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Limited reliability of grading scapular notching according to Nerot–Sirveaux on anteroposterior radiographs

  • Orthopaedic Surgery
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Abstract

Introduction

Incidences of scapular notching (SN) in reverse shoulder arthroplasty (RSA) range between 0% and 96%, and controversy remain as to its relevance for patient outcome. We assessed the reliability of scapular notching (SN) grading based on the Sirveaux classification system using anteroposterior radiographs.

Materials and methods

206 RSA procedures with 5-year postoperative anteroposterior shoulder radiographs were classified independently by seven assessors according to Sirveaux (session 1). After a review meeting, three assessors re-classified the radiographs along with quality criteria (session 2). SN grading by the majority of assessors was taken as the reference. Classification interobserver reliability was analyzed using Kappa statistics.

Results

The incidence of SN was estimated at 53% and 37% at the first and second sessions, respectively. Interobserver reliability Kappa coefficients resulting from the first and second sessions were 0.27 and 0.43, respectively. Case selection based on radiographic quality criteria did not improve SN grading reliability in the second session.

Conclusion

Agreement between individual surgeons was low when grading SN in RSA according to Sirveaux using anteroposterior radiographs. Consensus among several assessors may increase reliability in research settings.

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Acknowledgements

The authors thank M. Wilhelmi, Ph.D., medical writer at Schulthess Clinic, for manuscript preparation and editing.

Funding

Support for this research was provided by Schulthess Clinic.

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Authors and Affiliations

  1. Upper Extremities Department, Schulthess Clinic, Zurich, Switzerland

    Marco M. Schneider, Felix Toft, Christoph Kolling, Barbara Wirth, Robert Vachenauer, Nils Horn, Quinten T. M. Felsch & Laurent Audigé

  2. Research and Development Department, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland

    Christoph Kolling & Laurent Audigé

  3. University of Witten/Herdecke, Witten, Germany

    Marco M. Schneider

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  1. Marco M. Schneider
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Correspondence to Laurent Audigé.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

The study was performed in accordance with the ethical standards of the cantonal ethics committee of Zurich (KEK-ZH) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Approval for analyses of the local clinical register (KEK-ZH Nr. 2014-0483: Clinical and subjective long-term outcome after an implantation of a shoulder arthroplasty) was granted on 23.01.2015.

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Schneider, M.M., Toft, F., Kolling, C. et al. Limited reliability of grading scapular notching according to Nerot–Sirveaux on anteroposterior radiographs. Arch Orthop Trauma Surg 139, 7–13 (2019). https://doi.org/10.1007/s00402-018-3027-5

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