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

Lin, Charles C.; Karlin, Elan; Boin, Michael A.; Dankert, John F.; Larose, Gabriel; Zuckerman, Joseph D.; Virk, Mandeep S.

doi:10.2106/jbjs.rvw.21.00245

Cited by 8 publications

(5 citation statements)

References 78 publications

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“…In the case of proximal humerus fracture sequelae, rTSA also has garnered more support than HA. Lin et al 27 in their systematic review totaling 23 articles, including 14 studies directly comparing HA and rTSA, reported overall superiority of rTSA over HA in acute proximal humerus fractures and sequelae, for reconstruction of symptomatic nonunion or malunion after nonoperative treatment, and in salvage operations. Given the more favorable results associated with rTSA, it should be used to maximize shoulder function, permitted that adequate glenoid bone stock is available to obtain baseplate fixation.…”

Section: Discussionmentioning

confidence: 99%

Allograft-Prosthetic Composite Reconstruction for Proximal Humerus Bone Loss

Hones,

Gutowski,

Srinivasan

et al. 2023

JBJS Reviews

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Background: In smaller studies, allograft-prosthetic composite (APC) has been used for proximal humerus bone loss with some success, although with notable complication risk. This systematic review and meta-analysis sought to describe outcomes and complications after proximal humerus APC and how major APC complications are defined in the literature. Methods: A systematic review was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane were queried for articles on APC for proximal humeral bone loss secondary to tumor, fracture, or failed arthroplasty. Primary outcomes included postoperative range of motion, outcome scores (Musculoskeletal Tumor Society [MSTS], Simple Shoulder Test [SST], American Shoulder and Elbow Surgeons [ASES], Constant, visual analog scale [VAS], and subjective shoulder value [SSV]), and complication incidence. We also described individual study definitions of APC malunion/nonunion, methods of postoperative evaluation, malunion/nonunion rates, allograft fracture/fragmentation rates, and mean union time, when available. Secondarily, we compared hemiarthroplasty and reverse total shoulder arthroplasty. Results: Sixteen articles including 375 shoulders were evaluated (average age: 49 years, follow-up: 54 months). Fifty-seven percent of procedures were performed for tumors, 1% for proximal humerus trauma sequelae, and 42% for revision arthroplasty. Average postoperative forward elevation was 82° (69-94°), abduction 60° (30-90°), and external rotation 23° (17-28°). Average MSTS score was 82% (77%-87%), SST score 5.3 (4.5-6.1), ASES score 64 (54-74), Constant score 44 (38-50), VAS score 2.2 (1.7-2.7), and SSV 51 (45-58). There was a 51% complication rate with an 18% nonallograft surgical complication rate, 26% APC nonunion/malunion/resorption rate, and 10% APC fracture/fragmentation rate. Fifteen percent of nonunited APCs underwent secondary bone grafting; 3% required a new allograft; and overall revision rate was 12%. APC nonunion/malunion was defined in 2 of 16, malunion/nonunion rates in 14 of 16, fracture/fragmentation rates in 6 of 16, and mean union time (7 months) in 4 of 16 studies. Conclusion: APC reconstruction of the proximal humerus remains a treatment option, albeit with substantial complication rates. In addition, there is a need for APC literature to report institutional definitions of nonunion/malunion, postoperative evaluation, and time to union for a more standardized evaluation. Level of Evidence: Level IV; systematic review. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Allograft-Prosthetic Composite Reconstruction for Proximal Humerus Bone Loss

Hones,

Gutowski,

Srinivasan

et al. 2023

JBJS Reviews

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“…Furthermore, all 3- and 4-part fractures are not the same and the challenge of patients who cannot tolerate nonsurgical treatment are difficult to define objectively and tend to dilute the advantage of RTSA in these studies. There is weak evidence to support for RTSA over nonsurgical treatment in elderly patients with 3- or 4-part proximal humerus fractures in absence of fracture-dislocation or head split fractures (grade C recommendation) [ 34 ].…”

Section: Evidence For the Use Of Rtsa In Phf Compared To Other Surgic...mentioning

confidence: 99%

“…Based on the available evidence, RTSA is preferred to HA for displaced 3- or 4-part PHFs and fracture-dislocations in patients >65 years of age (Grade B recommendation) [ 34 ].…”

Section: Evidence For the Use Of Rtsa In Phf Compared To Other Surgic...mentioning

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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“…3 Fractures of the proximal humerus make up 5% to 6% of all adult fractures in epidemiologic studies and are the second most common upper extremity fracture. 4,5 Most fractures of the proximal humerus are amenable to nonsurgical management with good outcomes; however, certain fracture morphologies are better treated with surgical intervention. 6 Reverse total shoulder arthroplasty (RSA) is an effective surgical treatment of rotator cuff arthropathy (RCA) and proximal humerus fracture (PHF) of higher complexity in appropriate patients.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Outcomes of Reverse Total Shoulder Arthroplasty for Proximal Humerus Fracture Versus Rotator Cuff Arthropathy

Maier,

Prabhat,

Collins

et al. 2023

JAAOS Glob Res Rev

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Introduction: Reverse total shoulder arthroplasty (RSA) is used to treat a variety of shoulder-related pathologies. This study compared medium-term clinical outcomes of less than 10-year follow-up in patients treated with RSA for proximal humerus fracture (PHF) versus rotator cuff arthropathy (RCA). Methods: This retrospective review was conducted at two tertiary care centers, in which self-reported clinical outcomes were assessed using four validated instruments, that is, American Shoulder and Elbow Society (ASES) score, Shoulder Pain and Disability Index (SPADI), visual analog scale (VAS), and shoulder subjective value (SSV). Statistical analyses were performed using linear or logistic regression with generalized estimating equations. Results: Of the 189 patients included in this study, 70 were treated for fracture and 119 for RCA. At a mean postoperative follow-up of 6.4 years, the means were 79.7 for ASES score, 20.8 for SPADI-Total, 0.8 for VAS, and 77.1 for SSV. After adjusting models for covariates, there was no significant difference in average SSV (P = 0.7), VAS (P = 0.7) or SPADI-Pain (P = 0.2) between PHF and RCA cohorts; however, the RCA cohort reported significantly better outcomes in ASES scores (P = 0.002), SPADI-Disability (P < 0.0001), and SPADI-Total (P = 0.0001). Discussion: Patients with RCA and PHF treated with RSA achieved similar medium-term outcomes in several domains, particularly postoperative pain levels; however, patients with PHF reported greater perceived disability. RSA is an effective pain-controlling procedure, but patients may have variable functional outcomes based on the indication for surgery.

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

Cited by 8 publications

References 78 publications

Allograft-Prosthetic Composite Reconstruction for Proximal Humerus Bone Loss

Allograft-Prosthetic Composite Reconstruction for Proximal Humerus Bone Loss

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

Outcomes of Reverse Total Shoulder Arthroplasty for Proximal Humerus Fracture Versus Rotator Cuff Arthropathy

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