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

Chang Hyuk Choi; Byung Hoon Kwack; Tae Bum Oh

doi:10.4055/jkoa.2018.53.4.316

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Choi, Kwack, and Oh: 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

Original Article

Journal of the Korean Orthopaedic Association 2018; 53(4): 316-323.

Published online: 31 August 2018

DOI: https://doi.org/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

Chang Hyuk Choi, M.D., Byung Hoon Kwack, M.D.

, Tae Bum Oh, M.D.

Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea.

Correspondence to: Byung Hoon Kwack, M.D. Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea. TEL: +82-53-650-4054, FAX: +82-53-626-4272, kwackbyunghoon@nate.com

Received 9 January 2017 Revised 16 June 2017 Accepted 10 November 2017

The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: shoulder, cuff tear athropathy, reverse total shoulder arthroplasty, anterosuperior approach, deltopectoral approach

Figures and Tables

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.

Table 1

Demographic Data

Values are presented as number only or mean±standard deviation.

Table 2

Operative Data

Values are presented as mean±standard deviation.

Table 3

Clinical Result Assessment between Preoperative Values and Final Follow-Up

Values are presented as mean±standard deviation, mean±standard deviation (range), or mean (range). VAS, visual analogue pain scale; ASES, American Shoulder and Elbow Surgeon; KSS, Korean shoulder scoring system; FF, forward flexion; ER, external rotation; IR, internal rotation.

Table 4

Clinical Result Assessment between the Group

Values are presented as mean±standard deviation unless otherwise indicated. ^*The difference is a value obtained by subtracting the final follow-up from the preoperative values. †Mean±standard deviation (the difference of spine level). VAS, visual analogue pain scale; ASES, American Shoulder and Elbow Surgeon; KSS, Korean shoulder scoring system; FF, forward flexion; ER, external rotation; IR, internal rotation.

Table 5

Radiologic Result Assessment between the Group

Values are presented as mean±standard deviation or number only. PSNA, prosthesis-scapular neck angle; PGRD, peg-glenoid rim distance; AT, acromion-greater tuberosity; GT, glenoid-greater tuberosity; NA, not applicable.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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ORCID iDs: Byung Hoon Kwack
https://orcid.org/0000-0003-4795-8294
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