Editor’s note: During the upcoming 30th Annual Tampa Shoulder Course: Arthroplasty & Sports, Dr. Mark Mighell will present a Technical Tips lecture on How to Do a Subscapularis-Sparing TSA We asked Dr. Mighell to preview the key points of this talk.
FORE: One of your presentations will be on subscapularis-sparing total shoulder arthroplasty (TSA). Why is it important to include this topic in the agenda for the Tampa Shoulder Course?
Mark A. Mighell, MD: The ability to avoid disruption of the subscapularis allows for a much easier rehabilitation after shoulder replacement. Patients, therefore, are able to return to work and other activities much quicker.
FORE: Is this the technique you use with all your shoulder replacement patients? Or is it a more appropriate approach for a certain subpopulation of your patients?
Dr. Mighell: I use this technique with all patients who require a primary TSA.
FORE: How long have you been performing subscapularis-sparing TSA, and what has been your experience regarding the ease of the technique and your patients’ outcomes?
Dr. Mighell: I’ve been performing subscapularis-sparing replacement for approximately 5 years and the outcomes have been very promising. This technique offers the advantage of early postoperative motion with no restrictions which means quicker return to activities of daily living, driving, and work.
FORE: What does the literature say about subscapularis-sparing TSA, and have there been any new developments in using the technique?
Dr. Mighell: Several articles have been written on subscapularis shoulder replacement, and they indicate that the ideal patient for a subscapularis sparing TSA on is an older female with greater than 20° of external rotation. Contraindications include trauma and inflammatory arthritis. Prior studies also have shown that this technique can be used to reliably attain acceptable radiographic outcomes. New developments that have improved the technique include precision cutting blocks and instruments that are specifically made to improve access to the glenoid during surgery.
FORE: What is the single most important thing a surgeon can do during a subscapularis-sparing TSA to avoid complications and maximize outcomes?
Dr. Mighell: A 360° release of the soft tissues off the glenoid is the single most important thing a surgeon can do during a subscapularis-sparing TSA. This allows for posterior and inferior translation of the humerus.
About the Author
Mark A. Mighell, MD, is one of the Course Chairs for the 30th Annual Tampa Shoulder Course: Arthroplasty & Sports. He is a board-certified orthopaedic surgeon specializing in treating shoulder and elbow conditions at the Florida Orthopaedic Institute in Tampa, Florida. Dr. Mighell is an Associate Professor in the Department of Orthopaedic Surgery at the University of South Florida and Co-Director of the Florida Orthopaedic Institute’s Shoulder and Elbow Fellowship Program.
The Tampa Shoulder Course: Arthroplasty & Sports will take place February 1-3, 2024, at the JW Marriott Tampa Water Street and FIVE Labs in Tampa, Florida. Please click here for more information and to register for the course.