Anterosuperior Approach Versus Deltopectoral Approach for Reverse Total Shoulder Arthroplasty: a Systematic Review and Meta-analysis

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2022 Dec 9

PMID 36482423

Authors

Hyun-Gyu Seok

Jeong Jin Park

Sam-Guk Park

Affiliations

Soon will be listed here.

Abstract

Background: Surgical approach is an important factor that may affect the outcomes of reverse total shoulder arthroplasty (RTSA). The most common approaches for RTSA are anterosuperior (AS) and deltopectoral (DP). However, controversy exists on which surgical approach is better. This meta-analysis aimed to compare both approaches in terms of radiological and clinical outcomes and complications.

Methods: We searched PubMed, Embase, and Cochrane Library databases for studies that compared the postoperative outcomes of the AS and DP approaches for RTSA. After screening and quality assessment of the articles, we obtained two randomized controlled trials and four retrospective comparative studies. We analyzed the radiologic outcomes, functional outcomes, and complications between the two approaches. The standardized mean difference and odds ratio were used to analyze the differences in outcomes between the two surgical approaches. Statistical significance was set at P < 0.05.

Results: The incidence rate of glenoid implant loosening was significantly (P = 0.04) lower in the AS group than that in the DP group. In terms of forward flexion after surgery, the DP approach produced significantly (P = 0.03) better outcomes compared with the AS approach. There were no significant differences in radiological outcomes or other complication rates between the two approaches.

Conclusion: As a result of this meta-analysis, one of the two approaches did not bring a better result than the other. One has strength for better forward flexion and the other for a lower glenoid loosening rate. With this in mind, it is recommended to use the approach that the surgeon is most familiar with.

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References

Edwards T, Williams M, Labriola J, Elkousy H, Gartsman G, OConnor D . Subscapularis insufficiency and the risk of shoulder dislocation after reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2009; 18(6):892-6. DOI: 10.1016/j.jse.2008.12.013. View

Levigne C, Boileau P, Favard L, Garaud P, Mole D, Sirveaux F . Scapular notching in reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2008; 17(6):925-35. DOI: 10.1016/j.jse.2008.02.010. View

Padegimas E, Maltenfort M, Lazarus M, Ramsey M, Williams G, Namdari S . Future patient demand for shoulder arthroplasty by younger patients: national projections. Clin Orthop Relat Res. 2015; 473(6):1860-7. PMC: 4418978. DOI: 10.1007/s11999-015-4231-z. View

Simovitch R, Zumstein M, Lohri E, Helmy N, Gerber C . Predictors of scapular notching in patients managed with the Delta III reverse total shoulder replacement. J Bone Joint Surg Am. 2007; 89(3):588-600. DOI: 10.2106/JBJS.F.00226. View

Matthewson G, Kooner S, Kwapisz A, Leiter J, Old J, Macdonald P . The effect of subscapularis repair on dislocation rates in reverse shoulder arthroplasty: a meta-analysis and systematic review. J Shoulder Elbow Surg. 2019; 28(5):989-997. DOI: 10.1016/j.jse.2018.11.069. View

De Wilde L, Poncet D, Middernacht B, Ekelund A . Prosthetic overhang is the most effective way to prevent scapular conflict in a reverse total shoulder prosthesis. Acta Orthop. 2010; 81(6):719-26. PMC: 3216083. DOI: 10.3109/17453674.2010.538354. View

Boileau P, Watkinson D, Hatzidakis A, Hovorka I . Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg. 2006; 15(5):527-40. DOI: 10.1016/j.jse.2006.01.003. View

Verstraete O, Van der Mast B, VAN Tongel A, Karelse A, VAN DER Bracht H, Berghs B . Prevalence and risk factors of scapular stress fracture after reverse shoulder arthroplasty: a multicentric retrospective study. Int Orthop. 2020; 45(1):209-216. DOI: 10.1007/s00264-020-04849-7. View

Simovitch R, Flurin P, Wright T, Zuckerman J, Roche C . Impact of scapular notching on reverse total shoulder arthroplasty midterm outcomes: 5-year minimum follow-up. J Shoulder Elbow Surg. 2019; 28(12):2301-2307. DOI: 10.1016/j.jse.2019.04.042. View

10.

Mole D, Wein F, Dezaly C, Valenti P, Sirveaux F . Surgical technique: the anterosuperior approach for reverse shoulder arthroplasty. Clin Orthop Relat Res. 2011; 469(9):2461-8. PMC: 3148356. DOI: 10.1007/s11999-011-1861-7. View

11.

Rugg C, Coughlan M, Lansdown D . Reverse Total Shoulder Arthroplasty: Biomechanics and Indications. Curr Rev Musculoskelet Med. 2019; 12(4):542-553. PMC: 6942071. DOI: 10.1007/s12178-019-09586-y. View

12.

Gillespie R, Garrigues G, Chang E, Namdari S, Williams Jr G . Surgical exposure for reverse total shoulder arthroplasty: differences in approaches and outcomes. Orthop Clin North Am. 2014; 46(1):49-56. DOI: 10.1016/j.ocl.2014.09.015. View

13.

Armijo-Olivo S, Stiles C, Hagen N, Biondo P, Cummings G . Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. J Eval Clin Pract. 2010; 18(1):12-8. DOI: 10.1111/j.1365-2753.2010.01516.x. View

14.

Ladermann A, Denard P, Tirefort J, Collin P, Nowak A, Schwitzguebel A . Subscapularis- and deltoid-sparing vs traditional deltopectoral approach in reverse shoulder arthroplasty: a prospective case-control study. J Orthop Surg Res. 2017; 12(1):112. PMC: 5513373. DOI: 10.1186/s13018-017-0617-9. View

15.

Wall B, Nove-Josserand L, OConnor D, Edwards T, Walch G . Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am. 2007; 89(7):1476-85. DOI: 10.2106/JBJS.F.00666. View

16.

Torrens C, Amestoy J, Rodriguez-Delourme I, Santana F . Positioning of the metaglene in reverse shoulder arthroplasty: deltopectoral versus anterosuperior approach: a prospective randomized trial. J Shoulder Elbow Surg. 2021; 30(12):2682-2690. DOI: 10.1016/j.jse.2021.07.025. View

17.

Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M . Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015; 350:g7647. DOI: 10.1136/bmj.g7647. View

18.

Drake G, OConnor D, Edwards T . Indications for reverse total shoulder arthroplasty in rotator cuff disease. Clin Orthop Relat Res. 2010; 468(6):1526-33. PMC: 2865601. DOI: 10.1007/s11999-009-1188-9. View

19.

Ladermann A, Lubbeke A, Collin P, Edwards T, Sirveaux F, Walch G . Influence of surgical approach on functional outcome in reverse shoulder arthroplasty. Orthop Traumatol Surg Res. 2011; 97(6):579-82. DOI: 10.1016/j.otsr.2011.04.008. View

20.

Kempton L, Balasubramaniam M, Ankerson E, Wiater J . A radiographic analysis of the effects of glenosphere position on scapular notching following reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2011; 20(6):968-74. DOI: 10.1016/j.jse.2010.11.026. View