Archives of Orthopaedic and Trauma Surgery

, Volume 134, Issue 6, pp 755–764 | Cite as

The metaphyseal bone defect predicts outcome in reverse shoulder arthroplasty for proximal humerus fracture sequelae

  • Stefan GreinerEmail author
  • Stephan Uschok
  • Sebastian Herrmann
  • Clemens Gwinner
  • Carsten Perka
  • Markus Scheibel
Orthopaedic Surgery


Reverse shoulder arthroplasty (RSA) represents an established procedure for treatment of fracture sequelae (FS) after proximal humerus fractures. The present work evaluates which factors are of influence for the clinical outcome. Fifty cases (mean age 69, range 44–89) have been evaluated postoperatively clinically [Constant Score (CS)] and radiographically (mean FU 34; range 24–93 months). The type of primary treatment, the amount of a metaphyseal bone defect, the preoperative status of the rotator cuff, the number of previous operative interventions and the type of FS according to Boileau were analysed whether they are of influence for clinical outcome. The mean CS increased significantly from 16.9 ± 6.7 preoperatively to 54.1 ± 15.7 points postoperatively. The CS of primary conservative treatment was significantly higher in comparison to primary operative treatment. Patients with a metaphyseal bone defect of more than 3 cm had significantly lower CS results. Degenerative changes of the teres minor muscle also had a significant negative influence on clinical results. Score results decreased with increasing number of previous operations. There were no significant difference in between patients classified as Boileau type I and II (category 1) compared to types III and IV (category 2). RSA significantly improved the clinical result. A metaphyseal bone defect and preoperative degeneration of the teres minor showed to be negative prognostic factors. Primary operative treatment and the number of previous operations also negatively influenced the clinical result.


Proximal humerus Bone defect Reversed shoulder arthroplasty Fracture sequelae 


Conflict of interest



  1. 1.
    Wall B, Nové-Josserand L, O’Connor DP et al (2007) Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Jt Surg Am 89:1476–1485. doi: 10.2106/JBJS.F.00666 CrossRefGoogle Scholar
  2. 2.
    Kılıç M, Berth A, Blatter G et al (2010) Anatomic and reverse shoulder prostheses in fracture sequelae of the humeral head. Acta Orthop Traumatol Turc 44:417–425PubMedCrossRefGoogle Scholar
  3. 3.
    Martinez AA, Bejarano C, Carbonel I et al (2012) The treatment of proximal humerus nonunions in older patients with the reverse shoulder arthroplasty. Injury. doi: 10.1016/j.injury.2011.12.015 Google Scholar
  4. 4.
    Martinez AA, Calvo A, Bejarano C et al (2012) The use of the Lima reverse shoulder arthroplasty for the treatment of fracture sequelae of the proximal humerus. J Orthop Sci. doi: 10.1007/s00776-011-0185-5 PubMedGoogle Scholar
  5. 5.
    Austin L, Zmistowski B, Chang ES, Williams GR (2011) Is reverse shoulder arthroplasty a reasonable alternative for revision arthroplasty? Clin Orthop Relat Res 469:2531–2537. doi: 10.1007/s11999-010-1685-x PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Kelly JD, Zhao JX, Hobgood ER, Norris TR (2012) Clinical results of revision shoulder arthroplasty using the reverse prosthesis. J Shoulder Elb Surg. doi: 10.1016/j.jse.2011.11.021 Google Scholar
  7. 7.
    Patel DN, Young B, Onyekwelu I et al (2012) Reverse total shoulder arthroplasty for failed shoulder arthroplasty. J Shoulder Elb Surg. doi: 10.1016/j.jse.2011.11.004 Google Scholar
  8. 8.
    Levy J, Frankle M, Mighell M, Pupello D (2007) The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture. J Bone Jt Surg Am 89:292–300. doi: 10.2106/JBJS.E.01310 CrossRefGoogle Scholar
  9. 9.
    Lollino N, Paladini P, Campi F et al (2009) Reverse shoulder prosthesis as revision surgery after fractures of the proximal humerus, treated initially by internal fixation or hemiarthroplasty. Chir Organi Mov 93(Suppl 1):S35–S39. doi: 10.1007/s12306-009-0006-6 PubMedGoogle Scholar
  10. 10.
    Boileau P, Trojani C, Walch G et al (2001) Shoulder arthroplasty for the treatment of the sequelae of fractures of the proximal humerus. J Shoulder Elb Surg 10:299–308. doi: 10.1067/mse.2001.115985 CrossRefGoogle Scholar
  11. 11.
    Goutallier D, Postel JM, Bernageau J, et al. (1994) Fatty muscle degeneration in cuffruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83Google Scholar
  12. 12.
    Fuchs B, Weishaupt D, Zanetti M et al (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elb Surg 8:599–605CrossRefGoogle Scholar
  13. 13.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164Google Scholar
  14. 14.
    Germann G, Harth A, Wind G, Demir E (2003) Standardisation and validation of the German version 2.0 of the Disability of Arm, Shoulder, Hand (DASH) questionnaire. Unfallchirurg 106:13–19. doi: 10.1007/s00113-002-0456-x PubMedCrossRefGoogle Scholar
  15. 15.
    Germann G, Wind G, Harth A (1999) The DASH (Disability of Arm-Shoulder-Hand) Questionnaire—a new instrument for evaluating upper extremity treatment outcome. Handchir Mikrochir Plast Chir 31:149–152. doi: 10.1055/s-1999-13902 PubMedCrossRefGoogle Scholar
  16. 16.
    Chacon A, Virani N, Shannon R et al (2009) Revision arthroplasty with use of a reverse shoulder prosthesis-allograft composite. J Bone Jt Surg 91:119–127. doi: 10.2106/JBJS.H.00094 CrossRefGoogle Scholar
  17. 17.
    Melis B, DeFranco MJ, Lädermann A et al (2011) The teres minor muscle in rotator cuff tendon tears. Skelet Radiol 40:1335–1344. doi: 10.1007/s00256-011-1178-3 CrossRefGoogle Scholar
  18. 18.
    Boileau P, Watkinson D, Hatzidakis AM, Hovorka I (2006) Neer Award 2005: the Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elb Surg 15:527–540. doi: 10.1016/j.jse.2006.01.003 CrossRefGoogle Scholar
  19. 19.
    Simovitch RW, Helmy N, Zumstein MA, Gerber C (2007) Impact of fatty infiltration of the teres minor muscle on the outcome of reverse total shoulder arthroplasty. J Bone Jt Surg 89:934–939. doi: 10.2106/JBJS.F.01075 CrossRefGoogle Scholar
  20. 20.
    Sirveaux F, Favard L, Oudet D et al (2004) 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 Jt Surg Br 86:388–395CrossRefGoogle Scholar
  21. 21.
    Gohlke F, Rolf O (2007) Revision of failed fracture hemiarthroplasties to reverse total shoulder prosthesis through the trans humeral approach: method incorporating a pectoralis-major-pedicled bone window. Oper Orthop Traumatol 19:185–208. doi: 10.1007/s00064-007-1202-x PubMedCrossRefGoogle Scholar
  22. 22.
    Werner CML, Steinmann PA, Gilbart M, Gerber C (2005) Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Jt Surg Am 87:1476–1486. doi: 10.2106/JBJS.D.02342 CrossRefGoogle Scholar
  23. 23.
    Favard L, Levigne C, Nerot C et al (2011) Reverse prostheses in arthropathies with cuff tear: are survivorship and function maintained over time? Clin Orthop Relat Res 469:2469–2475. doi: 10.1007/s11999-011-1833-y PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Stefan Greiner
    • 2
    Email author
  • Stephan Uschok
    • 1
  • Sebastian Herrmann
    • 1
  • Clemens Gwinner
    • 1
  • Carsten Perka
    • 1
  • Markus Scheibel
    • 1
  1. 1.Center for Musculoskeletal SurgeryCharité University Medicine BerlinBerlinGermany
  2. 2.Sporthopaedicum Regensburg, Shoulder and ElbowRegensburgGermany

Personalised recommendations