Reversed shoulder arthroplasty for the treatment of proximal humerus fracture in the elderly

Fitschen-Oestern, Stefanie; Behrendt, Peter; Martens, Eckhard; Finn, J. Paul; Schiegnitz, J; Borzikowsky, Christoph; Seekamp, Andreas; Weuster, Matthias; Lippross, Sebastian

doi:10.1016/j.jor.2019.08.029

Cited by 12 publications

(7 citation statements)

References 24 publications

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“…Keywords: Reverse shoulder arthroplasty; Periprosthetic joint infection; Cutibacterium acnes; Periprosthetic shoulder infection; Functional outcome; Surgical treatment Reverse shoulder arthroplasty (RSA) is a good surgical option for massive cuff-tear arthropathy, arthrosis and proximal humeral fractures in the elderly 14,29 . With an aging population, the number of procedures for these indications and therefore their related complication (e.g.…”

Section: Level Of Evidence: Level Iii; Retrospective Cohort Comparison; Treatment Studymentioning

confidence: 99%

Management of periprosthetic infection after reverse shoulder arthroplasty

Lemmens

Geelen

Depypere

et al. 2021

Journal of Shoulder and Elbow Surgery

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Level Of Evidence: Level Iii; Retrospective Cohort Comparison; Treatment Studymentioning

confidence: 99%

Management of periprosthetic infection after reverse shoulder arthroplasty

Lemmens

Geelen

Depypere

et al. 2021

Journal of Shoulder and Elbow Surgery

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“…Proximal humeral fractures (PHFs) are fragility fractures [1][2][3][4][5] that occur with low-energy trauma mechanisms and are sentinel markers of poor bone health and a general decline in health. At 1 year after a PHF, the mortality rate is 10% regardless of treatment [6].…”

Section: Introductionmentioning

confidence: 99%

Improved outcomes of elderly patients with acute and displaced proximal humerus fractures treated with window bone ingrowth fracture-specific stem reverse shoulder arthroplasty

Claro

Ribau

Fonte

et al. 2022

Preprint

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Background: The optimal treatment of displaced proximal humerus fractures (PHFs) in the elderly population remains controversial. Reverse shoulder arthroplasty (RSA) is a popular surgical treatment option that provides improved and reproducible results. However, the relevance of fracture-specific stem designs for RSA to improve tuberosity consolidation and shoulder function remains debatable. Methods: This study included all patients 70 years or older with acute and displaced PHFs primarily treated with RSA at a single institution between January 2010 and December 2019 who participated in a minimum follow-up of 2 years. Exclusion criteria were pathologic fractures and more than 6 weeks between fracture onset and the time of surgery. Results: A total of 112 patients (15 men and 97 women) with a median clinical follow-up of 52 months were included. The mean age at the time of fracture was 78.6 years. The mean time from trauma to surgery was 6.9 days. The mean length of the postoperative hospital stay was 5.2 days. According to the Charlson comorbidity index, 41 patients had a score of 4, and 17 patients had a score ≥ 6. All fractures were classified as Neer types 3 and 4 (n = 50 and n = 62, respectively). Most patients had American Society of Anesthesiology scores II and III (56% and 40%, respectively). A fracture-specific humeral implant was used for 86 patients, and a conventional humeral stem was used for 26 patients. Regarding the tuberosity fixation technique, 76 tuberosities were attached using technique A and 36 tuberosities were attached using technique B. The overall survival rate during the 2-year follow-up was 88.2%; however, this decreased to 79% at 5 years. Most patients returned to normal activities of daily living, and 45.5% of the patients achieved functional mobility. Only three patients had complications (two infections and one dislocation) requiring revision surgery. In the multivariable analysis, the tuberosity fixation technique (P = 0.012) and tuberosity anatomical consolidation (P < 0.001) were associated with improved Constant scores. Fracture-specific humeral implants (P = 0.051), the tuberosity fixation technique (P = 0.041), tuberosity anatomical consolidation (P < 0.001), and dementia influenced the achievement of functional mobility (P = 0.014). Tuberosity anatomic consolidation was positively associated with bone ingrowth fracture-specific humeral implants (P < 0.01) and a strong tuberosity fixation technique (P < 0.01). Conclusion: RSA is used for complex and displaced fractures of the proximal humerus in elderly patients. Dementia was negatively correlated with functional outcomes. A window bone ingrowth fracture-specific stem combined with strong tuberosity fixation can yield better clinical and radiological results.

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“…Total shoulder joint arthroplasty (TSA) experienced in the last years’ considerable advancements and is nowadays a well-established treatment option for various diagnoses such as proximal humerus fracture, osteoarthritis, and cuff tear arthropathy in the elderly [ 1 , 2 , 3 ]. The increasing number of performed TSA is accompanied by growing complication rates such as periprosthetic shoulder infection (PSI), where incidence estimates of 0.7 to 6% are reported [ 4 , 5 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Periprosthetic Infections of the Shoulder Joint: Characteristics and 5-Year Outcome of a Single-Center Series of 19 Cases

et al. 2021

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Periprosthetic shoulder infection (PSI) remains a devastating complication after total shoulder arthroplasty (TSA). Furthermore, there is a paucity in the literature regarding its diagnostic and therapeutic management, especially the absence of therapy concepts devised exclusively for PSI. The aim of the presenting study is to examine the characteristics and outcome of patients with PSI who were treated according to well-established algorithms developed originally for periprosthetic joint infection (PJI) of the hip and knee and determine if these algorithms can be applied to PSI. This single-center case series included all patients with a PSI presenting between 2010 and 2020. Recorded parameters included age, sex, affected side, BMI, ASA score, Charlson comorbidity index, preoperative anticoagulation, indication for TSA (fracture, osteoarthritis or cuff-arthropathy), and type of infection (acute or chronic PSI). The outcome was divided into treatment failure or infect resolution. Staphylococcus epidermidis and aureus were the commonest infecting pathogens. Acute PSI was mainly treated with debridement, irrigation, and retention of the prosthesis (DAIR) and chronic cases with two/multiple-stage exchange. The treatment failure rate was 10.5%. C-reactive protein was preoperatively elevated in 68.4% of cases. The mean number of operative revisions was 3.6 ± 2.6, and the mean total duration of antibiotic treatment was 72.4 ± 41.4 days. The most administered antibiotic was a combination of clindamycin and fluoroquinolone. In summary, the data of the current study suggest that therapeutical algorithms and recommendations developed for the treatment of PJI of the hip and knee are also applicable to PSI.

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Reversed shoulder arthroplasty for the treatment of proximal humerus fracture in the elderly

Cited by 12 publications

References 24 publications

Management of periprosthetic infection after reverse shoulder arthroplasty

Management of periprosthetic infection after reverse shoulder arthroplasty

Improved outcomes of elderly patients with acute and displaced proximal humerus fractures treated with window bone ingrowth fracture-specific stem reverse shoulder arthroplasty

Periprosthetic Infections of the Shoulder Joint: Characteristics and 5-Year Outcome of a Single-Center Series of 19 Cases

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