Reverse Shoulder Arthroplasty for Proximal Humeral Fracture

Aims The reasons for failure of a hemirthroplasty (HA) when used to treat a proximal humeral fracture include displaced or necrotic tuberosities, insufficient metaphyseal bone-stock, and rotator cuff tears. Reverse total shoulder arthroplasty (rTSA) is often the only remaining form of treatment in these patients. The aim of this study was to evaluate the clinical outcome after conversions from a failed HA to rTSA. Material and Methods A total of 35 patients, in whom a HA, as treatment for a fracture of the proximal humerus, had failed, underwent conversion to a rTSA. A total of 28 were available for follow-up at a mean of 61 months (37 to 91), having been initially reviewed at a mean of 20 months (12 to 36) postoperatively. Having a convertible design, the humeral stem could be preserved in nine patients. The stem was removed in the other 19 patients and a conventional rTSA was implanted. At final follow-up, patients were assessed using the American Shoulder and Elbow Surgeons (ASES) score, the Constant Score, and plain radiographs. Results At final follow-up, the mean ASES was 59 (25 to 97) and the mean adjusted Constant Score was 63% (23% to 109%). Both improved significantly (p < 0.001). The mean forward flexion was 104° (50° to 155°) and mean abduction was 98° (60° to 140°). Nine patients (32%) had a complication; two had an infection and instability, respectively; three had a scapular fracture; and one patient each had delayed wound healing and symptomatic loosening. If implants could be converted to a rTSA without removal of the stem, the operating time was shorter (82 minutes versus 102 minutes; p = 0.018). Conclusion After failure of a HA in the treatment of a proximal humeral fracture, conversion to a rTSA may achieve pain relief and improved shoulder function. The complication rate is considerable. Cite this article: Bone Joint J 2018;100-B:761–6.

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Regarding “Reverse total shoulder arthroplasty for acute proximal humeral fracture: comparison to open reduction-internal fixation and hemiarthroplasty”

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2014.05.018 ◽

2014 ◽

Vol 23 (9) ◽

pp. e221

Author(s):

Mohammed Shoaib Arshad ◽

Kevin R. Sharpe

Keyword(s):

Internal Fixation ◽

Shoulder Arthroplasty ◽

Open Reduction ◽

Proximal Humeral Fracture ◽

Total Shoulder Arthroplasty ◽

Humeral Fracture ◽

Open Reduction Internal Fixation ◽

Reverse Total Shoulder Arthroplasty ◽

Reverse Total Shoulder

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Prospective comparison of functional outcomes of primary reverse shoulder arthroplasty for acute fractures versus rotator cuff deficiencies

The Bone & Joint Journal ◽

10.1302/0301-620x.102b11.bjj-2020-0578.r1 ◽

2020 ◽

Vol 102-B (11) ◽

pp. 1555-1559

Author(s):

Emilio Sebastia-Forcada ◽

Alejandro Lizaur-Utrilla ◽

Gerard Mahiques-Segura ◽

Matias Ruiz-Lozano ◽

Fernando Anacleto Lopez-Prats ◽

...

Keyword(s):

Rotator Cuff ◽

Functional Outcomes ◽

Proximal Humeral Fracture ◽

Revision Rate ◽

Reverse Shoulder Arthroplasty ◽

Humeral Fracture ◽

Fracture Group ◽

Rotator Cuff Deficiency

Aims The purpose of this study was to determine whether there were long-term differences in outcomes of reverse shoulder arthroplasty (RSA) undertaken for acute proximal humeral fracture versus rotator cuff deficiency with a minimum follow-up of five years. Methods This was a prospective cohort study comparing 67 patients with acute complex proximal humeral fracture and 64 patients with irreparable rotator cuff deficiency who underwent primary RSA. In the fracture group, there were 52 (77.6%) females and 15 (22.4%) males, with a mean age of 73.5 years (51 to 85), while in the arthropathy group, there were 43 (67.1%) females and 21 (32.9%) males, with a mean age of 70.6 years (50 to 84). Patients were assessed by the Constant score, University of California Los Angeles shoulder score (UCLA), short version of the Disability of the Arm Shoulder and Hand score (QuickDASH), and visual analogue scales (VAS) for pain and satisfaction. Radiological evaluation was also performed. Results Mean follow-up was 8.4 years (5 to 11). There were no significant differences in mean absolute (p = 0.125) or adjusted (p = 0.569) Constant, UCLA (p = 0.088), QuickDASH (p = 0.135), VAS-pain (p = 0.062), or range of movement at the final follow-up. However, patient satisfaction was significantly lower in the fracture group (p = 0.002). The complication rate was 1.5% (one patient) versus 9.3% (six patients), and the revision rate was 1.5% (one patient) versus 7.8% (five patients) in the fracture and arthropathy groups, respectively. The ten-year arthroplasty survival was not significantly different (p = 0.221). Conclusion RSA may be used not only for patients with irreparable rotator cuff deficiencies, but also for those with acute complex proximal humeral fractures. We found that RSA provided similar functional outcomes and a low revision rate for both indications at long-term. However, satisfaction is lower in patients with an acute fracture. Cite this article: Bone Joint J 2020;102-B(11):1555–1559.

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