Skip to main content
SpringerLink
Log in

Reverse shoulder arthroplasty for proximal humeral fracture in the elderly. Cemented or uncemented stem?

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Objective

The purposes of this study were to compare functional outcomes, radiographic stem changes and complication rate in patients with proximal humeral fractures operated with cemented or uncemented RSA.

Methods

Retrospective review of 68 primary RSAs in PHF, 45 cemented/23 uncemented. Functional outcomes were evaluated according to constant, ASES scales and the range of motion (ROM). Radiographic assessment was performed at a minimum of two years post-operatively.

Results

The mean follow-up cemented/uncemented was 37.8/26.5 months (p = .04) and the mean age 78/80 years old (p = .09). The functional outcome and range of movement were equivalent in the two groups except for the forward flexion that was significantly higher in the cemented group (p = .03). Stress shielding was seen in 30.4% of uncemented group and none in the cemented. Anatomic tuberosity healing was significantly higher with uncemented components compared with cemented components (64% vs 91%, p = .02). Cemented stems had radiolucent lines with a width of 2 mm or more in three or more Gruen zones in 9% vs 0% in the uncemented group and an evident change in the stem position was present in 4% vs 0% in the non-cemented group.

Conclusion

At mid-term follow-up, no differences in functional outcomes were detected depending on the stem fixation technique. Cemented stems, however, have a complication rate (including stem loosening) significantly higher than press-fit stems.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

All the material and data are available for consultation and we ensure their transparency.

References

  1. Kim SH, Szabo RM, Marder RA (2012) Epidemiology of humerus fractures in the United States: nationwide emergency department sample, 2008. Arthritis Care Res (Hoboken) 64(3):407–414. https://doi.org/10.1002/acr.21563

    Article  Google Scholar 

  2. Palvanen M, Kannus P, Niemi S, Parkkari J (2006) Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 442:87–92. https://doi.org/10.1097/01.blo.0000194672.79634.78

    Article  PubMed  Google Scholar 

  3. Namdari S, Voleti PB, Mehta S (2012) Evaluation of the osteoporotic proximal humeral fracture and strategies for structural augmentation during surgical treatment. J Shoulder Elbow Surg 21(12):1787–1795. https://doi.org/10.1016/j.jse.2012.04.003

    Article  PubMed  Google Scholar 

  4. Litchfield RB, McKee MD, Balyk R, Mandel S, Holtby R, Hollinshead R et al (2011) Cemented versus uncemented fixation of humeral components in total shoulder arthroplasty for osteoarthritis of the shoulder: a prospective, randomized, double-blind clinical trial-A JOINTs Canada Project. J Shoulder Elbow Surg 20(4):529–536. https://doi.org/10.1016/j.jse.2011.01.041

    Article  PubMed  Google Scholar 

  5. Brolin TJ, Cox RM, Horneff Iii JG, Namdari S, Abboud JA, Nicholson K et al (2020) Humeral-sided radiographic changes following reverse total shoulder arthroplasty. Arch Bone Jt Surg 8(1):50–57. https://doi.org/10.22038/abjs.2019.36065.1951

    Article  PubMed  PubMed Central  Google Scholar 

  6. Gorman RA, Christmas KN, Simon P, Mighell MA, Frankle MA (2021) A cohort comparison of humeral implant designs in reverse shoulder arthroplasty: does implant design lead to lower rates of complications and revision? J Shoulder Elbow Surg 30(4):850–857. https://doi.org/10.1016/j.jse.2020.07.031

    Article  PubMed  Google Scholar 

  7. Mazaleyrat M, Favard L, Garaud P, Boileau P, Berhouet J (2021) Press-fit vs. cemented humeral stem fixation for reverse shoulder arthroplasty: functional outcomes at a mean follow-up of 9.5 years. J Shoulder Elbow Surg 30(1):72–79. https://doi.org/10.1016/j.jse.2020.04.052

    Article  PubMed  Google Scholar 

  8. Melis B, DeFranco M, Lädermann A, Molé D, Favard L, Nérot C et al (2011) An evaluation of the radiological changes around the Grammont reverse geometry shoulder arthroplasty after eight to 12 years. J Bone Joint Surg Br 93(9):1240–1246. https://doi.org/10.1302/0301-620X.93B9.25926

    Article  CAS  PubMed  Google Scholar 

  9. Salesky MA, Grace TR, Feeley BT, Ma CB, Zhang AL (2018) Effects of cemented versus press-fit primary humeral stem fixation in the setting of revision shoulder arthroplasty. J Shoulder Elbow Surg 27(5):801–807. https://doi.org/10.1016/j.jse.2017.11.010

    Article  PubMed  Google Scholar 

  10. Wiater BP, Baker EA, Salisbury MR, Koueiter DM, Baker KC, Nolan BM et al (2015) Elucidating trends in revision reverse total shoulder arthroplasty procedures: a retrieval study evaluating clinical, radiographic, and functional outcomes data. J Shoulder Elbow Surg 24(12):1915–1925. https://doi.org/10.1016/j.jse.2015.06.004

    Article  PubMed  Google Scholar 

  11. Schoch B, Aibinder W, Walters J, Sperling J, Throckmorton T, Sanchez-Sotelo J et al (2019) Outcomes of uncemented versus cemented reverse shoulder arthroplasty for proximal humerus fractures. Orthopedics 42(2):e236–e241. https://doi.org/10.3928/01477447-20190125-03

    Article  PubMed  Google Scholar 

  12. Rossi LA, Guillermina BM, Buljubasich M, Atala N, Tanoira I, Bongiovanni S, Ranalletta M (2021) Cemented vs uncemented reverse shoulder arthroplasty for acute proximal humeral fractures. J Shoulder Elbow Surg S1058–2746(21):00578–4. https://doi.org/10.1016/j.jse.2021.06.022

    Article  Google Scholar 

  13. Gruen TA, McNeice GM, Amstutz HC (1979) “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 141:17–27

    Google Scholar 

  14. Raiss P, Edwards TB, Deutsch A, Shah A, Bruckner T, Loew M et al (2014) Radiographic changes around humeral components in shoulder arthroplasty. J Bone Joint Surg Am 96(7):e54. https://doi.org/10.2106/JBJS.M.00378

    Article  PubMed  Google Scholar 

  15. Sanchez-Sotelo J, O’Driscoll SW, Torchia ME, Cofield RH, Rowland CM (2001) Radiographic assessment of cemented humeral components in shoulder arthroplasty. J Shoulder Elbow Surg 10(6):526–531. https://doi.org/10.1067/mse.2001.118482

    Article  CAS  PubMed  Google Scholar 

  16. Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Molé D (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 Joint Surg Br 86(3):388–395. https://doi.org/10.1302/0301-620x.86b3.14024

    Article  CAS  PubMed  Google Scholar 

  17. Zeckey C, Hildebrand F, Frink M, Krettek C (2011) Heterotopic ossifications following implant surgery–epidemiology, therapeutical approaches and current concepts. Semin Immunopathol 33(3):273–286. https://doi.org/10.1007/s00281-011-0240-5

    Article  PubMed  Google Scholar 

  18. Denard PJ, Haidamous G, Gobezie R, Romeo AA, Lederman E (2020) Short-term evaluation of humeral stress shielding following reverse shoulder arthroplasty using press-fit fixation compared with cemented fixation. J Shoulder Elbow Surg 29(5):906–912. https://doi.org/10.1016/j.jse.2019.09.042

    Article  PubMed  Google Scholar 

  19. Gilot G, Alvarez-Pinzon AM, Wright TW, Flurin P-H, Krill M, Routman HD et al (2015) The incidence of radiographic aseptic loosening of the humeral component in reverse total shoulder arthroplasty. J Shoulder Elbow Surg 24(10):1555–1559. https://doi.org/10.1016/j.jse.2015.02.007

    Article  PubMed  Google Scholar 

  20. Leonidou A, Virani S, Buckle C, Yeoh C, Relwani J (2020) Reverse shoulder arthroplasty with a cementless short metaphyseal humeral prosthesis without a stem: survivorship, early to mid-term clinical and radiological outcomes in a prospective study from an independent centre. Eur J Orthop Surg Traumatol 30(1):89–96. https://doi.org/10.1007/s00590-019-02531-2

    Article  PubMed  Google Scholar 

  21. Wiater JM, Moravek JE, Budge MD, Koueiter DM, Marcantonio D, Wiater BP (2014) Clinical and radiographic results of cementless reverse total shoulder arthroplasty: a comparative study with 2 to 5 years of follow-up. J Shoulder Elbow Surg 23(8):1208–1214. https://doi.org/10.1016/j.jse.2013.11.032

    Article  PubMed  Google Scholar 

  22. Lo EY, Rizkalla J, Montemaggi P, Majekodunmi T, Krishnan SG (2021) Clinical and radiographic outcomes of cementless reverse total shoulder arthroplasty for proximal humeral fractures. J Shoulder Elbow Surg 30(8):1949–1956. https://doi.org/10.1016/j.jse.2020.11.009

    Article  PubMed  Google Scholar 

  23. Phadnis J, Huang T, Watts A, Krishnan J, Bain GI (2016) Cemented or cementless humeral fixation in reverse total shoulder arthroplasty? A systematic review. Bone Joint J 98-B(1):65–74. https://doi.org/10.1302/0301-620X.98B1.36336

    Article  CAS  PubMed  Google Scholar 

  24. Ross M, Hope B, Stokes A, Peters SE, McLeod I, Duke PFR (2015) Reverse shoulder arthroplasty for the treatment of three-part and four-part proximal humeral fractures in the elderly. J Shoulder Elbow Surg 24(2):215–222. https://doi.org/10.1016/j.jse.2014.05.022

    Article  PubMed  Google Scholar 

  25. Sebastiá-Forcada E, Cebrián-Gómez R, Lizaur-Utrilla A, Gil-Guillén V (2014) Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study. J Shoulder Elbow Surg 23(10):1419–1426. https://doi.org/10.1016/j.jse.2014.06.035

    Article  PubMed  Google Scholar 

  26. Wright JO, Ho A, Kalma J, Koueiter D, Esterle J, Marcantonio D et al (2019) Uncemented reverse total shoulder arthroplasty as initial treatment for comminuted proximal humerus fractures. J Orthop Trauma 33(7):e263–e269. https://doi.org/10.1097/BOT.0000000000001465

    Article  PubMed  Google Scholar 

  27. Youn S-M, Deo S, Poon PC (2016) Functional and radiologic outcomes of uncemented reverse shoulder arthroplasty in proximal humeral fractures: cementing the humeral component is not necessary. J Shoulder Elbow Surg 25(4):e83-89. https://doi.org/10.1016/j.jse.2015.09.007

    Article  PubMed  Google Scholar 

  28. Jain NP, Mannan SS, Dharmarajan R, Rangan A (2019) 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 28(3):e78–e91. https://doi.org/10.1016/j.jse.2018.09.006

    Article  PubMed  Google Scholar 

  29. Cuff DJ, Pupello DR (2013) Comparison of hemiarthroplasty and reverse shoulder arthroplasty for the treatment of proximal humeral fractures in elderly patients. J Bone Joint Surg Am 95(22):2050–2055. https://doi.org/10.2106/JBJS.L.01637

    Article  PubMed  Google Scholar 

  30. Chun Y-M, Kim D-S, Lee D-H, Shin S-J (2017) Reverse shoulder arthroplasty for four-part proximal humerus fracture in elderly patients: can a healed tuberosity improve the functional outcomes? J Shoulder Elbow Surg 26(7):1216–1221. https://doi.org/10.1016/j.jse.2016.11.034

    Article  PubMed  Google Scholar 

  31. Nagels J, Stokdijk M, Rozing PM (2003) Stress shielding and bone resorption in shoulder arthroplasty. J Shoulder Elbow Surg 12(1):35–39. https://doi.org/10.1067/mse.2003.22

    Article  PubMed  Google Scholar 

  32. Harmsen SM, Norris TR (2017) Radiographic changes and clinical outcomes associated with an adjustable diaphyseal press-fit humeral stem in primary reverse shoulder arthroplasty. J Shoulder Elbow Surg 26(9):1589–1597. https://doi.org/10.1016/j.jse.2017.02.006

    Article  PubMed  Google Scholar 

  33. Raiss P, Schnetzke M, Wittmann T, Kilian CM, Edwards TB, Denard PJ et al (2019) Postoperative radiographic findings of an uncemented convertible short stem for anatomic and reverse shoulder arthroplasty. J Shoulder Elbow Surg 28(4):715–723. https://doi.org/10.1016/j.jse.2018.08.037

    Article  PubMed  Google Scholar 

  34. Sumner DR, Galante JO (1992) Determinants of stress shielding: design versus materials versus interface. Clin Orthop Relat Res 274:202–212

    Article  Google Scholar 

  35. Bogle A, Budge M, Richman A, Miller RJ, Wiater JM, Voloshin I (2013) Radiographic results of fully uncemented trabecular metal reverse shoulder system at 1 and 2 years’ follow-up. J Shoulder Elbow Surg 22(4):e20-25. https://doi.org/10.1016/j.jse.2012.08.019

    Article  PubMed  Google Scholar 

  36. Grey B, Rodseth RN, Roche SJ (2018) Humeral stem loosening following reverse shoulder arthroplasty: a systematic review and meta-analysis. JBJS Rev 6(5):e5. https://doi.org/10.2106/JBJS.RVW.17.00129

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Yaiza Lopiz and Carlos García-Fernandez contributed equally to this work

Authors and Affiliations

  1. Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, 5º Planta, Ala Sur. Calle Profesor Martín Lagos S/N, 28004, Madrid, Spain

    Yaiza Lopiz, Carlos García-Fernandez, María Vallejo-Carrasco, Daniel Garriguez-Pérez, Loreto Achaerandio, Carmen Tesoro-Gonzalo & Fernando Marco

  2. Department of Surgery, Complutense University, Madrid, Spain

    Yaiza Lopiz & Fernando Marco

Authors
  1. Yaiza Lopiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlos García-Fernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. María Vallejo-Carrasco
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel Garriguez-Pérez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Loreto Achaerandio
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carmen Tesoro-Gonzalo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fernando Marco
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yaiza Lopiz.

Ethics declarations

Ethical approval

Institutional Review Board (IRB) “Ethics Committee for Clinical Research” (CEIC) from Clínico San Carlos Hospital (Madrid, Spain) approve the present study (19/418-E_TFG).

Consent to publish and consent to participate

Consent to publish and consent to participate were obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Level of evidence: Level III

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lopiz, Y., García-Fernandez, C., Vallejo-Carrasco, M. et al. Reverse shoulder arthroplasty for proximal humeral fracture in the elderly. Cemented or uncemented stem?. International Orthopaedics (SICOT) 46, 635–644 (2022). https://doi.org/10.1007/s00264-021-05284-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-021-05284-y

Keywords

Search

Navigation