AP radiograph of a right shoulder in a patient with a RSA for rotator cuff arthropathy two years after implantation showing grade III scapular notching. The exact degree of scapular notching may be underdiagnosed if true AP views are not obtained. High-degree notching may be at risk for implant loosening and the patient must be closely monitored for evolving notching and advised of the possibility of component revision and bone grafting. Distalisation of the glenoid component with an eccentric component, along with the use of a humeral component with a more vertical joint line with or without humeral lateralisation may be advantageous in these situations.