Influence of the Consolidation of the Tuberosities on the Clinical Outcomes of the Reverse Arthroplasty in Proximal Humerus Fractures
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Published:
Aug 31, 2022
Keywords:
Proximal humerus fracture, reverse arthroplasty, tuberosities reconstruction
Main Article Content
Abstract
Objective: The objective of this study was to compare the clinical outcomes and complications of a consecutive series of patients with proximal humerus fractures (PHF) treated with reverse shoulder arthroplasty (RSA), with and without anatomical healing of the tuberosities.
Materials and Methods: We evaluated 113 patients >65 years old with PHF treated with RSA. Seventy patients presented anatomical healing of the tuberosities and 43 presented absence of healing. Range of motion (ROM), Constant score, ASES score, visual analog scale (VAS) and the score of the numerical evaluation of single evaluation (SANE) were evaluated.
Results: The mean follow-up was 56 months (range, 24-96 months) and the mean age was 73 years (range, 65-83 years). Mean postoperative active elevation and internal rotation were 131° (±14) and 27° (±5), respectively. The mean postoperative external rotation in abduction and adduction was 27° (±1) and 15° (±6) respectively. The mean postoperative VAS was 1.7 (±0.8). The mean ASES, Constant and SANE scores were 76 (±6), 62 (±11) and 74% (±7), respectively. Anterior elevation, external rotation, and final mean ASES and Constant functional scores were significantly better in the group with tuberosity healing than in the group without healing.
Conclusions: In patients >65 years old with PHF treated with RSA, both postoperative ranges of motion and functional scores were significantly better in patients where anatomic tuberosity healing was achieved than in those where it was not achieved.
Materials and Methods: We evaluated 113 patients >65 years old with PHF treated with RSA. Seventy patients presented anatomical healing of the tuberosities and 43 presented absence of healing. Range of motion (ROM), Constant score, ASES score, visual analog scale (VAS) and the score of the numerical evaluation of single evaluation (SANE) were evaluated.
Results: The mean follow-up was 56 months (range, 24-96 months) and the mean age was 73 years (range, 65-83 years). Mean postoperative active elevation and internal rotation were 131° (±14) and 27° (±5), respectively. The mean postoperative external rotation in abduction and adduction was 27° (±1) and 15° (±6) respectively. The mean postoperative VAS was 1.7 (±0.8). The mean ASES, Constant and SANE scores were 76 (±6), 62 (±11) and 74% (±7), respectively. Anterior elevation, external rotation, and final mean ASES and Constant functional scores were significantly better in the group with tuberosity healing than in the group without healing.
Conclusions: In patients >65 years old with PHF treated with RSA, both postoperative ranges of motion and functional scores were significantly better in patients where anatomic tuberosity healing was achieved than in those where it was not achieved.
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Rossi, L. A., Juana, C., Fieiras, C., Brandariz, R., Tanoira, I., & Ranalletta, M. (2022). Influence of the Consolidation of the Tuberosities on the Clinical Outcomes of the Reverse Arthroplasty in Proximal Humerus Fractures . Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(4), 466-475. https://doi.org/10.15417/issn.1852-7434.2022.87.4.1487
Section
Clinical Research
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References
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10. O’Sullivan J, Lädermann A, Parsons BO, Werner B, Steinbeck J, Tokish JM, et al. A systematic review of tuberosity healing and outcomes following reverse shoulder arthroplasty for fracture according to humeral inclination of the prosthesis. J Shoulder Elbow Surg 2020;29(9):1938-49. https://doi.org/10.1016/j.jse.2020.03.032
11. Jain NP, Mannan SS, Dharmarajan R, Rangan A. Tuberosity healing after reverse shoulder arthroplasty for complex proximal humeral fractures in elderly patients-does it improve outcomes? A systematic review and meta-analysis. J Shoulder Elbow Surg 2019;28(3):e78-e91. https://doi.org/10.1016/j.jse.2018.09.006
12. Neer CS II. Displaced proximal humeral fractures: part I. Classification and evaluation. 1970. Clin Orthop Relat Res 2006;442:77-82. https://doi.org/10.1097/01.blo.0000198718.91223.ca
13. Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Molé D. Grammont inverted total shoulder arthroplasty in
the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders. J Bone Joint Surg Br 2004;86(3):388-95. https://doi.org/10.1302/0301-620x.86b3.14024
14. Sanchez-Sotelo J, Wright TW, O’Driscoll SW, Cofield RH, Rowland CM. Radiographic assessment of uncemented humeral components in total shoulder arthroplasty. J Arthroplasty 2001;16(2):180-7.
https://doi.org/10.1054/arth.2001.20905
15. Dillon MT, Prentice HA, Burfeind WE, Chan PH, Navarro RA. The increasing role of reverse total shoulder
arthroplasty in the treatment of proximal humerus fractures. Injury 2019;50(3):676-80.
https://doi.org/10.1016/j.injury.2019.01.034
16. Hasty EK, Jernigan EW, 3rd, Soo A, Varkey DT, Kamath GV. Trends in surgical management and costs for operative treatment of proximal humerus fractures in the elderly. Orthopedics 2017;40(4):e641-e7.
https://doi.org/10.3928/01477447-20170411-03
17. Paras T, Raines B, Kohut K, Sabzevari S, Chang YF, Yeung M, et al. Clinical outcomes of reverse total shoulder
arthroplasty for elective indications versus acute 3- and 4-part proximal humeral fractures: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022;31(1):e14-e21. https://doi.org/10.1016/j.jse.2021.07.014
18. Gallinet D, Ohl X, Decroocq L, Dib C, Valenti P, Boileau P, et al. Is reverse total shoulder arthroplasty more
effective than hemiarthroplasty for treating displaced proximal humerus fractures in older adults? A systematic
review and meta-analysis. Orthop Traumatol Surg Res 2018;104(6):759-66. https://doi.org/10.1016/j.otsr.2018.04.025
19. Pizzo RA, Gianakos AL, Haring RS, Gage MJ, Stevens NM, Liporace FA, et al. Are arthroplasty procedures really
better in the treatment of complex proximal humerus fractures? A comprehensive meta-analysis and systematic
review. J Orthop Trauma 2021;35(3):111-9. https://doi.org/10.1097/BOT.0000000000001926
20. Rugg CM, Coughlan MJ, Lansdown DA. Reverse total shoulder arthroplasty: Biomechanics and indications. Curr Rev Musculoskelet Med 2019;12(4):542-53. https://doi.org/10.1007/s12178-019-09586-y
21. Rossi LA, Tanoira I, Ranalletta M, Kunze KN, Farivar D, Perry A, et al. Cemented vs. uncemented reverse shoulder arthroplasty for proximal humeral fractures: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022;31(3):e101-e119. https://doi.org/10.1016/j.jse.2021.10.011
22. Blaas LS, Yuan JZ, Lameijer CM, van de Ven PM, Bloemers FW, Derksen RJ. Surgical learning curve in reverse
shoulder arthroplasty for proximal humerus fractures. JSES Int 2021;5(6):1034-41.
https://doi.org/10.1016/j.jseint.2021.07.008
2. Chen L, Xing F, Xiang Z. Effectiveness and safety of interventions for treating adults with displaced proximal
humeral fracture: A network meta-analysis and systematic review. PLoS One 2016;11(11):e0166801.
https://doi.org/10.1371/journal.pone.0166801
3. Soler-Peiro M, García-Martínez L, Aguilella L, Perez-Bermejo M. Conservative treatment of 3-part and 4-part
proximal humeral fractures: a systematic review. J Orthop Surg Res 2020;15(1):347. https://doi.org/10.1186/s13018-020-01880-7
4. Suroto H, De Vega B, Deapsari F, Prajasari T, Wibowo PA, Samijo SK. Reverse total shoulder arthroplasty (RTSA)
versus open reduction and internal fixation (ORIF) for displaced three-part or four-part proximal humeral fractures: a systematic review and meta-analysis. EFORT Open Rev 2021;6(10):941-55. https:///doi.org/10.1302/2058-5241.6.210049
5. Cadet ER, Ahmad CS. Hemiarthroplasty for three- and four-part proximal humerus fractures. J Am Acad Orthop
Surg 2012;20(1):17-27. https://doi.org/10.5435/JAAOS-20-01-017
6. Boileau P, Krishnan SG, Tinsi L, Walch G, Coste JS, Molé D. Tuberosity malposition and migration: reasons for
poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg
2002;11(5):401-12. https://doi.org/10.1067/mse.2002.124527
7. Savin DD, Zamfirova I, Iannotti J, Goldberg BA, Youderian AR. Survey study suggests that reverse total shoulder
arthroplasty is becoming the treatment of choice for four-part fractures of the humeral head in the elderly. Int
Orthop 2016;40(9):1919-25. https://doi.org/10.1007/s00264-016-3227-y
8. Goetti P, Denard PJ, Collin P, Ibrahim M, Mazzolari A, Lädermann A. Biomechanics of anatomic and reverse
shoulder arthroplasty. EFORT Open Rev 2021;6(10):918-31. https://doi.org/10.1302/2058-5241.6.210014
9. Patiño JM, Martínez CE, Andres B, López Bustos F, Ruiz C, Fiminella H, et al. Resultados funcionales y
radiográficos de la prótesis reversa y la reinserción del troquíter en pacientes con fracturas de húmero proximal. Rev Asoc Argent Ortop Traumatol 2020;85(2):133-8. https://doi.org/10.15417/issn.1852-7434.2020.85.2.994
10. O’Sullivan J, Lädermann A, Parsons BO, Werner B, Steinbeck J, Tokish JM, et al. A systematic review of tuberosity healing and outcomes following reverse shoulder arthroplasty for fracture according to humeral inclination of the prosthesis. J Shoulder Elbow Surg 2020;29(9):1938-49. https://doi.org/10.1016/j.jse.2020.03.032
11. Jain NP, Mannan SS, Dharmarajan R, Rangan A. Tuberosity healing after reverse shoulder arthroplasty for complex proximal humeral fractures in elderly patients-does it improve outcomes? A systematic review and meta-analysis. J Shoulder Elbow Surg 2019;28(3):e78-e91. https://doi.org/10.1016/j.jse.2018.09.006
12. Neer CS II. Displaced proximal humeral fractures: part I. Classification and evaluation. 1970. Clin Orthop Relat Res 2006;442:77-82. https://doi.org/10.1097/01.blo.0000198718.91223.ca
13. Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Molé D. Grammont inverted total shoulder arthroplasty in
the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders. J Bone Joint Surg Br 2004;86(3):388-95. https://doi.org/10.1302/0301-620x.86b3.14024
14. Sanchez-Sotelo J, Wright TW, O’Driscoll SW, Cofield RH, Rowland CM. Radiographic assessment of uncemented humeral components in total shoulder arthroplasty. J Arthroplasty 2001;16(2):180-7.
https://doi.org/10.1054/arth.2001.20905
15. Dillon MT, Prentice HA, Burfeind WE, Chan PH, Navarro RA. The increasing role of reverse total shoulder
arthroplasty in the treatment of proximal humerus fractures. Injury 2019;50(3):676-80.
https://doi.org/10.1016/j.injury.2019.01.034
16. Hasty EK, Jernigan EW, 3rd, Soo A, Varkey DT, Kamath GV. Trends in surgical management and costs for operative treatment of proximal humerus fractures in the elderly. Orthopedics 2017;40(4):e641-e7.
https://doi.org/10.3928/01477447-20170411-03
17. Paras T, Raines B, Kohut K, Sabzevari S, Chang YF, Yeung M, et al. Clinical outcomes of reverse total shoulder
arthroplasty for elective indications versus acute 3- and 4-part proximal humeral fractures: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022;31(1):e14-e21. https://doi.org/10.1016/j.jse.2021.07.014
18. Gallinet D, Ohl X, Decroocq L, Dib C, Valenti P, Boileau P, et al. Is reverse total shoulder arthroplasty more
effective than hemiarthroplasty for treating displaced proximal humerus fractures in older adults? A systematic
review and meta-analysis. Orthop Traumatol Surg Res 2018;104(6):759-66. https://doi.org/10.1016/j.otsr.2018.04.025
19. Pizzo RA, Gianakos AL, Haring RS, Gage MJ, Stevens NM, Liporace FA, et al. Are arthroplasty procedures really
better in the treatment of complex proximal humerus fractures? A comprehensive meta-analysis and systematic
review. J Orthop Trauma 2021;35(3):111-9. https://doi.org/10.1097/BOT.0000000000001926
20. Rugg CM, Coughlan MJ, Lansdown DA. Reverse total shoulder arthroplasty: Biomechanics and indications. Curr Rev Musculoskelet Med 2019;12(4):542-53. https://doi.org/10.1007/s12178-019-09586-y
21. Rossi LA, Tanoira I, Ranalletta M, Kunze KN, Farivar D, Perry A, et al. Cemented vs. uncemented reverse shoulder arthroplasty for proximal humeral fractures: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022;31(3):e101-e119. https://doi.org/10.1016/j.jse.2021.10.011
22. Blaas LS, Yuan JZ, Lameijer CM, van de Ven PM, Bloemers FW, Derksen RJ. Surgical learning curve in reverse
shoulder arthroplasty for proximal humerus fractures. JSES Int 2021;5(6):1034-41.
https://doi.org/10.1016/j.jseint.2021.07.008