Tuberosity healing improves functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis

Schmalzl, Jonas; Jessen, Malik; Holschen, Malte; Cohen, Brian S.; Steinbeck, Jörn; Lehmann, Lars; Denard, Patrick J.

doi:10.1007/s00590-020-02649-8

Cited by 17 publications

(3 citation statements)

References 22 publications

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“… 25 Literature has shown that better external rotation was reported in patients whose tuberosities were repaired in an RTSA procedure. 42 , 43 Moreover, a multicentre study comprising 420 PHF patients who were analysed according to their tuberosity healing status following RTSA (Group A: anatomical healing was achieved; Group B: tuberosity resorption, malunion, or nonunion; Group C: tuberosity was excised) showed that Group A achieved a significantly better external rotation and forward flexion. 44 …”

Section: Discussionmentioning

confidence: 99%

Reverse total shoulder arthroplasty (RTSA) versus open reduction and internal fixation (ORIF) for displaced three-part or four-part proximal humeral fractures: a systematic review and meta-analysis

et al. 2021

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Despite rapid medical technology development, various challenges exist in three- and four-part proximal humeral fracture (PHF) management. This condition has led to a notably increased use of the reverse total shoulder arthroplasty (RTSA); however, open reduction and internal fixation (ORIF) is still the most widely performed procedure. Thus, these two modalities are crucial and require further discussion. We aim to compare the outcomes of three- or four-part PHF surgeries using ORIF and RTSA based on direct/head-to-head comparative studies. We conducted a systematic review and meta-analysis based on the Cochrane handbook and PRISMA guidelines. We searched MEDLINE (PubMed), Embase (Ovid), and CENTRAL (Cochrane Library) from inception to October 2020. Our protocol was registered at PROSPERO (registration number CRD42020214681). We assessed the individual study risk of bias using ROB 2 and ROBINS-I tools, then appraised our evidence using the GRADE approach. Six head-to-head comparative studies were included, comprising one RCT and five retrospective case-control studies. We found that RTSA significantly improved forward flexion but was comparable to ORIF in abduction (p = 0.03 and p = 0.47, respectively) and more inferior in external rotation (p < 0.0001). Moreover, RTSA improved the overall Constant-Murley score, but the difference was not significant (p = 0.22). Interestingly, RTSA increased complications (by 42%) but reduced the revision surgery rates (by 63%) compared to ORIF (p = 0.04 and p = 0.02, respectively). RTSA is recommended to treat patients aged 65 years or older with a three- or four-part PHF. Compared to ORIF, RTSA resulted in better forward flexion and Constant-Murley score, equal abduction, less external rotation, increased complications but fewer revision surgeries. Cite this article: EFORT Open Rev 2021;6:941-955. DOI: 10.1302/2058-5241.6.210049

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Section: Discussionmentioning

confidence: 99%

Reverse total shoulder arthroplasty (RTSA) versus open reduction and internal fixation (ORIF) for displaced three-part or four-part proximal humeral fractures: a systematic review and meta-analysis

et al. 2021

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“…A total of 29 studies (1550 patients) reporting on RSA in case series or comparing elderly patients treated for complex proximal humeral fractures with treatments other than NOT were included for review of functionality and range-of-motion outcomes and complications [ 7 , 8 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. Five case series and non-comparative studies after NOT were included (249 patients) ( Supplementary Materials Tables S4 and S6 ) [ 10 , 44 , 45 , 46 , 47 ].…”

Section: Resultsmentioning

confidence: 99%

Reverse Shoulder Arthroplasty versus Non-Operative Treatment of Three-Part and Four-Part Proximal Humerus Fractures in the Elderly Patient: A Pooled Analysis and Systematic Review

Bosch,

Beeres,

Ferree

et al. 2024

JCM

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Background: The treatment of complex proximal humerus fractures in elderly patients is not yet fully elucidated. Of all treatment options, reverse shoulder arthroplasty (RSA) and non-operative treatment (NOT) appear to provide the best results. Evidence to guide the choice between the two is sparse. Therefore, this review provides an overview of the available evidence on RSA versus NOT. Methods: Studies comparing complex proximal humerus fractures in patients aged >65 years treated either with RSA or NOT were included for systematic review and direct comparison via pooled analysis of patient-rated outcome and range of motion. Indirect comparison of case series and non-comparative studies on either treatment was performed separately. Results: Three comparative studies including 77 patients treated with RSA and 81 treated non-operatively were analysed. The RSA group scored better for both the Constant–Murley score (mean difference 6 points) and DASH score (mean difference 8 points). No differences were detected in ASES, PENN score, pain scores, or range of motion between treatment groups. The most common complications for RSA were infection (3%), nerve injury (2%), and dislocation (2%). Reoperation was required in 5%. In the NOT group, common complications included malunion (42%), osteonecrosis (25%), and non-union (3%); no reoperation was required. Patient satisfaction was equal in both groups. Conclusions: The functional outcomes and range of motion after RSA seemed satisfactory and potentially superior to NOT in elderly patients. Patient satisfaction was comparable despite a high malunion and osteonecrosis rate in the non-operative treatment group, which did not require re-interventions.

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“…The unreliable results achieved with HA in the elderly suffering from cPHFs led to attempts to treat these patients with RSA, since the functional outcomes are less dependent on tuberosity healing and cuff integrity [ 13 – 15 , 19 , 20 , 44 , 45 ]. However, recent studies have demonstrated that although tuberosity healing is not a prerequisite for a satisfactory outcome after RSA for cPHFs, it still leads to better clinical results [ 21 – 27 , 46 , 47 ]. It has been proven that tuberosity osteotomy or excision is associated with worse functional results, with particular reference to a loss of external rotation and to a higher risk of RSA instability [ 27 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

A novel “7 sutures and 8 knots” surgical technique in reverse shoulder arthroplasty for proximal humeral fractures: tuberosity healing improves short-term clinical results

Troiano,

Peri,

Calò

et al. 2023

J Orthop Traumatol

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Background Complex proximal humeral fractures (cPHFs) represent an important public health concern, and reverse shoulder arthroplasty (RSA) has emerged as a feasible treatment option in the elderly with high functional demands. Recent studies have shown that tuberosity healing leads to better clinical outcomes and an improved range of motion. However, the best surgical technique for the management of the tuberosities is still a topic of debate. The purpose of this retrospective observational study is to report the radiographic and clinical outcomes of a consecutive series of patients who underwent RSA for cPHFs using a novel “7 sutures and 8 knots” technique. Materials and methods A consecutive series of 32 patients (33 shoulders) were treated with this technique by a single surgeon from January 2017 to September 2021. Results at a minimum follow-up of 12 months and a mean ± SD follow-up of 35.9 ± 16.2 (range 12–64) months are reported. Results The tuberosity union rate was 87.9% (29 out of 33 shoulders), the mean Constant score was 66.7 ± 20.5 (range 29–100) points, and the mean DASH score was 33.4 ± 22.6 (range 2–85) points. Conclusions The “7 sutures and 8 knots” technique, which relies on three sutures around the implant and five bridging sutures between the tuberosities, is a relatively simple procedure which provides a reliable means for anatomic restoration of the tuberosities and allows functional recovery of the shoulder in elderly patients with cPHFs treated with RSA. Level of evidence: IV; retrospective atudy. Trial registration: At our institution, no institutional review board nor ethical committee approval is necessary for retrospective studies.

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Tuberosity healing improves functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis

Cited by 17 publications

References 22 publications

Reverse total shoulder arthroplasty (RTSA) versus open reduction and internal fixation (ORIF) for displaced three-part or four-part proximal humeral fractures: a systematic review and meta-analysis

Reverse total shoulder arthroplasty (RTSA) versus open reduction and internal fixation (ORIF) for displaced three-part or four-part proximal humeral fractures: a systematic review and meta-analysis

Reverse Shoulder Arthroplasty versus Non-Operative Treatment of Three-Part and Four-Part Proximal Humerus Fractures in the Elderly Patient: A Pooled Analysis and Systematic Review

A novel “7 sutures and 8 knots” surgical technique in reverse shoulder arthroplasty for proximal humeral fractures: tuberosity healing improves short-term clinical results

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