Anterosuperior approach versus deltopectoral approach for reverse total shoulder arthroplasty: a systematic review and meta-analysis

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.

Anterosuperior versus deltopectoral approach for primary reverse total shoulder arthroplasty

“…Humeral stem 25 (13) of 136 cases from two studies, Seok et al 16 found a lower rate of glenoid loosening with the anterosuperior approach (odds ratio 0.10 (95% CI 0.01 to 0.93)), which is similar to our initial bivariable model. However, the CI approaches 0, suggesting a poor correlation.…”

“…8 Several studies have compared the complications between the two approaches (Table I). 6,[9][10][11][12][13][14][15][16] Some studies have linked the anterosuperior with a lower postoperative instability rate compared to the deltopectoral approach, which is attributed to preserving the subscapularis and anterior ligament complex. 5,6 Previous studies have also associated the anterosuperior approach with a more superior placement and superior tilt of the metaglene compared to the deltopectoral approach.…”

“…7,19,20 Conversely, a recent systematic review and meta-analysis comparing the two surgical approaches found a significantly lower rate of glenoid component loosening with the anterosuperior approach. 16 There remain many discrepancies in the literature comparing the complications between the two approaches, with several studies reporting contradictory results. 6,7,[9][10][11][12][13][14][15][16][20][21][22] Furthermore, the current evidence comparing the two techniques relies on separate prospective cohort studies or retrospective comparative studies that are relatively small, have short follow-up periods, and are susceptible to selection and publication bias.…”

“…16 There remain many discrepancies in the literature comparing the complications between the two approaches, with several studies reporting contradictory results. 6,7,[9][10][11][12][13][14][15][16][20][21][22] Furthermore, the current evidence comparing the two techniques relies on separate prospective cohort studies or retrospective comparative studies that are relatively small, have short follow-up periods, and are susceptible to selection and publication bias. 1,6,7,21,23 There is no conclusive evidence supporting the superiority of one of the two techniques.…”

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.…”