Anterosuperior versus deltopectoral approach for primary reverse total shoulder arthroplasty

Abstract

AimsThe current evidence comparing the two most common approaches for reverse total shoulder arthroplasty (rTSA), the deltopectoral and anterosuperior approach, is limited. This study aims to compare the rate of loosening, instability, and implant survival between the two approaches for rTSA using data from the Dutch National Arthroplasty Registry with a minimum follow-up of five years.MethodsAll patients in the registry who underwent a primary rTSA between January 2014 and December 2016 using an anterosuperior or deltopectoral approach were included, with a minimum follow-up of five years. Cox and logistic regression models were used to assess the association between the approach and the implant survival, instability, and glenoid loosening, independent of confounders.ResultsIn total, 3,902 rTSAs were included. A deltopectoral approach was used in 54% (2,099/3,902) and an anterosuperior approach in 46% (1,803/3,902). Overall, the mean age in the cohort was 75 years (50 to 96) and the most common indication for rTSA was cuff tear arthropathy (35%; n = 1,375), followed by osteoarthritis (29%; n = 1,126), acute fracture (13%; n = 517), post-traumatic sequelae (10%; n = 398), and an irreparable cuff rupture (5%; n = 199). The two high-volume centres performed the anterosuperior approach more often compared to the medium- and low-volume centres (p < 0.001). Of the 3,902 rTSAs, 187 were revised (5%), resulting in a five-year survival of 95.4% (95% confidence interval 94.7 to 96.0; 3,137 at risk). The most common reason for revision was a periprosthetic joint infection (35%; n = 65), followed by instability (25%; n = 46) and loosening (25%; n = 46). After correcting for relevant confounders, the revision rate for glenoid loosening, instability, and the overall implant survival did not differ significantly between the two approaches (p = 0.494, p = 0.826, and p = 0.101, respectively).ConclusionThe surgical approach used for rTSA did not influence the overall implant survival or the revision rate for instability or glenoid loosening.Cite this article: Bone Joint J 2023;105-B(9):1000–1006.

Lateralising reverse shoulder arthroplasty using bony increased offset (BIO-RSA) or increasing glenoid component diameter: comparison of clinical, radiographic and patient reported outcomes in a matched cohort

“…The difference in follow-up time may be a source of bias, however, a previous study found no significant changes in results after 1 year, which was the minimum follow-up in this study [8]. Furthermore, the approach differed between the groups (the anterosuperior approach was used for regular RSA and the deltopectoral approach for BIO-RSA); however, the approach did not influence outcomes in previous studies [40,41]. Second, bone graft healing and viability, and implant positioning is best assessed on computed tomography (CT) scans instead of radiographs.…”

Shoulder & Elbow

“…This study from various centres, including Annecy (France) , compared the outcomes of these approaches using data from the Dutch National Arthroplasty Registry. 6 This is an important study as, to date, very little has been reported on any potential differences, and with a minimum follow-up of five years there is enough clinical follow-up here to identify any medium-term differences in outcomes. The aim was to assess the rate of complications, including glenoid loosening, instability, and overall implant survival between surgery undertaken with these two different approaches.…”