Clinical and radiographic outcomes of cementless reverse total shoulder arthroplasty for proximal humeral fractures

Lo, Eddie Y.; Rizkalla, James; Montemaggi, Paolo; Majekodunmi, Temilola; Krishnan, Sumant G.

doi:10.1016/j.jse.2020.11.009

Cited by 21 publications

(11 citation statements)

References 27 publications

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“…However, there are concerns regarding implant subsidence, compromised rotational stability, and intraoperative fracture in osteoporotic bone. Reports of cementless RTSAs have demonstrated good results and reliable fixation in the setting of fractures 60,61 . However, in a series of 30 patients who underwent cementless RTSA in the setting of comminuted PHFs, there was 1 complication involving an intraoperative humeral fracture while preparing the humerus 61 .…”

Section: Complications Of Rtsamentioning

confidence: 99%

Operative Treatment of Proximal Humeral Fractures with Reverse Total Shoulder Arthroplasty in Patients ≥65 Years Old

et al. 2022

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The majority of proximal humeral fractures (PHFs) in patients who are ≥65 years of age are treated nonoperatively, but certain complex fracture patterns benefit from surgical intervention. However, there continues to be debate regarding the indications for surgery and the optimal surgical treatment (repair versus replacement) in this population.Reverse total shoulder arthroplasty (RTSA) has grown in popularity for surgical treatment of fracture-dislocations and displaced complex PHFs in patients who are ≥65 years of age; it has definite advantages over surgical repair and hemiarthroplasty, but this finding requires additional higher-quality evidence.RTSA provides early pain relief and return of shoulder function as well as predictable elevation above shoulder level in the forward plane, but the indications for and understanding of the effect of timing on RTSA after a PHF continue to evolve.RTSA for an acute PHF is indicated in patients who are ≥65 years of age with 3- and 4-part fracture-dislocations, head-split fractures, and severely displaced fractures, and is an option in patients who are not able to tolerate nonoperative treatment of severely displaced 3- and 4-part fractures.RTSA is also indicated as a salvage operation for PHFs that have failed initial surgical repair (i.e., fixation failure, implant failure, rotator cuff failure, or osteonecrosis) and is an option for symptomatic nonunion or malunion after nonoperative treatment.

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Section: Complications Of Rtsamentioning

confidence: 99%

Operative Treatment of Proximal Humeral Fractures with Reverse Total Shoulder Arthroplasty in Patients ≥65 Years Old

et al. 2022

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“…However, uncemented stems carry a theoretical risk of early subsidence or loosening due to lack of rotational stability if the press fit stability is lost in the early postoperative period. The role of uncemented, press fit stem in RTSA for PHFs has been reported in several studies but only a few of them directly compare uncemented to cemented humeral stems [ 60 , 61 , 62 , 63 , 64 , 65 ]. Lopiz et al [ 61 ] retrospectively reviewed 68 patients with primary RTSA for PHF, which included 45 cemented and 23 press fit humeral stems.…”

Section: Special Considerations For Rtsa For Fracturesmentioning

confidence: 99%

The Evolution of Reverse Total Shoulder Arthroplasty and Its Current Use in the Treatment of Proximal Humerus Fractures in the Older Population

Larose

Virk

2022

JCM

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Proximal humerus fracture (PHF) is a common injury in the older population. While the majority of these fractures are treated non-operatively, a small subset of patients may benefit from surgical treatment. However, there continues to be an ongoing debate regarding the indications and ideal surgical treatment strategy. The use of reverse total shoulder arthroplasty (RTSA) has resulted in a paradigm shift in the treatment of PHFs in the older population. Unique biomechanical principles and design features of RTSA make it a suitable treatment option for PHFs in the older population. RTSA has distinct advantages over hemiarthroplasty and internal fixation and provides good pain relief and a reliable and reproducible improvement in functional outcomes. As a result, there has been an exponential increase in the volume of RTSA in the older population in last decade. The aim of this paper is to review the current concepts, outcomes and controversies regarding the use of RTSA for the treatment of PHFs in the older population.

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“…These innovations are intended to allow osteointegration between implant and tuberosities [31]. Depending on the bone quality and implant design, fracture stems can either be implanted in a traditional cemented technique or cementless with a press-fit technique [63]. In a recent meta-analysis looking at outcomes of fracture stems versus non-fracture stems in proximal humerus fractures, fracture stems were shown to result in significantly improved functional scores, external rotation and forward flexion as well as tuberosity healing [64].…”

Section: Implant Designsmentioning

confidence: 99%

Prosthesis Designs and Tuberosity Fixation Techniques in Reverse Total Shoulder Arthroplasty: Influence on Tuberosity Healing in Proximal Humerus Fractures

Borbas

Grubhofer

et al. 2021

JCM

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Reverse total shoulder arthroplasty (RTSA) is increasingly used for the treatment of complex proximal humerus fractures and fracture sequelae. In 2021, half a dozen models of fracture stems are commercially available, reflecting its growing utility for fracture management. Prosthesis designs, bone grafting and tuberosity fixation techniques have evolved to allow better and more reliable fixation of tuberosities and bony ingrowth. Patients with anatomical tuberosity healing not only have an increased range of active anterior elevation and external rotation, but also experience fewer complications and longer prosthesis survival. This review provides an overview of recent evidence on basic and fracture-specific RTSA design features as well as tuberosity fixation techniques that can influence tuberosity healing.

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Clinical and radiographic outcomes of cementless reverse total shoulder arthroplasty for proximal humeral fractures

Cited by 21 publications

References 27 publications

Operative Treatment of Proximal Humeral Fractures with Reverse Total Shoulder Arthroplasty in Patients ≥65 Years Old

Operative Treatment of Proximal Humeral Fractures with Reverse Total Shoulder Arthroplasty in Patients ≥65 Years Old

The Evolution of Reverse Total Shoulder Arthroplasty and Its Current Use in the Treatment of Proximal Humerus Fractures in the Older Population

Prosthesis Designs and Tuberosity Fixation Techniques in Reverse Total Shoulder Arthroplasty: Influence on Tuberosity Healing in Proximal Humerus Fractures

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