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

• Published in: BMC musculoskeletal disorders Vol. 21; no. 1; p. 35
• Main Authors: Schmalzl, Jonas, Jessen, Malik, Sadler, Nadine, Lehmann, Lars-Johannes, Gerhardt, Christian
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16.01.2020; BioMed Central; BMC
• Subjects: Activities of daily living; Age; Arthroplasty; Care and treatment; Fractures; Fractures (Injuries); Geriatrics; Humeral inclination; Humerus; Injuries; Joint surgery; Musculoskeletal diseases; Orthopedic surgery; Patient outcomes; Patient satisfaction; Prostheses; Prostheses and implants; Proximal humeral fracture; Reverse shoulder arthroplasty; Shoulder; Shoulder surgery; Statistical analysis; Surgery; Tuberosity healing; Vertebrae; Germany; United States > US; Tuberosity healing; Proximal humeral fracture; 135; Humeral inclination; Reverse shoulder arthroplasty
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-020-3060-8

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. 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. 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). 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.