This live surgery recording features Dr. Anthony A. Romeo performing a Reverse Total Shoulder Arthroplasty (RTSA) on a 76-year-old personal trainer who previously underwent a rotator cuff repair 15 years prior.

Below is a detailed overview of the surgical breakdown provided in the video:

1. Patient Profile and Surgical Goal

• Patient:A highly active 76-year-old female fitness trainer presenting with severe cuff tear arthropathy (Hamada stage 2). The existing rotator cuff is torn and the humeral head has migrated upward, making a standard rotator cuff re-repair impossible.
• Objective:Perform a reverse shoulder replacement to alleviate pain and restore mobility. The goal is to allow her to resume instructing fitness clients within a couple of months and return to full personal training activities in 4 to 6 months without long-term restrictions.

2. Surgical Exposure & Release

• Incision: Dr. Romeo begins with a standard deltopectoral approach, incising from just below the clavicle down to the level of the axilla.
• Dissection: He identifies the deltopectoral interval by tracking the fat stripe of the cephalic vein and isolates crossing vessels using electrocautery.
• Deltoid Management: Preserving the deltoid muscle is stressed as paramount, given that it acts as the primary motor driving shoulder function following a reverse arthroplasty.
• Capsular Release: Complete 360-degree releases of the scarred capsule are systematically conducted. This thorough posterior release ensures optimal exposure and avoids postoperative internal rotation stiffness.

3. Joint Preparation

• Humeral Preparation: The center of the humeral canal is targeted using structural landmarks. After navigating an old subpectoral bicep interference screw that initially blocks the reamers, Dr. Romeo drills through it to ensure safe, stable canal preparation. The humeral head is cut using an anatomic cutting guide, saving the reamed autologous bone to use later as impaction grafting.
• Glenoid Preparation: Remaining cartilage is manually curated away down to bare bone to match preoperative 3D CT scan planning precisely. The central post hole is drilled bicortically through the second cortical wall to maximize absolute skeletal fixation.

4. Component Implantation

• Glenosphere Baseplate: A 33mm baseplate is combined with +2mm lateralization. This offset shifts the center of rotation closer to the patient's native anatomy to yield better functional outcomes.
• Fixation: Structural hold is established using a central post plus four auxiliary screws—two locking and two compression screws.
• Humeral Component: A size 5 long-stem implant is selected to safely span past the drilled window in the humerus, packed tight with the patient’s own saved bone graft. A +3mm final trial cup is attached.

5. Joint Reduction, Subscapularis Repair & Closure

• Reduction & Range of Motion: The shoulder is safely reduced, exhibiting flawless stability, over 70 degrees of external rotation, and solid elevation with no gapping.
• Subscapularis Repair: To reinforce structural longevity and optimize internal rotation recovery, the subscapularis tendon is reattached securely using heavy-duty transosseous sutures through drilled bony anchor tunnels.
• Closure: The joint cavity is irrigated with a diluted betadine solution and treated with 1g of vancomycin antibiotic powder. The incision is closed in layers.

6. Postoperative Care Strategy

• Day 1: The patient stays overnight, discharging the following day with instructions to execute immediate active hand, wrist, and elbow movements at her side.
• Week 1: Initial follow-up clinic check. Early functional movements are allowed, such as self-feeding, washing the face, and adjusting glasses.
• Week 4: All protective restrictions are removed, allowing her to lift and use the arm fully as tolerated.