Use of the subscapularis preserving technique in anatomic total shoulder arthroplasty

Subscapularis tenotomy for total shoulder arthroplasty has been the standard approach for shoulder surgeons that utilize the deltopectoral approach. The risk of subscapularis insufficiency after this approach has been well documented. In order to avoid subscapularis complications, Lafosse reported a technique for total shoulder arthroplasty that utilizes a trans-deltoid approach through the rotator interval that yielded satisfactory clinical outcomes. However, he also reported concerns about humeral head undersizing and inadequate osteophyte resection. We present an alternative subscapularis preserving technique that is performed through the deltopectoral interval and allows complete osteophyte excision and accurate humeral head sizing. This technique requires modified instrumentation and is facilitated by the use of an adaptable prosthesis with dual eccentricity. Case examples using this technique are presented.