Abstract
Purpose
The aim of this study is to report the clinical and radiological results of reverse total shoulder arthroplasty (rTSA) in elderly patients who have been treated for complex humeral fractures.
Materials and methods
From January 2005 to December 2014, we have implanted rTSA for proximal humeral fractures in 95 patients (80 womens, 15 mens) about 75 years old on average (range 62–95 years). All rates and results on intraoperative and postoperative complications have been collected in a specific database. In all cases we have used a modular implant prosthesis (Lima Corporate, San Daniele del Friuli, Italy). The prosthesis was implanted cementless in 92 cases. Because of the presence of a high percentage of comorbidities in the elderly patients, we have retrospectively analyzed the necessity of a secondary hospitalization, from a week to a 6-month time after the discharge, due to general health problems and specific postoperative shoulder complications. The mean follow-up was 5 years (range 1–9 years) for 70 of 95 patients, 50 of whom had adequate radiographic controls.
Results
None of 95 patients has required a reoperation or a hospitalization for general health problems from 1 week to 6 months postoperative. No early or late infection of prosthesis has been observed. There were seven cases of perioperative complications, three humeral vertical bone fissuring, two glenoid fractures and two cases of deltoid muscle damage. We have had three cases of postoperative hematoma and one case of ulnar nerve neuropathy. The mean constant score was 85.4, and the mean simple shoulder test was 7.4. We have observed a grade 1 scapular notching in 15 cases (30 %). In the remaining 35 reviewed cases, there was no notching. Peri-articular heterotopic ossifications were found in 11 cases (22 %).
Conclusion
Reverse shoulder prosthesis in complex humeral fractures in the elderly can be considered as a reliable surgical procedure, which leads to very good clinical and radiological results in case of cementless prosthesis, as well.
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References
Robinson CM, Page RS (2003) Severely impacted valgus proximal humeral fractures. Results of operative treatment. J Bone Joint Surg Am 85-A:1647–1655
Neer CS (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 52:1077–1089
Handoll HH, Ollivere BJ, Rollins KE (2012) Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev 12:CD000434
Russo R, Cautiero F, Della Rotonda G (2012) The classification of complex 4-part humeral fractures revisited: the missing fifth fragment and indications for surgery. Musculoskelet Surg 96(Suppl 1):S13–S19
Hatzidakis AM, Norris TR, Boileau P (2007) Reverse shoulder arthroplasty indications, technique, and results. Tech Shoulder Elbow Surg 16:e55
Sershon RA, Van Thiel GS, Lin EC, McGill KC, Cole BJ, Verma NN, Romeo AA, Nicholson GP (2014) Clinical outcomes of reverse total shoulder arthroplasty in patients aged younger than 60 years. J Shoulder Elbow Surg 23:395–400
Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 8:599–605
Brems JJ (2002) Shoulder arthroplasty in the face of acute fracture: puzzle pieces. J Arthroplasty 17(4 Suppl 1):32
Ciccarelli M, Russo R, Della Rotonda G, Cautiero F (2013) The “Bone-Collar-and-Tie” (BCAT). J Bone J Surg Br 93(II):202
Constant CR, Murley AHG (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164
Valenti PH, Boutens D, Nerot C (2001) 2000 shoulder prostheses: two to ten year follow-up. In: Walch G, Boileau P, Molé D (eds.), Montpellier, Paris, France: Sauramps Medical. Delta 3 reversed prosthesis for osteoarthritis with massive rotator cuff tear: long term results. pp 253–259
Grammont PM, Baulot E (1993) Delta shoulder prosthesis for rotator cuff rupture. Orthopedics 16:65–68
Ross M, Hope B, Stokes A, Peters SE, McLeod I, Duke PF (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
Jobin CM, Galdi B, Anakwenze OA, Ahmad CS, Levine WN (2015) Reverse shoulder arthroplasty for the management of proximal humerus fractures. J Am Acad Orthop Surg 23(3):190–201
Cazeneuve JF, Cristofari DJ (2014) Grammont reversed prosthesis for acute complex fracture of the proximal humerus in an elderly population with 5 to 12 years follow-up. Orthop Traumatol Surg Res 100(1):93–97
Groh GI, Groh GM (2014) Complications rates, reoperation rates and the learning curve in reverse shoulder arthroplasty. J Shoulder Elbow Surg 23:388–394
Walch G, Wall B, Mottier F (2006) Complications and revision of the reverse prosthesis, a multicenter study of 457 cases. In: Walch G, Boileau P, Molè D, Favard L, Lévigne C, Sirveaux F (eds) Reverse shoulder arthroplasty. Sauramp Medical, Montpellier, pp 335–352
Gillespie RJ, Garrigues GE, Chang ES, Namdari S, Williams GR Jr (2015) Surgical exposure for reverse total shoulder arthroplasty: differences in approaches and outcomes. Orthop Clin North Am 46(1):49–56
Molé D, Wein F, Dézaly C, Valenti P, Sirveaux F (2011) Surgical technique: the anterosuperior approach for reverse shoulder arthroplasty. Clin Orthop Relat Res 469(9):2461–2468
Russo R, Lombardi LV, Cautiero F, Giudice G, Ciccarelli M (2008) Medial reconstruction technique in the treatment of complex fractures of humeral proximal epiphysis with SMR prosthetic modular system. Chir Organi Mov 91(2):117–123
Nowinski RJ, Gillespie RJ, Shishani Y, Cohen B, Walch G, Gobezie R (2012) Antibiotic-loaded bone cement reduce deep infection rates for primary reverse total shoulder arthroplasty: a retrospective, cohort study of 501 shoulders. J Shoulder Elbow Surg 21:324–328
Cheung EV, Sperling JW, Cofield RH (2008) Infection associated with hematoma formation after shoulder arthroplasty. Clin Orthop Relat Res 466:1363–1367
Brown NM, Cipriano CA, Moric M, Sporer SM, Della Valle CJ (2012) Diluite betadine lavage before closure for the prevention of acute postoperative deep periprosthetic joint infection. J Arthroplasty 27:27–30
Boileau P, Melis B, Duperron D, Moineau G, Rumian AP, Han Y (2013) Revision surgery of reverse shoulder arthroplasty. J Shoulder Elbow Surg 22(10):1359–1370
Brorson S, Rasmussen JV, Olsen BS, Frich LH, Jensen SL, Hróbjartsson A (2013) Reverse shoulder arthroplasty in acute fractures of the proximal humerus: a systematic review. Int J Shoulder Surg 7:70–78
Budge MD, Moravek JE, Zimel MN, Nolan EM, Wiater JM (2013) Reverse total shoulder arthroplasty for the management of failed shoulder arthroplasty with proximal humeral bone loss: is allograft augmentation necessary? J Shoulder Elbow Surg 22(6):739–744
Langohr GD, Giles JW, Athwal GS, Johnson JA (2014) The effect of glenosphere diameter in reverse shoulder arthroplasty on muscle force, joint load, and range of motion. J Shoulder Elbow Surg (in press)
De Biase CF, Delcogliano M, Borroni M, Castagna A (2012) Reverse total shoulder arthroplasty: radiological and clinical result using an eccentric glenosphere. Musculoskelet Surg 96(Suppl 1):S27–S34
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Russo, R., Della Rotonda, G., Cautiero, F. et al. Reverse shoulder prosthesis to treat complex proximal humeral fractures in the elderly patients: results after 10-year experience. Musculoskelet Surg 99 (Suppl 1), 17–23 (2015). https://doi.org/10.1007/s12306-015-0367-y
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DOI: https://doi.org/10.1007/s12306-015-0367-y