The role of teriparatide in tuberosity healing after reverse shoulder arthroplasty in complex proximal humeral fragility fracture

Abstract

Introduction: Tuberosity healing is known to be one of the factors that increase functional outcome in Reverse Total Shoulder Arthroplasty (rTSA). In fragility fractures, tuberosity healing is difficult to be achieved. The fragment stability and bone-forming agent application become strategies to overcome this problem. The purpose of this study was to evaluate the benefit of teriparatide application to promote tuberosity union in rTSA on four-part proximal humeral fractures to achieve better functional outcome. Methods: A retrospective study of a prospectively collected shoulder arthroplasty medical record was performed. Eleven patients were included in this analysis and consisted of two groups, teriparatide and no-teriparatide groups. Patients were evaluated on the range of motions and clinical outcome using the American Shoulder Elbow Surgeon (ASES) Shoulder Score and X-ray to determine tuberosity union. The group differences were analyzed by t-test or Mann-Whitney U test with SPSS version 20.0 for Windows. Results: The statistical analysis revealed no significant differences in mean age in both the groups. There were significant differences between teriparatide and no-teriparatide groups in external rotation (29.5 vs. 7.5 ; p ¼ 0.004), external rotation in 90 abduction (55 vs. 12.5 ; p < 0.020), forward flexion (120 vs. 105 ; p ¼ 0.002) range of motions, and ASES (84.5 vs. 74.6; p ¼ 0.019). We found clinical difference between teriparatide and no-teriparatide groups in time to achieve the initial callus (33 + 18.3 days vs. 150 + 42.4 days) and tuberosity consolidation (165.8 + 70.3 days vs. 315 + 106.1 days). Conclusions: Teriparatide administration supports tuberosity repair results in a high tuberosity healing rate with restoration of external rotation after rTSA in acute complex proximal humeral fractures.

A novel “7 sutures and 8 knots” surgical technique in reverse shoulder arthroplasty for proximal humeral fractures: tuberosity healing improves short-term clinical results

“…Anatomical tuberosity healing and rotator cuff integrity have been shown to be essential for good functional recovery after HA for PHFs [ 41 – 43 ]. The unreliable results achieved with HA in the elderly suffering from cPHFs led to attempts to treat these patients with RSA, since the functional outcomes are less dependent on tuberosity healing and cuff integrity [ 13 – 15 , 19 , 20 , 44 , 45 ]. However, recent studies have demonstrated that although tuberosity healing is not a prerequisite for a satisfactory outcome after RSA for cPHFs, it still leads to better clinical results [ 21 – 27 , 46 , 47 ].…”

Radiographic Evaluation and Changes in Bone Density of the Humeral Side after Reverse Total Shoulder Arthroplasty

“…Therefore, monitoring changes in bone density before surgery in patients with rotator cuff tears requiring RSA is crucial. Postoperative administration of teriparatide and denosumab is reportedly effective in maintaining bone quality around artificial joints [29][30][31][32]. Hence, we strongly recommend that osteoporosis drugs should be considered after surgery.…”