The Deltopectoral Approach for Reverse Shoulder Arthroplasty

Eighty-six reverse shoulder arthroplasty (RSA) cases performed through a deltopectoral (DP) approach were reviewed at an average of 17.2 months after surgery. All procedures were performed by 2 fellowship-trained shoulder surgeons who perform a high volume of shoulder arthroplasty. We describe the surgical technique for the DP approach for primary and revision RSA, preliminary results, intraoperative complications, and early postoperative complications. We did not encounter instability in this series of patients. The DP approach affords an extensile view of the humerus during primary and revision RSA and can have a low incidence of instability contrary to recent reports. Reverse shoulder arthroplasty (RSA) is an effective operative treatment for rotator cuff tear arthropathy and other complex shoulder disorders.1-4 When selecting a surgical approach for RSA, the surgeon should consider that the deltoid muscle is the primary source of shoulder movement after RSA. Any surgical approach used for RSA either should preserve the deltoid entirely or should leave the deltoid in excellent condition. Surgical approaches described for this procedure range from transacromial5 to superior/deltoid splitting/ MacKenzie6 and to deltoid sparing/deltopectoral7 approaches. We present a series of patients who had RSA through a deltoid sparing/deltopectoral approach and describe the surgical techniques for primary and revision RSAs, including implant revision surgery. We also discuss the benefi ts of a deltoid sparing/deltopectoral approach and the short-term results in these patients.