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
REVERSE SHOULDER ARTHROPLASTY USING TRANSDELTOID APPROACH
TECHNICAL NOTE and RESULTS
BACKGROUND:Nowadays, reverse total shoulder arthroplasty (RTSA) is the treatment of choice for rotator cuff tear arthropathy (CTA). As indications continue to expand, surgeons must be familiar with this implants, and consider potential surgical variations of the standar technique depending on the individual circunstances for each case. The purpose of this work is to show a detailed video-demonstration of this surgical technique at our Institution using the transdeltoid, also called, anterolateral approach, as an alternative to the classic deltopectoral. As an adjunct, the video is accompanied with rationale for the use of RTSA and advantages/disvantages for this uncommon approach are detailed. >2 years follow up results as well as our specific staged rehabilitation program is summarized at the end.
METHODS:The records of patients with the diagnosis of CTA and Massive irreparable cuff tear who had received a RTSA were reviewed. A minimum of 2 years' follow-up was required. Active shoulder elevation, external rotation, internal rotation; Constant, satisfaction level, shoulder pain and strength scores were obtained. Demographic data and complications rate were obtained as well.
RESULTS:We identified 95 reverse shoulder arthroplasties with a minimum of 2 years' follow-up (24 to 100 mo). The mean follow-up was 48.3 mo in the RTSA group. The mean age was 70.2 years. Constant score improved from 21 to 61 and satisfaction rate was 93%. Active elevation was significantly better.
CONCLUSIONS:In CTA and massive irreparable cuff tear, the RTSA has optimistic results regarding pain relief, function, and active elevation accompanied with a low rate of complications at 2-year follow-up. Transdeltoid approach is a reliable option for this surgical procedure and surgeons could consider to have it on their therapeutic arsenal.