Subscapularis- and deltoid-sparing vs traditional deltopectoral approach in reverse shoulder arthroplasty: a prospective case-control study
Abstract Background With the growth of reverse shoulder arthroplasty (RSA), it is becoming increasingly necessary to establish the most cost-effective methods for the procedure. The surgical approach is one factor that may influence the cost and outcome of RSA. The purpose of this study was to compa...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2017-07-01
|
| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13018-017-0617-9 |
| _version_ | 1811306698994876416 |
|---|---|
| author | Alexandre Lädermann Patrick Joel Denard Jérome Tirefort Philippe Collin Alexandra Nowak Adrien Jean-Pierre Schwitzguebel |
| author_facet | Alexandre Lädermann Patrick Joel Denard Jérome Tirefort Philippe Collin Alexandra Nowak Adrien Jean-Pierre Schwitzguebel |
| author_sort | Alexandre Lädermann |
| collection | DOAJ |
| description | Abstract Background With the growth of reverse shoulder arthroplasty (RSA), it is becoming increasingly necessary to establish the most cost-effective methods for the procedure. The surgical approach is one factor that may influence the cost and outcome of RSA. The purpose of this study was to compare the clinical results of a subscapularis- and deltoid-sparing (SSCS) approach to a traditional deltopectoral (TDP) approach for RSA. The hypothesis was that the SSCS approach would be associated with decreased length of stay (LOS), equal complication rate, and better short-term outcomes compared to the TDP approach. Methods A prospective evaluation was performed on patients undergoing RSA over a 2-year period. A deltopectoral incision was used followed by either an SSCS approach or a traditional tenotomy of the subscapularis (TDP). LOS, adverse events, physical therapy utilization, and patient satisfaction were collected in the 12 months following RSA. Results LOS was shorter with the SSCS approach compared to the TDP approach (from 8.2 ± 6.4 days to 15.2 ± 11.9 days; P = 0.04). At 3 months postoperative, the single assessment numeric evaluation score (80 ± 11% vs 70 ± 6%; P = 0.04) and active elevation (130 ± 22° vs 109 ± 24°; P = 0.01) were higher in the SSCS group. The SSCS approach resulted in a net cost savings of $5900 per patient. Postoperative physical therapy, pain levels, and patient satisfaction were comparable in both groups. No immediate intraoperative complications were noted. Conclusion Using a SSCS approach is an option for patients requiring RSA. Overall LOS is minimized compared to a TDP approach with subscapularis tenotomy. The SSCS approach may provide substantial healthcare cost savings, without increasing complication rate or decreasing patient satisfaction. |
| first_indexed | 2024-04-13T08:49:05Z |
| format | Article |
| id | doaj.art-a4b8768418cc4147bcafc06c7405f012 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-13T08:49:05Z |
| publishDate | 2017-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-a4b8768418cc4147bcafc06c7405f0122022-12-22T02:53:32ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2017-07-011211610.1186/s13018-017-0617-9Subscapularis- and deltoid-sparing vs traditional deltopectoral approach in reverse shoulder arthroplasty: a prospective case-control studyAlexandre Lädermann0Patrick Joel Denard1Jérome Tirefort2Philippe Collin3Alexandra Nowak4Adrien Jean-Pierre Schwitzguebel5Division of Orthopaedics and Trauma Surgery, La Tour HospitalSouthern Oregon OrthopedicsDivision of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University HospitalsSaint-Grégoire Private Hospital CenterDivision of Orthopaedics and Trauma Surgery, La Tour HospitalDivision of Orthopaedics and Trauma Surgery, La Tour HospitalAbstract Background With the growth of reverse shoulder arthroplasty (RSA), it is becoming increasingly necessary to establish the most cost-effective methods for the procedure. The surgical approach is one factor that may influence the cost and outcome of RSA. The purpose of this study was to compare the clinical results of a subscapularis- and deltoid-sparing (SSCS) approach to a traditional deltopectoral (TDP) approach for RSA. The hypothesis was that the SSCS approach would be associated with decreased length of stay (LOS), equal complication rate, and better short-term outcomes compared to the TDP approach. Methods A prospective evaluation was performed on patients undergoing RSA over a 2-year period. A deltopectoral incision was used followed by either an SSCS approach or a traditional tenotomy of the subscapularis (TDP). LOS, adverse events, physical therapy utilization, and patient satisfaction were collected in the 12 months following RSA. Results LOS was shorter with the SSCS approach compared to the TDP approach (from 8.2 ± 6.4 days to 15.2 ± 11.9 days; P = 0.04). At 3 months postoperative, the single assessment numeric evaluation score (80 ± 11% vs 70 ± 6%; P = 0.04) and active elevation (130 ± 22° vs 109 ± 24°; P = 0.01) were higher in the SSCS group. The SSCS approach resulted in a net cost savings of $5900 per patient. Postoperative physical therapy, pain levels, and patient satisfaction were comparable in both groups. No immediate intraoperative complications were noted. Conclusion Using a SSCS approach is an option for patients requiring RSA. Overall LOS is minimized compared to a TDP approach with subscapularis tenotomy. The SSCS approach may provide substantial healthcare cost savings, without increasing complication rate or decreasing patient satisfaction.http://link.springer.com/article/10.1186/s13018-017-0617-9ShoulderReverse shoulder arthroplastyLength of stayDeltopectoral approachSubscapularis sparingApproach |
| spellingShingle | Alexandre Lädermann Patrick Joel Denard Jérome Tirefort Philippe Collin Alexandra Nowak Adrien Jean-Pierre Schwitzguebel Subscapularis- and deltoid-sparing vs traditional deltopectoral approach in reverse shoulder arthroplasty: a prospective case-control study Journal of Orthopaedic Surgery and Research Shoulder Reverse shoulder arthroplasty Length of stay Deltopectoral approach Subscapularis sparing Approach |
| title | Subscapularis- and deltoid-sparing vs traditional deltopectoral approach in reverse shoulder arthroplasty: a prospective case-control study |
| title_full | Subscapularis- and deltoid-sparing vs traditional deltopectoral approach in reverse shoulder arthroplasty: a prospective case-control study |
| title_fullStr | Subscapularis- and deltoid-sparing vs traditional deltopectoral approach in reverse shoulder arthroplasty: a prospective case-control study |
| title_full_unstemmed | Subscapularis- and deltoid-sparing vs traditional deltopectoral approach in reverse shoulder arthroplasty: a prospective case-control study |
| title_short | Subscapularis- and deltoid-sparing vs traditional deltopectoral approach in reverse shoulder arthroplasty: a prospective case-control study |
| title_sort | subscapularis and deltoid sparing vs traditional deltopectoral approach in reverse shoulder arthroplasty a prospective case control study |
| topic | Shoulder Reverse shoulder arthroplasty Length of stay Deltopectoral approach Subscapularis sparing Approach |
| url | http://link.springer.com/article/10.1186/s13018-017-0617-9 |
| work_keys_str_mv | AT alexandreladermann subscapularisanddeltoidsparingvstraditionaldeltopectoralapproachinreverseshoulderarthroplastyaprospectivecasecontrolstudy AT patrickjoeldenard subscapularisanddeltoidsparingvstraditionaldeltopectoralapproachinreverseshoulderarthroplastyaprospectivecasecontrolstudy AT jerometirefort subscapularisanddeltoidsparingvstraditionaldeltopectoralapproachinreverseshoulderarthroplastyaprospectivecasecontrolstudy AT philippecollin subscapularisanddeltoidsparingvstraditionaldeltopectoralapproachinreverseshoulderarthroplastyaprospectivecasecontrolstudy AT alexandranowak subscapularisanddeltoidsparingvstraditionaldeltopectoralapproachinreverseshoulderarthroplastyaprospectivecasecontrolstudy AT adrienjeanpierreschwitzguebel subscapularisanddeltoidsparingvstraditionaldeltopectoralapproachinreverseshoulderarthroplastyaprospectivecasecontrolstudy |