Rotator cuff disease that arises from glenohumeral arthritis is probably the top condition that calls for a reverse shoulder arthroplasty. Reverse shoulder replacement was specifically designed for a problem called rotator cuff tear arthropathy. Rotator cuff tear arthropathy is a problem that occurs when a patient has both shoulder arthritis and a rotator cuff tear. This surgery also helps correct irreparable anterosuperior cuff tears in the elderly, the proximal humeral fractures in elderly, significant glenoid defects and as a revision procedure for a failed hemiarthroplasty and total shoulder arthroplasty. The anterosuperior approach is a surgical approach used in reverse shoulder arthroplasty. This technique is a combination of the earlier used transacromial approach and the anterosuperior approach that is used for shoulder arthroplasty. The anterosuperior approach has better postoperative stability when compared to the classic deltopectoral approach.
The anterosuperior approach is a preferred technique in primary and revision reverse shoulder arthroplasty and also for acute humeral head fracture. In the case of the anterosuperior approach the patient is positioned in a similar manner. But in this method the elbow has to be free of any support to enable a proximally directed force at the elbow so the proximal subluxation of the humeral head is possible. The skin incision begins on the anterior part of the acromioclavicular joint and it is directed toward the front edge of the clavicle, stretching few meters behind the anterior acromion and beyond the lateral side of the acromion. This approach though will spare the subscapularis which has inconsistently resulted in lower dislocation incidences. This approach offers a better end-on view of the glenoid, the option of subscapularis preservation while enabling accurate placement of implants, earlier return to function, and a lower rate of postoperative instability.
When compared to the deltopectoral approach, the anterosuperior approach offers the advantages of better conditions of release and fixation of the greater tuberosity. Some other advantages of this technique are simplicity, ease of axial preparation of the humerus, quality of the frontal exposure of the glenoid, and preservation of the subscapularis tendon.
The anterosuperior approach has found to be especially useful for total shoulder replacement as well because it gives excellent face-on view of the glenoid for accurate preparation and implantation of a glenoid component. The other approach may not offer a satisfactory exposure of the glenoid in the well-muscled. The anterosuperior approach splits the anterior third fibers of the deltoid while protecting the cephalic vein and also ensuring that there is no damage to the axillary nerve.
Reverse shoulder arthroplasty is recommended when there is an irreparable anatomic or functional destruction of the rotator cuff along with an unstable center of rotation for the glenohumeral joint. The other prerequisites for this type of surgery are that the deltoid muscle is well functioning and that there should be adequate glenoid bone. Age is another important factor when reverse shoulder arthroplasty is being considered. Reverse shoulder arthroplasty should be limited to elderly patients that may be 70 years and older, with poor function, low activity, and severe pain in the presence of sufficient quantity and quality glenoid bone capable of providing unyielding fixation of the prosthetic glenoid component.