Grammont reversed prosthesis for acute complex fracture of the proximal humerus in an elderly population with 5 to 12 years follow-up

Abstract

For acute complex fractures of the proximal humerus in elderly subjects with poor bone quality, when effective and reliable re-fixation of the tubercles is difficult or impossible, the reverse ball-and-socket shoulder prosthesis is a possible alternative providing good functional outcome except for rotations, but with the risk of inferior scapular notching. Although not problematic in the medium term, these notches may contribute to glenoid loosening with bone loss in the long term. Nevertheless, this procedure seems to improve the status of patients with such fractures.

Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly

“…In this series, we found a very high subjective satisfaction rate, with 92% of patients (48 of 52) rating their subjective satisfaction as good or very good, with a mean SSV of 83% and relative CS of 87%, which compares favorably with published data. 4,7,8,16,26,32 The revision rate of 5% (4 of 74 RTSAs) is relatively low compared with other series, and only 3% of shoulders (2 of 74 RTSAs) needed temporary removal of the prosthesis because of infection.…”

“…We tried to reattach the greater tuberosity and can confirm that the results with reattached and healed greater tuberosities are better than those with resected or secondarily displaced greater tuberosities, 8,15,27,31,36 so a major effort to reattach the greater tuberosity seems clearly justified. Compared with hemiarthroplasty, in which nonunion or displacement of the greater tuberosity has been reported to occur at a rate of 20% to 50%, 12 tuberosity nonunion or displacement of the greater tuberosity occurred in only 9%.…”

“…35,46 The primary use of RTSA for acute fractures has been reported in several small single-center series. 4,7,8,11,24,26,39,40,42 Our series reports the outcomes from 2 independent centers using the same implant and technique. We did not find any differences in the primary outcome endpoints of the patients at one center versus the other, so the results were reproducible.…”

“…The use of a reverse total shoulder replacement (reverse total shoulder arthroplasty [RTSA]) as proposed by Grammont et al 19 is an alternative that addresses the additional fragility of the rotator cuff and has shown promising results in a few case series. 4,[7][8][9]11,12,24,26,32,40 It appears established that reattachment of the greater tuberosity yields a better functional outcome than resection of the greater tuberosity.…”

Future Patient Demand for Shoulder Arthroplasty by Younger Patients: National Projections

“…Analyses have shown poorer long-term outcomes with hemiarthroplasty compared with TSA for older patients with glenohumeral joint arthritis [3,14,37,40,41]. Additionally, the expansion of indications for reverse shoulder arthroplasties, specifically for patients with proximal humerus fractures [1,6,7,34] previously treated almost exclusively with hemiarthroplasties, may explain the decline in hemiarthroplasties in treating elderly patients. The decline may accelerate as some comparative results between reverse shoulder arthroplasty and hemiarthroplasty have shown superiority of the reverse prosthesis in patients with complex proximal humerus fractures [9] and in patients with rotator cuff insufficiency [41].…”