Effectiveness of Reverse Total Shoulder Arthroplasty for Primary and Secondary Fracture Care: Mid-Term Outcomes in a Single-Centre Experience

Abstract

Background The introduction of reverse total shoulder arthroplasty (RSA) as a treatment option in complex proximal humeral fractures, has significantly extended the surgical armamentarium.The aim of this study was to investigate the mid-term outcome following fracture RSA in acute or sequelae, as well as salvage procedures. It was hypothesized that revision RSA (SRSA) leads to similar mid-term results as primary fracture treatment by RSA (PRSA).Methods This retrospective study describes the radiological and clinical mid-term outcomes in a standardized single-centre and Inlay design. Patients who underwent RSA in fracture care between 2008 and 2017 were included (minimum follow-up: two years, minimum age: 60 years).The assessment tools used for functional findings were range of motion (ROM), Visual Analogue Scale, absolute (CS) plus normative Constant Score, QuickDASH, and Subjective Shoulder Value. All adverse events as well as the radiological results and their clinical correlations were statistically analysed (using p < .05 and 95% confidence intervals).Results Following fracture RSA, 68 patients were included (mean age: 72.5 years, mean follow-up: 46 months). Forty-two underwent primary RSA (PRSA), and 26 underwent revision RSA (SRSA). Adverse advents were observed in 13% (n = 9/68).No statistically significant results were found for the scores of the PRSA and SRSA groups, while the failed osteosynthesis SRSA subgroup obtained statistically significantly negative values for ROM subzones (flexion: p = .020, abduction: p = .020). Decreased instances of tubercle healing were observed for the in PRSA group relative to the SRSA group (p = .006). The absence of bony healing of the tubercles was related to significant negative clinical and subjective outcomes (all scores: p < .05, external rotation: p = .019). Significant postoperative improvements were evaluated in the SRSA group (CS: 23 to 56 at mean, p = .001), the time from index surgery to operative revision revealed no associations in functional findings.Conclusions RSA is an effective option in severe shoulder fracture management with predictable results for salvage as well as first-line treatment. Promising mid-term functional results, reasonable implant survival rates, and high patient satisfaction can be achieved.Trial RegistrationNot applicable, level of evidence III.

Reverse shoulder arthroplasty-early results

“…It has a more stable prosthesis design than total and partial shoulder prostheses (Matsen et al, 2007). Although RSA are used in massive rotator cuff tear arthropathy, it has also been found to be used in failed shoulder arthroplasty or internal fixation revisions, shoulder involvement of rheumatological diseases, tumor reconstruction, multi-fragmentary proximal humerus fractures (Boileau et al, 2006;Guery et al, 2006;Matsen et al, 2007;Levy and Badman, 2011;Melis et al, 2012;Shafritz and Flieger, 2012;Schwarz et al, 2021). In this study, we aimed to report the clinical and radiological results of RSA that have been performed with different diagnoses.…”