MINIMALLY INVASIVE SURGERY IN REVERSE SHOULDER ARTHROPLASTY: 100 CASES OF TISSUE SPARING ANTERO SUPERIOR APPROACH

A certain number of patients with rotator cuff deficiency progress to end-stage osteoarthritic disease with concomitant pain and loss of function and independence. In 1987 Grammont et Baulot introduced a novel semiconstrained reverse shoulder arthroplasty (RSA) as a treatment for patients with cuff tear arthropathy. It involved reversing the polarity of ball-and-socket by placing a "ball" component at the glenoid and an articular "socket" at the proximal humerus. The geometric inversion of the implanted joint components has two essential biomechanical consequences. Medialization of the center of rotation optimizes the deltoid lever arm. Increasing the subacromial space by lowering the humerus results in an increase in deltoid strength by restoring deltoid tension which corrects rotator cuff deficiencies. Good clinical outcome is achieved through maximization of the length-tension relationship of the deltoid and remaining cuff musculature, and it may allow patients to achieve a good functional result even in the presence of a severely deficient rotator cuff RSA has advanced the treatment of shoulder disorders, the ideal indications, surgical techniques, implant designs, and rehabilitation protocols continue to be refined. With improvements in modern implant design and instrumentation, surgical techniques for RSA continue to evolve, as do the surgical indications. Reverses shoulder arthroplasty is most commonly performed via a deltopectoral (DP) or anterosuperior (AS) approach, and several modifications of each have been described. This work aims to explain our surgical technique of mini invasive tissue-sparing antero superior approach and to examine the related evidence