These authors point out that "Accurate positioning of these implants can be challenging using the superolateral approach". They aimed to evaluate the clinical and radiologic results of reverse short-stem arthroplasties inserted using a superolateral approach with a minimum of 2 years’ follow-up in 76 patients (79 shoulders) using a short uncemented humeral stem for shoulder arthritis with irreparable rotator cuff tear. Arthroplasties for post-traumatic osteoarthritis were excluded.
The clinical scores were improved. No radiologic evidence of periprosthetic loosening was noted. Mean varus of the humeral stem was 1±6 degrees. The mean glenoidal inclination was 98±7 degrees. The average filling ratio was between 50% and 60% in both the metaphysis and the diaphysis.
A partial glenoid fracture was realized during one procedure. Two cases of late sepsis were diagnosed during follow-up (at 8 and 13 months), and were treated by a staged revision with an antibiotic spacer. No cases of shoulder stiffness, algodystrophy, or dislocation were noted. In 3 cases, they observed an acromial stress fracture.
A partial glenoid fracture was realized during one procedure. Two cases of late sepsis were diagnosed during follow-up (at 8 and 13 months), and were treated by a staged revision with an antibiotic spacer. No cases of shoulder stiffness, algodystrophy, or dislocation were noted. In 3 cases, they observed an acromial stress fracture.
The authors state that "The complication rate was 9% in the present series, which is similar to those reported in the literature. We believe that this complication rate is similar for both approaches and is characteristic of shoulder arthroplasty surgery. Although this approach provides a satisfactory view of the glenoid, the fracture of the glenoid was related to a technical error."
Below is an example of stress shielding
Here is an example of acromial stress fracture in a case where the humerus was substantially distalized.
In that regard it is of note that the average amount of distalization was over 26 mm.
Comment: The indication for these surgeries was the most straightforward diagnosis: glenohumeral arthritis with deficient rotator cuff.Other indications (trauma, tumor, revisions) were not included.
Even with that, it is apparent that there is a substantial learning curve associated with this approach as well as the risk to the deltoid and difficulty in controlling the amount of distalization. It is not clear that this approach adds value to the practice of reverse total shoulder arthroplasty in comparison to the legacy approach described in this link.
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