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Tuberosity healing improves functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

Reverse shoulder arthroplasty (RSA) is a common treatment for proximal humeral fractures (PHFs) in the elderly. This study evaluates the influence of tuberosity healing (TH) on functional outcome following a 135° humeral inclination RSA for PHFs.

Methods

Retrospectively, all patients with an acute PHF treated with a 135° humeral inclination RSA at four centers during a three-year period were followed up. Constant score (CS), TH and glenoid notching were analyzed.

Results

Sixty-four of 100 patients (64%) with a mean age of 76 ± 7 years were available for follow-up at 22 ± 8 months. The mean-adjusted CS was 72%. TH of the greater tuberosity (GT) was 77% and resulted in significantly improved forward flexion (128° vs. 92°; p = 0.003), external rotation (33° vs. 17°; p = 0.03) and adjusted CS (78% vs. 54%, p < 0.005). GT healing rate was 86% with neutral, 70% with lateralized and 33% with an inferior eccentric glenosphere. TH of the lesser tuberosity was 79%. There was 8% complication and 3% revision rate; implant survival was 100%.

Conclusion

RSA with 135° humeral inclination for PHFs leads to good functional outcome, reproducible results and a high rate of TH. The short-term revision rate is low. TH is associated with improved ROM and functional outcome.

Level of evidence

III.

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Funding

This work was supported by Arthrex. Drs. Lehmann, Cohen, Steinbeck and Denard are consultants for Arthrex, Inc.

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Authors and Affiliations

  1. Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Teaching Hospital Albert-Ludwigs-University Freiburg, Suedendstraße 32, 76137, Karlsruhe, Germany

    Jonas Schmalzl, Malik Jessen & Lars-Johannes Lehmann

  2. University Mannheim, Mannheim, Germany

    Lars-Johannes Lehmann

  3. Adena Bone and Joint Center, Chillicothe, OH, USA

    Brian C. Cohen

  4. Orthopedic Practice Clinic (OPPK), Muenster, Germany

    Malte Holschen & Jörn Steinbeck

  5. Southern Oregon Orthopedics, Medford, OR, USA

    Patrick J. Denard

  6. Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA

    Patrick J. Denard

Authors
  1. Jonas Schmalzl
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  2. Malik Jessen
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  3. Malte Holschen
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  4. Brian C. Cohen
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  5. Jörn Steinbeck
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  6. Lars-Johannes Lehmann
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  7. Patrick J. Denard
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Correspondence to Jonas Schmalzl.

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Schmalzl, J., Jessen, M., Holschen, M. et al. Tuberosity healing improves functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis. Eur J Orthop Surg Traumatol 30, 909–916 (2020). https://doi.org/10.1007/s00590-020-02649-8

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  • DOI: https://doi.org/10.1007/s00590-020-02649-8

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