Surgical approach and techniques for total shoulder arthroplasty: tips and tricks.

In patients treated with total shoulder arthroplasty, it is beneficial to be aware of several tips and tricks to optimize patient outcomes. Prior to surgery, appropriate preoperative planning is essential to ensure a smooth procedure with no unexpected intraoperative findings. The procedure begins with appropriate patient positioning to allow for safety and ease of shoulder manipulation. The approach using the deltopectoral interval is described, with emphasis on the proper use of retractors and adequate soft-tissue releases. Appropriate handling of the subscapularis and lesser tuberosity during both exposure and closure is imperative for a good surgical outcome. Other portions of the procedure also can be less problematic if the surgeon is familiar with certain techniques.