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: 2 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 < .05and 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. Level of evidence Level III.

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

“…However, Seidel et al demonstrated that delaying RTSA for >4 weeks, in the setting of an acute PHF is associated with higher short-term revision rate and dislocation rate compared to earlier intervention (<4 weeks) [ 91 ]. Schwartz et al [ 93 ] compared the outcomes of RTSA in an acute setting versus RTSA for fracture sequela or salvage situation in a retrospective study with a minimum follow up of 2 years and minimum age of 60 years. They compared the outcomes of 42 RTSA done for acute PHF (<10 days) with 26 RTSAs done for delayed fracture care or revision indication (10 failed ORIF, 12 failed non-operative treatment, and 4 failed HA).…”

“…Several retrospective cohort studies have shown improved PROM scores and ROM outcomes after a salvage with a RTSA [ 94 , 95 , 96 ]. Furthermore, primary RTSA in an acute setting is associated with slightly better PROM, ROM and less complication rate compared to RTSA after failed osteosynthesis [ 93 , 97 , 98 , 99 , 100 ].…”

Satisfactory Short-Term Outcomes of Reverse Shoulder Arthroplasty for Complex Three- and Four-Part Fractures of the Humeral Head in Octogenarians

“…Proximal humeral fractures are among the most common injuries in the population above the age of 65 years [ 1 , 2 ]. Often, it occurs as a result of low-energy trauma, such as falls onto the outstretched limb or the shoulder itself [ 3 , 4 ].…”