Outcomes of Reverse Total Shoulder Arthroplasty for Proximal Humeral Fractures: Primary Arthroplasty Versus Secondary Arthroplasty After Failed Proximal Humeral Locking Plate Fixation

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Abstract

Objective:

To compare the outcomes of reverse shoulder arthroplasty (RSA) between patients with failed proximal humeral locking plate (PHLP) fixation and those with acute fractures.

Design:

Matched case–control study.

Setting:

University hospital, Level I trauma center.

Patients:

Thirty consecutive patients with fracture sequelae because of failed PHLP fixation (mean age 73) were age and sex matched to 30 patients with acute fracture (mean age 75).

Intervention:

All patients underwent RSA.

Main Outcome Measurements:

Constant, University of California Los Angeles (UCLA) and Disability of the Arm, Shoulder and Hand (DASH) scores. Radiological assessments were also performed.

Results:

The mean postoperative follow-up was 3.2 (range, 2–5) years. All functional scores significantly improved from preoperative to postoperative (P = 0.001) in the sequelae group. Pain was relieved in all but one patient, and all but 2 patients were satisfied with their RSA. However, the functional outcomes at the last follow-up were significantly worse in the sequelae group compared with acute group in terms of adjusted Constant (P = 0.013), UCLA (P = 0.020) and DASH (P = 0.048) scores, strength (P = 0.01), anterior forward (P = 0.021), and abduction (P = 0.007). Six patients (20%) in the sequelae group had complications including 2 intraoperative (diaphyseal false passages), 2 early dislocations, 1 acromial fracture, and 1 aseptic loosening of glenoid component. Four of these patients were revised resulting all in a successful outcome at the last follow-up. In the acute group there was one intraoperative humeral fracture with no impact on the final outcome.

Conclusions:

Patients with failed PHLP fixation for fracture who were revised to RSA secondarily obtained marginally lower functional scores and higher complication rates compared with patients treated with primary RSA for fracture. However, patients who treated with secondary RSA had significant functional improvement and pain relief compared with their preoperative status, and most complications were manageable without a significant effect on final outcome.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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