Anteromedial approach for shoulder arthroplasty: current indications, complications, and results

The anteromedial approach to the shoulder with detachment of the anterior deltoid from its clavicular and anterior acromial origins is a method of enhancing exposure for difficult shoulder arthroplasty cases. The aim of this study is to describe the current frequency of use, indications, complications, and results of this approach.

Between 2000 and 2003, 723 consecutive shoulder arthroplasties were performed. In 110 (15%) an anteromedial approach was used. Patient data; previous surgery; indications for surgery; pain, motion, and strength before and after surgery; complications; and the need for reoperation were assessed.

This approach was used in 9.5% of primary cases and 39% of revision cases. Seventy percent had had previous surgery. For primary arthroplasty, the most frequent diagnoses were osteoarthritis and the sequelae of fractures. In revision cases the most common diagnoses were instability and glenoid loosening. The structural indications for the anteromedial approach were severe scarring, protection of a frail deltoid, improvement in rotator cuff or glenoid exposure, protection of osteopenic bone, or enhancement of exposure in oncologic cases or resections. Ninety patients had more than 2 years of follow-up. Pain improved after primary and revision arthroplasty. Motion only improved in primary arthroplasty. There was little change in strength. No proximal deltoid detachments or other approach-related complications were identified.

The anteromedial approach is a reliable technique to improve surgical exposure in difficult shoulder arthroplasty cases. When performed adequately, it can be applied safely without anterior deltoid detachment or clinically evident major complications.