Early clinical and radiological outcomes of reverse shoulder arthroplasty with an eccentric all-polyethylene glenosphere to treat failed hemiarthroplasty and the sequelae of proximal humeral fractures

Merolla, Giovanni; Tartarone, Antonio; Sperling, John W.; Paladini, Paolo; Fabbri, Elisabetta; Porcellini, Giuseppe

doi:10.1007/s00264-016-3188-1

Cited by 19 publications

(20 citation statements)

References 36 publications

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“…However, patients coming from conservative treatment of the index proximal humeral fracture did significantly better in the Constant Score in terms of absolute forward elevation and external rotation when compared to patients coming from ORIF. The complication rate observed was similar to what has been reported (14,8%) 8, 11, 12, 13, 15, 16, 17, 18, 20, 21, 22, 23, 24. Although it did not reach significance, there was a trend towards a higher complication rate in the ORIF group when compared to the conservative group.…”

Section: Discussionsupporting

confidence: 88%

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Reverse shoulder arthroplasty for fracture sequelae: How the initial fracture treatment influences the outcomes of joint replacement

Santana

Alentorn-Geli²,

Guirro

et al. 2019

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThe aim of this study was to analyze and compare the results of reverse shoulder arthroplasty (RSA) in proximal humeral fracture sequelae (PHFS) in fractures initially treated conservatively versus those initially treated with open reduction and internal fixation (ORIF).MethodsIt is a retrospective study that includes all PHFS treated with a RSA from September 2006 to December 2013. Twenty-seven patients met the inclusion criteria. There were 9 patients (7 females and 2 males; mean age: 79.11 years) treated with RSA due to a fracture sequelae following conservative treatment and 18 patients (15 females and 3 males; mean age: 76.83 years) treated with a RSA owing to a fracture sequelae after ORIF.The functional outcome was recorded with the aid of the pre-surgery Constant Score and at the latest follow-up (minimum of two years). All the patients included underwent an imaging study that included plain X-Rays and a CT scan prior to surgery and plain X-Rays after surgery. All complications and reoperations during follow-up were also recorded.ResultsBoth groups had significantly increased Constant Scores after surgery (p < 0.0001), but the patients in the conservative group had significantly better outcomes for the total Constant Score (p = 0.024), for forward elevation (p = 0.026) and for external rotation (p = 0.004).A total of 4 complications (14.8%) were present during the follow-up period. In the conservative group, 1 patient developed an infection and there were 2 dislocations and 1 infection in the ORIF group.ConclusionThe use of RSA in the treatment of PHFS results in a limited outcome improvement but with an acceptable complication rate. Patients developing PHFS after conservative treatment may expect better outcomes and fewer complications than those developing PHFS after ORIF.Level of evidenceLevel IV, Therapeutic Study.

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Section: Discussionsupporting

confidence: 88%

“…They include mal-unions, non-unions, cephalic avascular necrosis, a loss of reduction and hardware complications 1, 2, 3, 4. Surgery of fracture sequelae is challenging and usually leads to limited functional results and may also result in a high complication rate 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23…”

Section: Introductionmentioning

confidence: 99%

Reverse shoulder arthroplasty for fracture sequelae: How the initial fracture treatment influences the outcomes of joint replacement

Santana

Alentorn-Geli²,

Guirro

et al. 2019

Acta Orthopaedica et Traumatologica Turcica

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“…Furthermore, whereas most series of PHFS in the literature have been heterogeneous and included RSA for failed hemiarthroplasty, our series is homogeneous. 17,20,28 We believe that our study adds substantially to the existing literature, providing useful information with clear clinical applications for shoulder surgeons.…”

Section: Discussionmentioning

confidence: 73%

SECEC Grammont Award 2017: the prejudicial effect of greater tuberosity osteotomy or excision in reverse shoulder arthroplasty for fracture sequelae

Boileau

Seeto

Clowez

et al. 2020

Journal of Shoulder and Elbow Surgery

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Hypothesis: The aim was to evaluate risk factors for complications, revision, and mid-to long-term outcomes after reverse shoulder arthroplasty (RSA) implanted for proximal humeral fracture sequelae (PHFS). Methods: The radiographs of 98 patients (mean age, 68 years) who underwent RSA for the treatment of PHFS were reviewed at a minimum 5-year follow-up. PHFS were divided into 4 types according to the Boileau classification: type 1 (46 cases), type 2 (6 cases), type 3 (12 cases), and type 4 (34 cases). The tuberosities underwent osteotomy in 28 cases and excision in 12 (all type 3 or 4 PHFS). The mean follow-up period was 8.4 years (range, 5-14 years). Results: The functional results and rate of RSA survival without revision (85% vs. 100% at 10 years, P ¼ .007) were significantly lower for types 3 and 4 vs. types 1 and 2. Overall, our findings showed that RSA for PHFS is not the panacea that surgeons once believed: At a mean follow-up of 8.5 years (range, 5-14 years), 59% of the patients in our series had fair or poor results. Patients who underwent tuberosity osteotomy or excision had lower functional results (adjusted Constant score, 69% vs. 88%; P < .001), more postoperative complications (32% vs. 9%, P ¼ .003), and a higher revision rate (15% vs. 2%, P ¼ .017). Patients who underwent tuberosity osteotomy or excision at the time of RSA were at risk of postoperative prosthetic instability and humeral stem loosening. The absence of the greater tuberosity at last radiographic follow-up was predictive of higher rates of complications and revisions, as well as a poorer final outcome. Previous fracture fixation was associated with a higher rate of complete tuberosity resorption (56% vs. 33%, P ¼ .026) and with higher rates of postoperative complications (27% vs. 13%, P ¼ .099) and reinterventions (17% vs. 2%, P ¼ .018). Conclusion: The functional results and rates of complications and revision depend on the type of fracture sequelae and tuberosity management. Patients with more severe (type 3 and 4) fracture sequelae who undergo tuberosity osteotomy or excision are at risk of having a poorer functional result and higher rates of complications and revision with lower survival. Previous fracture fixation is also a prejudicial factor.

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“…Traditionally, RTSA was used primarily as a salvage procedure after failed HA, ORIF, or nonoperative fracture sequelae when no other options remained. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] However, these patients frequently experience only mild improvements in their activities of daily living (ADLs) 15,25 and face a high risk of complications. 24,26,27 Several systematic reviews have suggested that RTSA may be superior to HA for acute PHFs [28][29][30] and in recent years RTSA has become an increasingly popular initial option for these injuries.…”

Section: Introductionmentioning

confidence: 99%

Primary Versus Salvage Reverse Total Shoulder Arthroplasty for Displaced Proximal Humerus Fractures in the Elderly: A Systematic Review and Meta-analysis

Nelson

Kwan

Tjong

et al. 2020

Journal of Shoulder and Elbow Arthroplasty

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Background There is currently no established consensus on best treatment for complex proximal humerus fractures (PHFs) in the elderly. Reverse total shoulder arthroplasty (RTSA) is a viable option in this population but many times is used as a salvage procedure. Methods A systematic review of studies comparing RTSA as a primary treatment for PHF versus as a salvage procedure following failed open reduction internal fixation (ORIF), humeral intramedullary nailing, hemiarthroplasty (HA) or non-operative treatment was conducted using PRISMA guidelines. Pooled outcomes and sub-group analyses assessing range of motion, patient reported outcomes and complications were examined using RevMan. Results Five articles were included in final analysis with 104 patients in the primary RTSA group and 147 in the salvage RTSA group compromising 251 total patients. Primary RTSA had a statistically significant advantage in range of motion (forward flexion and external rotation), patient reported outcomes, and complications compared to salvage RTSA. Conclusions Based on the best available evidence, primary RTSA may result in slightly better patient reported outcomes, range of motion and a lower rate of complication when compared to salvage RTSA. Further high-quality prospective studies are needed to confirm the findings of the current review.

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Early clinical and radiological outcomes of reverse shoulder arthroplasty with an eccentric all-polyethylene glenosphere to treat failed hemiarthroplasty and the sequelae of proximal humeral fractures

Abstract: Level 4, retrospective therapeutic case series.

Cited by 19 publications

References 36 publications

Reverse shoulder arthroplasty for fracture sequelae: How the initial fracture treatment influences the outcomes of joint replacement

Reverse shoulder arthroplasty for fracture sequelae: How the initial fracture treatment influences the outcomes of joint replacement

SECEC Grammont Award 2017: the prejudicial effect of greater tuberosity osteotomy or excision in reverse shoulder arthroplasty for fracture sequelae

Primary Versus Salvage Reverse Total Shoulder Arthroplasty for Displaced Proximal Humerus Fractures in the Elderly: A Systematic Review and Meta-analysis

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