Influence of surgical approach on functional outcome in reverse shoulder arthroplasty - 22/08/11

Doi : 10.1016/j.otsr.2011.04.008

A. Lädermann ^a,^⁎ , A. Lubbeke ^a, P. Collin ^b, T.B. Edwards ^c, F. Sirveaux ^d, G. Walch ^e
^a Department of Orthopaedic Surgery and Traumatology, Geneva University Hospitals, 4, rue Gabrielle-Perret-Gentil, 1211 Genève, Switzerland
^b Saint-Grégoire Private Hospital Center, 6, boulevard Boutière, 35768 Saint-Grégoire cedex, France
^c Fondren Orthopedic Group, Houston, Texas, USA
^d Centre chirurgical Émile-Gallé Surgical Center, 49, rue Hermite, 54000 Nancy, France
^e Orthopaedic Center and Jean-Mermoz Private Hospital, 24, avenue Paul-Santy, 69008 Lyon, France

Corresponding author. Tel.: +41 22 372 79 08; fax: +41 22 372 79 03.

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Summary

Introduction

Reverse shoulder arthroplasties (RSA) can be performed using a Deltopectoral (DP) or alternatively a Transdeltoid (TD) approach.

Hypothesis

Although the humeral cut is lower by TD approach, this should not affect postoperative functional results.

Material and methods

This retrospective multicentric study evaluated the complete medical records of RSA implanted between October 2003 and December 2008. Inclusion criteria were: follow-up of at least 1year, a complete file including a comparative radiological work-up making it possible to analyze eventual arm and humeral lengthening. Evaluation of postoperative function was based on Active Anterior Elevation (AAE).

Results

We studied 144 RSA in 142 patients. One hundred and nine RSA were implanted by the DP approach and 35 by the TD approach. Mean lengthening of the humerus compared to the controlateral side by DP approach was 0.5±1.3cm while there was a mean shortening of −0.5±1.0cm by TD approach (P<0.001). The difference in cut was partially compensated by using thicker polyethylene inserts with the TD approach. Mean arm lengthening compared to the controlateral side was 1.7±1.7cm by DP approach and 1.2±1.4cm by TD approach (mean difference 0.5cm; (95% CI −0.1; 1.2). AAE for RSA by DP approach was 145±22° and 135±29° by TD approach (mean difference 10°, 95% CI −1; 21).

Discussion

RSA results in improved AAE because of restored deltoid tension and an increase in the deltoid lever arm. The humeral cut by TD is lower, but this was partially corrected in this study by the use of thicker polyethylene inserts. Nevertheless there is no significant clinical difference in postoperative function between the two approaches.