Anterosuperior versus deltopectoral approach for primary reverse total shoulder arthroplasty.

Publisher: British Editorial Society of Bone & Joint Surgery Country of Publication: England NLM ID: 101599229 Publication Model: Electronic Cited Medium: Internet ISSN: 2049-4408 (Electronic) Linking ISSN: 20494394 NLM ISO Abbreviation: Bone Joint J Subsets: MEDLINE

Original Publication: London : British Editorial Society of Bone & Joint Surgery

Arthroplasty, Replacement, Shoulder* ; Osteoarthritis* ; Arthritis, Infectious*; Humans ; Aged ; Arthroplasty ; Disease Progression

Aims: The 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.
Methods: All 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.
Results: In 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).
Conclusion: The surgical approach used for rTSA did not influence the overall implant survival or the revision rate for instability or glenoid loosening.
Competing Interests: None declared.
(© 2023 The British Editorial Society of Bone & Joint Surgery.)

Erratum in: Bone Joint J. 2023 Oct 1;105-B(10):1131. doi: 10.1302/0301-620X.105B10.BJJ-2023-00035. (PMID: 37777196)

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Date Created: 20230831 Date Completed: 20230904 Latest Revision: 20230930

20250114

10.1302/0301-620X.105B9.BJJ-2023-0238.R1

37652454