Subscapularis and deltoid preserving anterior approach for reverse shoulder arthroplasty

Abstract

Hypothesis: We hypothesize that performing a RSA using an anterior approach without cutting the subscapularis tendon and the deltoid muscle could provide patients with superior short-term clinical outcomes and immediate active range of motion (ROM) without immobilization.

Methods: Between August 2013 and June 2015, all patients who had a primary RSA were considered potentially eligible for inclusion in this prospective study.

Results: No immediate intra- or postoperative complications were noted. A statistically significant improvement of VAS (from 6.7 to 1; P<.001), SANE (from 34 to 80; P<.001), and elevation (from 103° to 128°; P=.02) was observed. In some cases, patients who had pseudoparalysis preoperative were able to achieve full anterior elevation few days after the operation.

Discussion: Using a subscapularis and deltoid preserving anterior approach is an option for patients requiring RSA. Leaving this tendon intact and preserving the deltoid minimize the need for immediate postoperative immobilization and allow for faster recovery of shoulder ROM, without risking the concern of humeral anterior dislocation. Overall duration of hospital stay as well as length of postoperative physical therapy may be minimized, with substantial long-term economic gain. Longer follow-up and comparison with standard approaches is necessary in the future.

Level of evidence of the study: Level IV, case series with no comparative group.

Keywords: Complication; Function; Reverse shoulder arthroplasty; Shoulder prosthesis; Subscapularis and deltoid preserving approach.