Reverse Total Shoulder Arthroplasty for Complex Proximal Humerus Fractures: Mid-Term Results
DOI:
https://doi.org/10.5281/zenodo.22326879Keywords:
Reverse total shoulder arthroplasty, Proximal humerus fracture., Hemiarthroplasty, Tuberosity healing, Scapular notchingAbstract
Background: Comminuted proximal humerus fractures in osteoporotic older adults are difficult to treat with fixation or
hemiarthroplasty because of unpredictable tuberosity healing. Reverse total shoulder arthroplasty (RTSA) restores a stable
fulcrum independent of cuff function. Objective: To synthesise mid-term evidence on RTSA for complex fractures versus hemiarthroplasty and fixation. Methods: Narrative review of comparative cohorts, randomised trials, registry analyses, and reviews on tuberosity fixation, outcomes, and complications. Findings: RTSA yields superior elevation and functional scores versus hemiarthroplasty; tuberosity healing modulates but does not abolish this advantage. Registry data show durable survivorship comparable to elective RTSA through ten years. Notching, instability, and neurological injury remain the principal complications.
Conclusions: RTSA is effective for complex fractures in selected older patients, though superiority over well-executed fixation in
younger patients is less certain.
References
Bufquin, T., Hersan, A., Hubert, L., Massin, P. (2007) Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly. Journal of Bone and Joint Surgery (Br), 89(4): 516-520.
Klein, M., Juschka, M., Hinkenjann, B., Scherger, B., Ostermann, P.A.W. (2008) Treatment of comminuted fractures of the proximal humerus in elderly patients with the Delta III reverse shoulder prosthesis. Journal of Orthopaedic Trauma, 22(10): 698-704.
Grammont, P.M., Baulot, E. (1993) Delta shoulder prosthesis for rotator cuff rupture. Orthopedics, 16(1): 65-68.
Cuff, D.J., Pupello, D.R. (2013) Comparison of hemiarthroplasty and reverse shoulder arthroplasty for the treatment of proximal humeral fractures in elderly patients. Journal of Bone and Joint Surgery (Am), 95(22): 2050-2055.
Sebastia-Forcada, E., Cebrian-Gomez, R., Lizaur-Utrilla, A., Gil-Guillen, V. (2014) Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study. Journal of Shoulder and Elbow Surgery, 23(10): 1419-1426.
Watts, A.C., Jenkins, C.W., Boyle, S.P., Crowther, M.A.A., Monga, P., Packham, I.N., Smith, C.C., Thomas, W.J., Walton, M.J. (2024) Superior functional outcome following reverse shoulder arthroplasty compared to hemiarthroplasty for displaced three- and four-part fractures in patients 65 and older: results from a prospective multicenter randomized controlled trial - the Shoulder Hemiarthroplasty or Reverse Polarity Arthroplasty (SHeRPA) trial. Journal of Shoulder and Elbow Surgery, 33(11): 2335-2344.
Wang, J., Zhu, Y., Zhang, F., Chen, W., Tian, Y., Zhang, Y. (2016) Meta-analysis suggests that reverse shoulder arthroplasty in proximal humerus fractures is a better option than hemiarthroplasty in the elderly. International Orthopaedics, 40(3): 531-539.
Gallinet, D., Ohl, X., Decroocq, L., Dib, C., Valenti, P., Boileau, P. (2018) Is reverse total shoulder arthroplasty more effective than hemiarthroplasty for treating displaced proximal humerus fractures in older adults? A systematic review and meta-analysis. Orthopaedics & Traumatology: Surgery & Research, 104(6): 759-766.
Critchley, O., McLean, A., Page, R., Taylor, F., Graves, S., Lorimer, M., Peng, Y., Hatton, A., Bain, G. (2020) Reverse total shoulder arthroplasty compared to stemmed hemiarthroplasty for proximal humeral fractures: a registry analysis of 5946 patients. Journal of Shoulder and Elbow Surgery, 29(12): 2538-2547.
Chalmers, P.N., Slikker, W., Mall, N.A., Gupta, A.K., Rahman, Z., Enriquez, D., Nicholson, G.P. (2014) Reverse total shoulder arthroplasty for acute proximal humeral fracture: comparison to open reduction-internal fixation and hemiarthroplasty. Journal of Shoulder and Elbow Surgery, 23(2): 197-204.
Suroto, H., De Vega, B., Deapsari, F., Prajasari, T., Wibowo, P., Samijo, S. (2021) Reverse total shoulder arthroplasty versus open reduction internal fixation for 3-part or 4-part proximal humeral fractures: a systematic review and meta-analysis. EFORT Open Reviews, 6(10): 941-955.
Chen, L., Xing, F., Xiang, Z. (2016) Effectiveness and safety of interventions for treating adults with displaced proximal humeral fracture: a network meta-analysis and systematic review. PLoS One, 11(11): e0166801.
Pizzo, R.A., Gianakos, A.L., Haring, R.S., Kane, L.T., Nwachukwu, B.U., Kaplan, D.J., Zuckerman, J.D. (2021) Are arthroplasty procedures really better in the treatment of complex proximal humerus fractures? A comprehensive meta-analysis and systematic review. Journal of Orthopaedic Trauma, 35(3): 111-119.
Garrigues, G.E., Johnston, P.S., Pepe, M.D., Tucker, B.S., Ramsey, M.L., Austin, L.S. (2012) Hemiarthroplasty versus reverse total shoulder arthroplasty for acute proximal humerus fractures in elderly patients. Orthopedics, 35(5): e703-e708.
Jain, N.P., Mannan, S.S., Dharmarajan, R., Rangan, A. (2019) Tuberosity healing after reverse shoulder arthroplasty for complex proximal humeral fractures in elderly patients: does it improve outcomes? A systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery, 28(2): e78-e91.
O'Sullivan, J., Ladermann, A., Parsons, B.O., Chen, X., Cunningham, G., Egervari, K., Edwards, T.B. (2020) A systematic review of tuberosity healing and outcomes following reverse shoulder arthroplasty for fracture according to humeral inclination of the prosthesis. Journal of Shoulder and Elbow Surgery, 29(9): 1938-1949.
Luciani, P., Farinelli, L., Procaccini, R., Verducci, C., Gigante, A. (2019) Primary reverse shoulder arthroplasty for acute proximal humerus fractures: a 5-year long term retrospective study of elderly patients. Injury, 50(11): 1974-1977.
Bolam, S.M., Wells, Z., Tay, M.L., Frampton, C.M.A., Coleman, B., Dalgleish, A. (2024) Reverse total shoulder arthroplasty for acute proximal humeral fracture has comparable 10-year outcomes to elective indications: results from the New Zealand Joint Registry. Journal of Shoulder and Elbow Surgery, 33(9): 1946-1954.
Klug, A., Wincheringer, D., Harth, J., Schmidt-Horlohe, K., Hoffmann, R., Gramlich, Y. (2019) Complications after surgical treatment of proximal humerus fractures in the elderly: an analysis of complication patterns and risk factors for reverse shoulder arthroplasty and angular-stable plating. Journal of Shoulder and Elbow Surgery, 28(9): 1674-1684.
Zumstein, M.A., Pinedo, M., Old, J., Boileau, P. (2011) Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. Journal of Shoulder and Elbow Surgery, 20(1): 146-157.
Shah, S.S., Gaal, B.T., Roche, A.M., Namdari, S., Grawe, B.M., Lawler, M., Dalton, S., King, J.J., Helmkamp, J., Garrigues, G.E. (2020) The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part I. JSES International, 4(4): 929-943.
Clark, J.C., Ritchie, J., Song, F.S., Kissenberth, M.J., Tolan, S.J., Hart, N.D., Hawkins, R.J. (2012) Complication rates, dislocation, pain, and postoperative range of motion after reverse shoulder arthroplasty in patients with and without repair of the subscapularis. Journal of Shoulder and Elbow Surgery, 21(1): 36-41.
Scarlat, M.M. (2013) Complications with reverse total shoulder arthroplasty and recent evolutions. International Orthopaedics, 37(5): 843-851.
Sirveaux, F., Favard, L., Oudet, D., Huquet, D., Walch, G., Mole, D. (2004) Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff: results of a multicentre study of 80 shoulders. Journal of Bone and Joint Surgery (Br), 86(3): 388-395.
Levigne, C., Boileau, P., Favard, L., Garaud, P., Mole, D., Sirveaux, F., Walch, G. (2008) Scapular notching in reverse shoulder arthroplasty. Journal of Shoulder and Elbow Surgery, 17(6): 925-935.
Roche, C.P., Stroud, N.J., Martin, B.L., Steiler, C.A., Flurin, P.H., Wright, T.W., Zuckerman, J.D., DiPaola, M.J. (2013) The impact of scapular notching on reverse shoulder glenoid fixation. Journal of Shoulder and Elbow Surgery, 22(7): 963-970.
Spiry, C., Berhouet, J., Agout, C., Bacle, G., Favard, L. (2021) Long-term impact of scapular notching after reverse shoulder arthroplasty. International Orthopaedics, 45(6): 1559-1566.
