Tuberosity healing after reverse shoulder arthroplasty for complex proximal humeral fractures in elderly patients—does it improve outcomes? A systematic review and meta-analysis

Jain, Nimesh; Mannan, Syed; Dharmarajan, Ramasubramanian; Rangan, Amar

doi:10.1016/j.jse.2018.09.006

Cited by 92 publications

(70 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Jain et al [50] identified a tubercle healing rate of 70.5%, which is equivalent to our results of 72% in a meta-analysis of 382 shoulder arthroplasties and a similar follow-up period. Acceptable functional results in unhealed tubercle patients (28% of the total collective) substantiate that a fracture RSA implantation allows predictable postoperative results.…”

Section: Discussionsupporting

confidence: 88%

Effectiveness of reverse total shoulder arthroplasty for primary and secondary fracture care: mid-term outcomes in a single-centre experience

Schwarz

Hohenberger

Sauerschnig

et al. 2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background The introduction of reverse total shoulder arthroplasty (RSA) as a treatment option in complex proximal humeral fractures, has significantly extended the surgical armamentarium. The aim of this study was to investigate the mid-term outcome following fracture RSA in acute or sequelae, as well as salvage procedures. It was hypothesized that revision RSA (SRSA) leads to similar mid-term results as primary fracture treatment by RSA (PRSA). Methods This retrospective study describes the radiological and clinical mid-term outcomes in a standardized single-centre and Inlay design. Patients who underwent RSA in fracture care between 2008 and 2017 were included (minimum follow-up: 2 years, minimum age: 60 years). The assessment tools used for functional findings were range of motion (ROM), Visual Analogue Scale, absolute (CS) plus normative Constant Score, QuickDASH, and Subjective Shoulder Value. All adverse events as well as the radiological results and their clinical correlations were statistically analysed (using p < .05and 95% confidence intervals). Results Following fracture RSA, 68 patients were included (mean age: 72.5 years, mean follow-up: 46 months). Forty-two underwent primary RSA (PRSA), and 26 underwent revision RSA (SRSA). Adverse advents were observed in 13% (n = 9/68). No statistically significant results were found for the scores of the PRSA and SRSA groups, while the failed osteosynthesis SRSA subgroup obtained statistically significantly negative values for ROM subzones (flexion: p = .020, abduction: p = .020). Decreased instances of tubercle healing were observed for the in PRSA group relative to the SRSA group (p = .006). The absence of bony healing of the tubercles was related to significant negative clinical and subjective outcomes (all scores: p < .05, external rotation: p= .019). Significant postoperative improvements were evaluated in the SRSA group (CS: 23 to 56 at mean, p = .001), the time from index surgery to operative revision revealed no associations in functional findings. Conclusions RSA is an effective option in severe shoulder fracture management with predictable results for salvage as well as first-line treatment. Promising mid-term functional results, reasonable implant survival rates, and high patient satisfaction can be achieved. Level of evidence Level III.

show abstract

Section: Discussionsupporting

confidence: 88%

Effectiveness of reverse total shoulder arthroplasty for primary and secondary fracture care: mid-term outcomes in a single-centre experience

Schwarz

Hohenberger

Sauerschnig

et al. 2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…Le taux moyen de consolidation des tubérosités est de 79% dans notre étude et d'environ 70% pour Jain dans sa méta-analyse [28]. Nous pouvons expliquer cette amélioration de la consolidation par l'utilisation de la cage, une bonne technique de suture, et le design de…”

Section: Figureunclassified

Tuberosity healing in reverse shoulder arthroplasty in traumatology: Use of an offset modular system with bone graft

Fortané¹,

Beaudouin

Lateur

et al. 2020

Orthopaedics & Traumatology: Surgery & Research

View full text Add to dashboard Cite

“…Similar to our findings they showed that tenotomy of the Ssp tendon leads to better external rotation in RSA for fractures. These results were confirmed by 2 systematic reviews by Anakwenze et al and Jain et al 5 , 23 The biomechanical work of Miquel et al provides further evidence that a more stable tuberosity construct improves external rotation through the teres minor and infraspinatus . 16 …”

Section: Discussionmentioning

confidence: 73%

“…Some past work showed that patients whose tuberosities had been refixed and healed had better functional outcomes than those without tuberosity repair. 5 , 15 , 23 For example Bonnevialle et al 15 observed comparable results regarding tuberosity integration and displacement. Similar to our findings they showed that tenotomy of the Ssp tendon leads to better external rotation in RSA for fractures.…”

Section: Discussionmentioning

confidence: 92%

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

Siebenbürger

Fleischhacker

Gleich

et al. 2021

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

Background: The aim of this study was to evaluate the functional and radiographic outcome in patients with reverse total shoulder arthroplasty (RSA) for displaced proximal humeral fractures (PHF) with or without tenotomy of the supraspinatus tendon. Methods: Between June 2011 and June 2018, 159 patients (age >65 years) with a displaced proximal humeral fracture underwent reverse total shoulder arthroplasty (Grammont design) in a single-center study and were longitudinally followed up. In all cases, the tuberosities were attached to the prosthesis in a standardized procedure. Functional outcome, range of motion as well as tuberosity integration, resorption and displacement were assessed at final follow-up. Outcomes were compared between patients that underwent RSA in combination with tenotomy of the supraspinatus (ST) and patients that underwent RSA without supraspinatus tenotomy (NT). Results: At a mean follow up of 22.2 ± 16.4 months 76 patients (mean age 77.1 ± 7.2 years, 83% women) could be evaluated (follow-up rate 47.8%). There were no statistically significant differences between the ST (n = 29) and NT groups (n = 47) in tuberosity integration, resorption </≥50%, or displacement (p = 0.99/0.31/0.7/0.99). Functional outcome was better in ST group (Constant score 76.2 ± 5.9 vs. 64.5 ± 12.8; p < 0.05) especially regarding mean active external rotation (>20°: 65.5% vs. 14.9%, p < 0.05) and active abduction (>120°: 89.7% vs. 21.3%, p < 0.05). Tuberosity integration (ST and NT together: n = 34) showed better functional results than resorption or displacement (p < 0.05). Conclusions: Tenotomy of the supraspinatus tendon in RSA for displaced PHF leads to similar radiographic results regarding tuberosity integration, resorption and displacement but better functional outcome with regard to range of motion. Level of Evidence: III

show abstract

Tuberosity healing after reverse shoulder arthroplasty for complex proximal humeral fractures in elderly patients—does it improve outcomes? A systematic review and meta-analysis

Cited by 92 publications

References 57 publications

Effectiveness of reverse total shoulder arthroplasty for primary and secondary fracture care: mid-term outcomes in a single-centre experience

Effectiveness of reverse total shoulder arthroplasty for primary and secondary fracture care: mid-term outcomes in a single-centre experience

Tuberosity healing in reverse shoulder arthroplasty in traumatology: Use of an offset modular system with bone graft

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

Contact Info

Product

Resources

About