Prospective comparison of functional outcomes of primary reverse shoulder arthroplasty for acute fractures versus rotator cuff deficiencies

Abstract

Aims The purpose of this study was to determine whether there were long-term differences in outcomes of reverse shoulder arthroplasty (RSA) undertaken for acute proximal humeral fracture versus rotator cuff deficiency with a minimum follow-up of five years. Methods This was a prospective cohort study comparing 67 patients with acute complex proximal humeral fracture and 64 patients with irreparable rotator cuff deficiency who underwent primary RSA. In the fracture group, there were 52 (77.6%) females and 15 (22.4%) males, with a mean age of 73.5 years (51 to 85), while in the arthropathy group, there were 43 (67.1%) females and 21 (32.9%) males, with a mean age of 70.6 years (50 to 84). Patients were assessed by the Constant score, University of California Los Angeles shoulder score (UCLA), short version of the Disability of the Arm Shoulder and Hand score (QuickDASH), and visual analogue scales (VAS) for pain and satisfaction. Radiological evaluation was also performed. Results Mean follow-up was 8.4 years (5 to 11). There were no significant differences in mean absolute (p = 0.125) or adjusted (p = 0.569) Constant, UCLA (p = 0.088), QuickDASH (p = 0.135), VAS-pain (p = 0.062), or range of movement at the final follow-up. However, patient satisfaction was significantly lower in the fracture group (p = 0.002). The complication rate was 1.5% (one patient) versus 9.3% (six patients), and the revision rate was 1.5% (one patient) versus 7.8% (five patients) in the fracture and arthropathy groups, respectively. The ten-year arthroplasty survival was not significantly different (p = 0.221). Conclusion RSA may be used not only for patients with irreparable rotator cuff deficiencies, but also for those with acute complex proximal humeral fractures. We found that RSA provided similar functional outcomes and a low revision rate for both indications at long-term. However, satisfaction is lower in patients with an acute fracture. Cite this article: Bone Joint J 2020;102-B(11):1555–1559.

Short-term comparative outcomes between reverse shoulder arthroplasty for shoulder trauma and shoulder arthritis: a Southeast Asian experience

“…Existing studies rarely report post-surgical complications stratified by indication. Sebastia-Forcada et al 's prospective series [8] reported no significant difference in long-term complication rate or 10-year arthroplasty survival between RSA for fracture or for arthropathy. We recognize the higher-than-expected complication rate in the arthritis group in our study.…”

“…They found that, although RSA provided significant within-group improvements in all outcomes regardless of indication, the acute PHF and PHF sequelae groups consistently showed significantly lower postoperative means of all four standard planes of shoulder motion, as well as lower patient-reported outcome measures (ASES and Constant shoulder), than the groups with GHOA or massive cuff tear with or without GHOA or CTA. Conversely, one of the few long-term prospective studies on RSA for acute fractures versus rotator cuff deficiencies in the elderly, by Sebastia-Forcada et al [8], showed no significant differences in mean functional scores or ranges of shoulder motion at the end of a mean 8.4 years of follow-up.…”

Comparison of Early Range of Motion in Reverse Shoulder Arthroplasty Based on Indication: A Single Center Retrospective Review

“…Two studies report no difference in final aROM or patient reported outcomes scores. 9,10 One study reports a difference in forward elevation, as well as early differences in functional scores which become equivalent around 6 months to 1 year. 11 Two describe a statistical difference in aROM and patient reported outcomes only in chronic fracture sequela subgroups.…”

Supraspinatus Tenotomy in Reverse Shoulder Arthroplasty for Fractures: A Comparative Cohort Study

“…Despite this, these patients have a better outcome than those who had the RSA implanted because of a fracture and in whom the tuberosities have been refixed. 12 - 14 Recent studies on RSA in proximal humerus fracture show improved stability of the tuberosity construct and no functional disadvantage after excision of the tendon. Furthermore, this allows for better intraoperative visualization of the glenoid, enabling even more precise implant positioning.…”