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

Fortané, Thibaut; Beaudouin, Emmanuel; Lateur, Gabriel; Giraudo, Pedro; Kerschbaumer, Gaël; Boudhissa, Mehdi; Tonetti, Jérôme

doi:10.1016/j.otsr.2020.04.018

Cited by 14 publications

(7 citation statements)

References 31 publications

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“…As we can notice it in our study, ER group had better clinical and functional results despite less tuberosities' anatomical union. Furthermore, analysis according to tuberosities' union did not show a statistically significant difference between ER group and DR group, as also reported by Fortané et al [31].…”

Section: Discussionsupporting

confidence: 78%

Early rehabilitation after reverse total shoulder prosthesis on fracture of proximal humerus in elderly patients provides better functional outcome

Tuphe

Caubriere

Hubert

et al. 2023

Eur J Orthop Surg Traumatol

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Purpose Reverse total shoulder arthroplasty (RSA) has revolutionized the management of proximal humerus fractures (PHF) in the elderly patients. There is few or no consensus regarding to management of postoperative rehabilitation in elderly patients. An early rehabilitation from D1 allowed better functional results compared to rehabilitation started to D30 independently from tuberosities consolidation. Methods 94 patients operated on for PHF were evaluated retrospectively, with a minimum radio-clinical follow-up of 2 years. Clinical evaluation included mobilities and four functional scores: ASES, quick DASH, gross constant, weighted constant. Radiological evaluation was performed on a frontal shoulder X-ray with evaluation of tuberosities' consolidation. ResultsThe mean follow-up was 45 ± 19 months (24-88 months). Early rehabilitation was significantly associated with a

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Section: Discussionsupporting

confidence: 78%

Early rehabilitation after reverse total shoulder prosthesis on fracture of proximal humerus in elderly patients provides better functional outcome

Tuphe

Caubriere

Hubert

et al. 2023

Eur J Orthop Surg Traumatol

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“…However, recent studies have highlighted that tuberosity healing, as in hemiarthroplasty, is a significant outcome variable in RTSA performed in complex proximal humerus fractures [27][28][29][30][31]. The tuberosity healing rate ranges from 37 to 90% in RTSA [32][33][34][35]. An overall tuberosity healing rate of 68% was recently described in a meta-analysis [36].…”

Section: Importance Of Tuberosity Healing On Functionmentioning

confidence: 99%

“…Along with implant characteristics, several fixation techniques have been developed to impart satisfactory reattachment of the tuberosities [31,[74][75][76][77]. Some studies have focused on stem-based fixation of tuberosities [30,75,78] while others have explored bone grafting [32,33,[79][80][81] and suture techniques [74,77,82] to secure the tuberosities to the humeral stem. Cemented humeral fixation has not improved tuberosity healing, but has led to worse patient-reported outcomes [83,84].…”

Section: Tuberosity Fixation Techniquesmentioning

confidence: 99%

“…These techniques may be simple and reproducible tuberosity fixation methods in theory, but require a period of familiarisation as they can be challenging intraoperatively. The use of bone graft has shown promising results in tuberosity healing in RTSA [32,33,[79][80][81]. Boileau et al [32] demonstrated, in 38 elderly patients with displaced 3-and 4-part fractures, that the Aequalis Reverse-Fracture prosthesis (Tornier, Edina, MN, USA) combined with bone grafting resulted in an 84% tuberosity union rate.…”

Section: Tuberosity Fixation Techniquesmentioning

confidence: 99%

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Prosthesis Designs and Tuberosity Fixation Techniques in Reverse Total Shoulder Arthroplasty: Influence on Tuberosity Healing in Proximal Humerus Fractures

Borbas

Grubhofer

et al. 2021

JCM

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Reverse total shoulder arthroplasty (RTSA) is increasingly used for the treatment of complex proximal humerus fractures and fracture sequelae. In 2021, half a dozen models of fracture stems are commercially available, reflecting its growing utility for fracture management. Prosthesis designs, bone grafting and tuberosity fixation techniques have evolved to allow better and more reliable fixation of tuberosities and bony ingrowth. Patients with anatomical tuberosity healing not only have an increased range of active anterior elevation and external rotation, but also experience fewer complications and longer prosthesis survival. This review provides an overview of recent evidence on basic and fracture-specific RTSA design features as well as tuberosity fixation techniques that can influence tuberosity healing.

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“…Reverse shoulder arthroplasty (rTSA) is indicated for a number of conditions, including rotator cuff tear arthropathy, glenohumeral arthritis, and three-and four-part proximal humerus fractures in the elderly [1]. rTSA has demonstrated better outcomes and fewer complications, as compared to hemiarthroplasty or plate fixation for severe proximal humerus fractures [2][3][4][5]. However, complications of rTSA remain frequent and are diverse in nature [1].…”

Section: Introductionmentioning

confidence: 99%

Surgeon-designed patient-specific instrumentation improves glenoid component screw placement for reverse total shoulder arthroplasty in a population with small glenoid dimensions

Yung

Fang

et al. 2023

International Orthopaedics (SICOT)

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Purpose Glenoid component loosening is a potential complication of reverse total shoulder arthroplasty (rTSA), occurring in part due to lack of adequate screw purchase in quality scapular bone stock. This study was to determine the efficacy of a surgeon-designed, 3D-printed patient-specific instrumentation (PSI) compared to conventional instrumentation (CI) in achieving longer superior and inferior screw lengths for glenoid component fixation. Methods A multi-centre retrospective analysis of patients who underwent rTSA between 2015 and 2020. Lengths of the superior and inferior locking screws inserted for fixation of the glenoid baseplate component were recorded and compared according to whether patients received PSI or CI. Secondary outcomes included operative duration and incidence of complications requiring revision surgery. Results Seventy-three patients (31 PSI vs. 42 CI) were analysed. Average glenoid diameter was 24.5 mm (SD: 3.1) and 81% of patients had smaller glenoid dimensions compared to the baseplate itself. PSI produced significantly longer superior (44.7 vs. 30.7 mm; P < 0.001) and inferior (43.0 vs. 31 mm; P < 0.001) mean screw lengths, as compared to CI. A greater proportion of maximal screw lengths for the given rTSA construct (48 mm) were observed in the PSI group (71.9% vs. 11.9% superior, 59.4% vs. 11.9% inferior). Operative duration was not statistically significantly different between the PSI and CI groups (150 min vs. 169 min, respectively; P = 0.229). No patients had radiographic loosening of the glenoid component with an average of 2-year follow-up. Conclusion PSI facilitates longer superior and inferior screw placement in the fixation of the glenoid component for rTSA. With sufficient training, PSI can be designed and implemented by surgeons themselves.

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

Cited by 14 publications

References 31 publications

Early rehabilitation after reverse total shoulder prosthesis on fracture of proximal humerus in elderly patients provides better functional outcome

Early rehabilitation after reverse total shoulder prosthesis on fracture of proximal humerus in elderly patients provides better functional outcome

Prosthesis Designs and Tuberosity Fixation Techniques in Reverse Total Shoulder Arthroplasty: Influence on Tuberosity Healing in Proximal Humerus Fractures

Surgeon-designed patient-specific instrumentation improves glenoid component screw placement for reverse total shoulder arthroplasty in a population with small glenoid dimensions

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