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

Abstract

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.

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

“…Previous fracture fixation is also a prejudicial factor with higher rates of complications and revision. 10,37 The fact that GT osteotomy or excision is a prejudicial prognostic factor in patients undergoing RSA for PHFS, with lower functional and subjective results, is not surprising. This has already been shown in studies of RSA for acute proximal humeral fractures 31 and ASA for fracture sequelae.…”

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

“…Two recent studies have noted that patients undergoing salvage RTSA for failed non-operative management may have better outcomes when compared to those undergoing RTSA for failed HA of PHFs. 47 , 48 These findings would suggest that patients at high risk of failing HA may fare better with non-operative management initially with the option to undergo RTSA in the future, if indicated. While this review found statistical significance favoring primary RTSA compared to RTSA as a salvage procedure, the clinical significance of these results is less clear.…”

Current Role of Reverse Total Shoulder Arthroplasty for Fractures of the Proximal Humerus

“…[48][49][50][51][52] But in comparing these 2 groups, those undergoing revision for sequelae after initial conservative management show improved functional outcomes. 53,54 In a recent retrospective study conducted by Santana et al, 53 the outcomes for 27 patients were compared after RSA for treatment of fracture sequelae after initial conservative management and RSA for treatment of fracture sequelae after initial management with ORIF. Both groups demonstrated significantly increased Constant scores postoperatively after revision RSA, but patients initially managed conservatively had significantly better outcomes compared with those developing fracture sequelae after initial ORIF management.…”