J Korean Orthop Assoc.  2018 Aug;53(4):316-323. 10.4055/jkoa.2018.53.4.316.

Difference in the Surgical Approach in Reverse Total Shoulder Arthroplasty for Cuff Tear Arthroplasty: Comparison of the Radiological and Clinical Result according to the Deltopectoral and Anterosuperior Approach

• Choi CH
• Kwack BH
• Oh TB

• KMID: 2419467
• DOI: http://doi.org/10.4055/jkoa.2018.53.4.316

Abstract

PURPOSE
This study compared the clinical and radiological results of reverse total shoulder arthroplasty (RSA) using an anterosuperior approach with those using a deltopectoral approach to determine the difference in cuff tear arthroplasty between both approaches.
MATERIALS AND METHODS
A retrospective review of 24 consecutive patients who underwent RSA due to cuff tear arthroplasty from February 2014 to November 2015 was performed. The anterosuperior and deltopectoral approaches were 12 cases each. The mean age was 72 years and the mean follow-up period was 13.2 months. The clinical results were assessed using the visual analogue pain scale, American Shoulder and Elbow Surgeon score, Korean shoulder scoring system, and the Constant score. The prosthesis-scapular neck angle (PSNA), peg-glenoid rim distance (PGRD), scapular neck-inferior glenosphere rim distance (inferior glenosphere overhang), acromion-greater tuberosity (AT) distance, glenoid-greater tuberosity (GT) distance were assessed, and severity of notching according to the Nerot-Sirveaux classification, were measured from the radiology evaluation.
RESULTS
Compared to the anterosuperior approach, the PSNA (9.6°, p=0.018) and inferior glenosphere overhang (2.0 mm, p=0.024) were significantly greater in the deltopectoral approach and the PGRD (2.2 mm, p=0.043) was shorter. The AT and GT distance was similar in the two groups. Two and three cases of implant notching occurred on deltopectoral approach and anterosuperior approach, respectively. No metal loosening, acromion fracture, or nerve injury was noted. The clinical results improved significantly in both groups, but there was no statistically significant difference between the two groups.
CONCLUSION
The anterosuperior approach could cause the superior position of the glenoid baseplate and a decrease in the inferior tilt compared to the deltopectoral approach, but the clinical results had improved in both groups and there was no difference between the two groups.

Keyword

shoulder; cuff tear athropathy; reverse total shoulder arthroplasty; anterosuperior approach; deltopectoral approach

MeSH Terms

Acromion
Arthroplasty*
Classification
Elbow
Follow-Up Studies
Humans
Neck
Pain Measurement
Retrospective Studies
Shoulder*
Tears*

Figure

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  Figure 1 (A) An intraoperative photograph shows skin incision for the anterosuperior approach. (B) An intraoperative photograph shows the glenoid exposure and retractors placement for the anterosuperior approach. (C) An intraoperative photograph shows the sutures to reattach anterior deltoid. (D) An intraoperative photograph shows skin incision for the deltopectoral approach. (E) An intraoperative photograph shows the glenoid exposure and retractors placement for the deltopectoral approach. (F) An intraoperative photograph shows the sutures to reattach subscapularis.

• 

  Figure 2 (A) The prosthesis-scapular neck angle. (B) The peg glenoid rim distance. (C) The scapular neck-inferior glenosphere rim distance. (D) The acromion-greater tuberosity distance. (E) The glenoid-greater tuberosity distance.

Reference

1. Neer CS 2nd. Replacement arthroplasty for glenohumeral osteoarthritis. J Bone Joint Surg Am. 1974; 56:1–13.

2. Mackenzie DB. The antero-superior exposure for total shoulder replacement. Orthop Traumatol. 1993; 2:71–77.

3. Edwards TB, Williams MD, Labriola JE, Elkousy HA, Gartsman GM, O'Connor DP. Subscapularis insufficiency and the risk of shoulder dislocation after reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2009; 18:892–896.

4. Gillespie RJ, Garrigues GE, Chang ES, Namdari S, Williams GR Jr. Surgical exposure for reverse total shoulder arthroplasty: differences in approaches and outcomes. Orthop Clin North Am. 2015; 46:49–56.

5. Molé D, Wein F, Dézaly C, Valenti P, Sirveaux F. Surgical technique: the anterosuperior approach for reverse shoulder arthroplasty. Clin Orthop Relat Res. 2011; 469:2461–2468.

6. Valenti P, Sauziéres P, Cogswell L, O'Toole G, Katz D. The reverse shoulder prosthesis: surgical technique. Tech Hand Up Extrem Surg. 2008; 12:46–55.

7. Cazeneuve JF, Cristofari DJ. Delta III reverse shoulder arthroplasty: radiological outcome for acute complex fractures of the proximal humerus in elderly patients. Orthop Traumatol Surg Res. 2009; 95:325–329.

8. Gallinet D, Clappaz P, Garbuio P, Tropet Y, Obert L. Three or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis: a comparative study of 40 cases. Orthop Traumatol Surg Res. 2009; 95:48–55.

9. Cabezas AF, Krebes K, Hussey MM, et al. Morphologic variability of the shoulder between the populations of North American and East Asian. Clin Orthop Surg. 2016; 8:280–287.

10. 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.

11. De Biase CF, Delcogliano M, Borroni M, Castagna A. Reverse total shoulder arthroplasty: radiological and clinical result using an eccentric glenosphere. Musculoskelet Surg. 2012; 96:Suppl 1. S27–S34.

12. Otto RJ, Virani NA, Levy JC, Nigro PT, Cuff DJ, Frankle MA. Scapular fractures after reverse shoulder arthroplasty: evaluation of risk factors and the reliability of a proposed classification. J Shoulder Elbow Surg. 2013; 22:1514–1521.

13. Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Molé D. Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders. J Bone Joint Surg Br. 2004; 86:388–395.

14. Molé D, Favard L. Excentered scapulohumeral osteoarthritis. Rev Chir Orthop Reparatrice Appar Mot. 2007; 93:S37–S94.

15. Lynch NM, Cofield RH, Silbert PL, Hermann RC. Neurologic complications after total shoulder arthroplasty. J Shoulder Elbow Surg. 1996; 5:53–61.

16. Boileau P, Watkinson D, Hatzidakis AM, Hovorka I. Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg. 2006; 15:527–540.

17. Lädermann A, Lübbeke A, Mélis B, et al. Prevalence of neurologic lesions after total shoulder arthroplasty. J Bone Joint Surg Am. 2011; 93:1288–1293.

18. Lädermann A, Lubbeke A, Collin P, Edwards TB, Sirveaux F, Walch G. Influence of surgical approach on functional outcome in reverse shoulder arthroplasty. Orthop Traumatol Surg Res. 2011; 97:579–582.

19. Gutiérrez S, Greiwe RM, Frankle MA, Siegal S, Lee WE 3rd. Biomechanical comparison of component position and hardware failure in the reverse shoulder prosthesis. J Shoulder Elbow Surg. 2007; 16:S9–S12.

20. de Wilde LF, Poncet D, Middernacht B, Ekelund A. Prosthetic overhang is the most effective way to prevent scapular conflict in a reverse total shoulder prosthesis. Acta Orthop. 2010; 81:719–726.

21. Poon PC, Chou J, Young SW, Astley T. A comparison of concentric and eccentric glenospheres in reverse shoulder arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2014; 96:e138.

22. Mizuno N, Denard PJ, Raiss P, Walch G. The clinical and radiographical results of reverse total shoulder arthroplasty with eccentric glenosphere. Int Orthop. 2012; 36:1647–1653.