Abstract
Reverse shoulder arthroplasty (RSA) has become an optimal treatment for numerous orthopedic entities, such as rotator cuff tear arthropathies, pseudoparalysis, fracture sequelae, acute fractures, failed arthroplasties, osteoarthritis, and rheumatoid arthritis, and is linked with relief of topical pain and regaining of functionality. Presently, RSA has been conducted through anterosuperior (AS) or deltopectoral (DP) approach. The aim of the study was to discuss both approaches and to examine broadly their features to render a comparison in terms of clinical effectiveness. An electronic search in PubMed, EMBASE, and Google Scholar databases was performed, using combinations of the following keywords: RSA, DP approach, AS approach, notching, and cuff tear arthropathy. A total of 61 studies were found, and 16 relevant articles were eventually included. Currently published literature has not shown significant diversities in the clinical course due to approach preference; risk of instability seems to be greater in DP approach, while regarding scapular notching and fracture rates the findings were conflicted. In addition, the AS approach has been associated with decreased risk of acromial and scapular spine fractures. In conclusion, both surgical approaches have shown similar clinical outcomes and effectiveness concerning pain and restoring range of motion (ROM) in rotator cuff tear arthropathies. In the future, further investigations based on large-scale well-designed studies are required to address clinical gaps allowing in-depth comparison of both approaches.
Highlights
Osteoarthritis is an ordinary degenerative entity of the shoulder joint, signalized by compressed glenohumeral joint space, and the most favorable therapy is shoulder replacement (1)
The DP approach was overall observed to a greater extent, it seems that the AS approach has been used mainly in European countries (14, 22, 25, 26, 32, 34, 35), especially in France (14, 22, 25, 26) and in some USA centers (15, 23)
The aim of this review was to comprehensively describe DP and AS approaches to compare their clinical effectiveness as revealed by published data
Summary
Osteoarthritis is an ordinary degenerative entity of the shoulder joint, signalized by compressed glenohumeral joint space, and the most favorable therapy is shoulder replacement (1). Shoulder osteoarthritis displays regional pain, rigidity, and restriction of shoulder function. Shoulder pain is correlated with a remarkable disability, disability assertions, augmented usage of healthcare resources, and marked morbidity, principally in the elderlies (2). The results of anatomical total shoulder arthroplasty in cases with rotator cuff tear arthropathies have been scarce (3, 4); reverse shoulder arthroplasty (RSA) may be an appropriate, effective open procedure (5, 6). RSA has become one of the most significant medical progresses in the field of shoulder arthroplasty, in the last three decades and from its genesis has achieved outstanding popularity in view of the capability to treat patients with severe rotator cuff deficiency
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