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Reverse Shoulder Arthroplasty Using Transdeltoid Approach: Technical Note and Results

February 19, 2016

Contributors: Ashish Gupta, MD; Kalojan Petkin, MD; Laurent Lafosse, MD; Gonzalo Samitier Solis, MD; Gonzalo Samitier Solis, MD

Background: Currently, reverse total shoulder arthroplasty (RTSA) is the treatment option of choice for the management of rotator cuff tear arthropathy. As indications for RTSA continue to expand, surgeons must be familiar with RTSA implants and consider potential surgical variations of the standard technique, depending on the circumstances of each patient. This video demonstrates RTSA via the transdeltoid approach, which also is called the anterolateral approach and is an alternative to the classic deltopectoral approach for RTSA. The video provides our rationale for the use of RTSA and reviews advantages and disadvantages of this uncommon approach. More than 2 years of follow up results and our specific, staged rehabilitation protocol are summarized. Methods: The records of patients diagnosed with rotator cuff tear arthropathy and a massive irreparable rotator cuff tear who underwent RTSA were reviewed. A minimum follow-up of 2 years was required. Active shoulder elevation, external rotation, internal rotation, Constant assessment scores, satisfaction levels, and shoulder pain and strength scores were obtained. Demographic data and complication rates also were obtained. Results: We identified 95 RTSA procedures with a minimum follow-up of 2 years (range, 24 to 100 months). The mean follow-up was 48.3 months. The mean patient age was 70.2 years. The mean Constant assessment score improved from 21 to 61, and the mean satisfaction rate was 93%. Active elevation was considerably better postoperatively. Conclusions: In patients with rotator cuff tear arthropathy and a massive irreparable rotator cuff tear, RTSA is associated with optimistic results with regard to pain relief, function, and active elevation and a low rate of complications at a follow-up of 2 years. The transdeltoid approach is a reliable option for RTSA, and surgeons should consider including the approach in their therapeutic arsenal.