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. 2024 Mar 1:8:24715492241234178.
doi: 10.1177/24715492241234178. eCollection 2024.

Better Constant Scores and Active Forward Elevation Using Deltopectoral Versus Anterosuperior Approach for Reverse Shoulder Arthroplasty: Matched Cohort Study

Cecile Nerot  1   2 , Julien Berhouet  2   3 , Jérôme Garret  2   4 , Jean Kany  2   5 ; ReSurg; SoFEC; Arnaud Godenèche  2   6
Collaborators, Affiliations

Better Constant Scores and Active Forward Elevation Using Deltopectoral Versus Anterosuperior Approach for Reverse Shoulder Arthroplasty: Matched Cohort Study

Cecile Nerot et al. J Shoulder Elb Arthroplast. .

Abstract

Purpose: To determine, from a sizable cohort of reverse shoulder arthroplasty (RSA), whether the deltopectoral (DP) or anterosuperior (AS) approach grant better outcomes at a minimum follow-up of 24 months.

Methods: The authors reviewed 743 RSAs in patients with primary osteoarthritis (OA) with or without rotator cuff lesions and secondary OA due to rotator cuff tears. The DP approach was used in 540 and the AS approach in 203. Pre- and post-operative constant scores (CSs) and shoulder range of motion were recorded.

Results: Of the initial cohort of 743 shoulders, 193 (25.7%) were lost to follow-up, 16 (2.1%) died, and 33 (4.4%) were revised; 540 shoulders were operated using DP approach (73%), of which 22 were revised (4.1%), while 203 were operated using the AS approach (27%), of which 11 were revised (5.4%). Propensity score matching resulted in two groups: 172 shoulders operated by DP approach, and 88 shoulders operated by AS approach. Comparing outcomes of the matched groups at 2 or more years also revealed that, compared to the AS approach, the DP approach resulted in significantly better post-operative CSs (67.3 ± 14.0° vs 60.8 ± 18.3, P = 0.017), active forward elevation (137° ± 27.4° vs 129° ± 29.8; P = 0.031).

Conclusion: At 2 or more years following RSA, the DP approach granted significantly better CS (by 6.5 points) and active forward elevation (by 8°) compared to the AS approach. The differences observed are clinically relevant and must be considered to manage patient expectations following RSA and for selecting surgical approach depending on their functional needs.

Level of evidence: III, comparative study.

Keywords: RSA; Reverse shoulder arthroplasty; anterolateral approach; constant score; range of motion; superolateral approach.

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Conflict of interest statement

Declaration of Conflicting Interests: CN and LH report fees from DePuy Synthes outside of the submitted work. JK reports personal fees and other from VIMS. JB and FS report consulting for Wright Medical outside the submitted work. JGa and AG report fees from Tornier SAS outside of the submitted work. JGu reports fees from moveUP outside of the submitted work. DG reports consulting and royalties from moveUP outside the submitted work. LNJ reports consulting and royalties from 3S Ortho. FVR, AH, LN, MS, PM, LP, RA report no conflicts of interest.

Figures

Figure 1.
Figure 1.
Flowchart of the study cohort.
See this image and copyright information in PMC

References

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