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

Eur J Orthop Surg Traumatol. 2020 Jul;30(5):909-916. doi: 10.1007/s00590-020-02649-8. Epub 2020 Mar 11.


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.

Keywords: 135°; Glenosphere design; Humeral inclination; Inferior notching; Primary reverse shoulder arthroplasty; Proximal humeral fracture; Tuberosity healing.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Shoulder / adverse effects
  • Arthroplasty, Replacement, Shoulder / methods*
  • Female
  • Follow-Up Studies
  • Fracture Healing
  • Humans
  • Humerus / injuries
  • Humerus / physiopathology*
  • Male
  • Postoperative Complications / etiology
  • Range of Motion, Articular
  • Reoperation
  • Retrospective Studies
  • Shoulder Fractures / surgery*
  • Shoulder Joint / physiopathology*
  • Shoulder Joint / surgery
  • Shoulder Prosthesis