Journal Article

Mid- to long-term outcome of reverse total shoulder arthroplasty as revision procedure for failed hemiarthroplasty after proximal humerus fracture

Akgün, Doruk, Scheibel, Markus, Lacheta, Lucca, Paksoy, Alp, Gebauer, Henry, Hayta, Agahan, Imiolczyk, Jan-Philipp, Moroder, Philipp

2024

Overview

Background Insufficient tuberosity healing is the most common reason for poor outcome after treatment of proximal humerus fractures (PHFs) using hemiarthroplasty (HA). In these cases, revision to reverse total shoulder arthroplasty (RTSA) can improve function and reduce pain in the short term, however, long-term results remain scarce. Aim of this study was to evaluate the clinical and radiological mid- to long-term results in patients with a revision RTSA after failed HA for PHF. Methods In this retrospective study all patients that received a revision to RTSA after failed fracture HA between 2006 and 2018 were included. A total of 49 shoulders in 48 patients (38 female, 10 male; mean age 82 ± 9 years) were identified in our database. A total of 20 patients (17 female, 3 male; mean age was 79 ± 9 years) were available for follow-up examination after a mean time period of approximately eight years (3–14 years) after revision surgery. At final follow-up, patients were assessed using a subjective shoulder value (SSV), range of motion (ROM), visual analogue score (VAS), the Constant Score (CS) and the 12-Item Short Form Survey (SF-12). Results At final follow-up, mean CS was 55 ± 19 (19–91), VAS averaged 3 ± 3 (0–8) and mean SSV was 61 ± 18% (18–90%). Mean SF-12 was 44 (28–57) with a mean physical component summary (PCS) of 38 (21–56) and a mean mental component summary (MCS) of 51 (29–67). On average active forward flexion (FF) was 104° (10–170°), active abduction (ABD) was 101° (50–170°), active external rotation (ER) was 19° (10–30°) and active internal rotation (IR) of the lumbosacral transition was reached. Three patients presented with a periprosthetic humeral fracture after RTSA implantation and underwent a reoperation (15%) during follow-up period. Conclusions Revision RTSA results in promising clinical results in patients after initial failed HA after PHF. A complication and reoperation rate of 15% is tolerable in consideration of satisfactory functional and psychological outcome. Trial registration Retrospectively registered.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Aged, 80 and over / Antibiotics / Arthroplasty / Arthroplasty, Replacement, Shoulder - methods / Bone healing / Care and treatment / Debridement / Epidemiology / Female / Follow-Up Studies / Fracture fixation / Fractures / Hemiarthroplasty / Hemiarthroplasty - methods / Humans / Humerus / Infection / Internal Medicine / Joint replacement surgery / Long-term follow-up / Male / Medicine / Medicine & Public Health / Methods / Motion detection / Orthopedics / Patient outcomes / Patients / Proximal humerus fracture / Range of Motion, Articular / Rehabilitation / Reoperation / Retrospective Studies / Reverse shoulder arthroplasty / Revision / Rheumatology / Rotator cuff / Shoulder / Shoulder and elbow pathologies / Shoulder Fractures - diagnostic imaging / Shoulder Fractures - surgery / Shoulder injuries / Shoulder Joint - diagnostic imaging / Shoulder Joint - physiopathology / Shoulder Joint - surgery / Shoulder replacement arthroplasty / Sports Medicine / Transplants & implants / Treatment Failure / Treatment Outcome