Management of Failed Shoulder Surgery by Giuseppe Milano Andrea Grasso Angel Calvo & Roman Brzóska

Author:Giuseppe Milano, Andrea Grasso, Angel Calvo & Roman Brzóska
Language: eng
Format: epub
Publisher: Springer Berlin Heidelberg, Berlin, Heidelberg

16.3 How to Prevent Failure

Taking into account the main causes of failure of TSAs, surgical technique has a major role. Several key steps have to be respected to achieve a good outcome in TSA. First, accurate preoperative planning is essential for a successful surgery. Therefore, the routine acquisition of preoperative computed tomography (CT) or magnetic resonance imaging (MRI) scans is highly encouraged. Glenoid morphology according to Walch’s classification [3], glenoid version and posterior subluxation of the humeral head need to be evaluated preoperatively. Glenoid wear according to Sirveaux’s classification [5] and available bone stock do further dictate guidewire placement, so that the glenoid can be corrected anatomically. Finally, muscle volume and tendon status guide the decision on which implant to choose.

A deltopectoral approach is the gold standard for TSA. The skin incision is leading inferior-laterally from the coracoid with the possibility of simple extension, if necessary together with a clavicular osteotomy [6]. After splitting the deltopectoral interval, the long head of the biceps (LHB) tendon is approached, which should be routinely sacrificed, whereas data show that a biceps tenodesis provides a more favourable postoperative outcome than a tenotomy (Fig. 16.1).

Fig. 16.1Standard deltopectoral approach for anatomic TSA. The patient is placed in beach chair position (a). An oblique skin incision approximately from the tip of the coracoid following the deltoid muscle to lateral of the axilla is made (b). The deltopectoral interval is opened (c) and dissection continued down to the rotator cuff muscles. By following the LHB tendon proximally, the rotator cuff interval can be opened and the superior edge of the subscapularis muscle is defined (d)

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