortical erosion at the inferior scapular neck due to adduction impingement.

Imaging appearance:

• Concave defect just below the baseplate (Sirveaux grades 1–4)
  
  
• CT: sharp cortical step-off, cavitary loss ± osteolysis from polyethylene wear
  
  
• SPECT/CT may show focal uptake when symptomatic
  
  

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3. Glenoid Migration & Tilt – When Position Starts to Drift

What suggests mechanical failure:

• Cranial or caudal translation of baseplate/glenosphere
  
  
• Medialization or lateralization compared with initial postoperative imaging
  
  
• Development of unintended superior tilt
  
  
• Progressive change beyond expected early settling
  
  

Best modalities:
Serial standardized radiographs → CT for precise translation/rotation assessment

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Quick Summary for Clinicians

Complication	Key Imaging Signs	Best Modality
Glenoid loosening	>2 mm radiolucent lines, screw haloing, osteolysis, positional change	Radiographs, CT, SPECT/CT
Scapular notching	Inferomedial cortical erosion, graded severity, sub-baseplate bone loss	AP radiographs, CT
Migration/tilting	Cranial/caudal shift, unintended superior tilt, progressive rotation	Radiographs, CT

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#RTSA, #ShoulderArthroplasty, #GlenoidLoosening, #ScapularNotching, #Orthopaedics, #Radiology, #MSKRadiology, #ShoulderImaging, #CTImaging, #PostoperativeImaging

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