High tuberosity healing rate associated with better functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis

Abstract

Background Reverse shoulder arthroplasty (RSA) is a common treatment for proximal humeral fractures. (PHF) in the elderly. This study evaluates the functional outcome and the influence of. tuberosity healing (TH) following RSA with 135° humeral inclination and a neutral glenosphere without lateralization for PHFs. Methods In this retrospective case series, all patients with an acute PHF treated with primary RSA with 135° humeral inclination and a standard glenosphere without lateralization during a four-year period were followed up. Constant score (CS), patient satisfaction (subjective shoulder value (SSV)), TH and glenoid notching were analyzed. Results 38 patients with a mean age of 77 ± 8 years were available for follow-up at 34 ± 5 months. The mean adjusted CS was 61 ± 9 points. TH of the greater tuberosity (GT) was 82% and resulted in significantly improved abduction (117° vs. 81°; P < 0.001), forward flexion (139° vs. 99°; p < 0.001), external rotation (28° vs. 10°; p = 0.002), CS (65 vs. 41 points; p < 0.001) and patient satisfaction (SSV 79% vs. 48%; p < 0.001). TH of the LT was 87% without affecting internal rotation or overall outcome. The complication- and revision rate was 5%; implant survival was 100%. Scapular notching occurred in 3 (8%) cases (all grade 1). Conclusion RSA with 135° humeral inclination and a standard glenosphere for PHF leads to good functional outcome in combination with a high rate of TH and a low rate of scapular notching. The short-term revision rate is low and the results are predictable and continuous. TH is associated with improved ROM, patient satisfaction and functional outcome.

Fracture-Specific and Conventional Stem Designs in Reverse Shoulder Arthroplasty for Acute Proximal Humerus Fractures—A Retrospective, Observational Study

“…As our patients perform better on average (CS: 74 points) as previously described in the literature (mean CS: 60–64 points) with similar refixation techniques [ 21 , 39 , 40 , 42 , 43 ] this might be due to our selection bias. Patients with revisions were excluded, only specialised shoulder surgeons with extensive training and experience performed surgery.…”

“…This higher rate of anatomical tuberosity healing in group B could account for the better results on average in CS, ROM, and SSV because according to theoretical models, GT healing does improve stability through deltoid wrapping [ 41 ]. Tuberosity healing has been described in the literature with similar GT healing of 65–84% [ 21 , 39 , 40 , 42 , 43 ] comparable to a rate of 82% for both group A and B.…”

“…However, compared to different studies, rehabilitation protocols range from pain-adapted active movements beginning Day 1 [ 45 ], two days of immobilisation [ 9 ], internal rotation slings for four to five [ 46 ] or up to six [ 39 , 43 ] weeks, or abduction pillows for six weeks [ 21 ]. As all patients in our cohort performed relatively better, it could be argued that our rehabilitation with a strict immobilisation in 0° ER, reducing stress on tuberosities, provides superior results.…”

“…Physiological GT alignment also appears to impact function in RSA [ 21 ] however, the outcome-dependency on tuberosity healing seems to be lower [ 16 , 22 , 23 , 24 ].…”

“…In general, tuberosity healing in RSA can be dependent on many different factors like humeral inclination, lateralisation, torsion of the humeral component, retroversion of the glenoid component, or the tuberosity fixation technique [ 21 , 25 , 26 , 27 , 28 , 29 , 30 ].…”