Reverse shoulder arthroplasty with tuberosity healing after proximal humeral fractures and rotator cuff arthropathy: similar functional outcomes and complications in patients after 10 years follow-up

Abstract

Background: The purpose of this study was to compare the functional outcomes, complications, and revision rates of reverse total shoulder arthroplasty (rTSA) for the treatment of proximal humeral fractures (PHFs) in patients who achieved anatomical tuberosity healing and those treated with rTSA for rotator cuff arthropathy (RCA) after a minimum follow-up period of 8 years.

Methods: This was a retrospective comparative cohort study. We included patients aged ≥65 years with an acute PHF (<4 weeks from injury) or RCA treated with rTSA who had at least 8 years follow-up. Patients were divided in 3 groups for clinical assessment: Group 1: rTSA for PHF in which anatomical tuberosity healing was achieved, Group 2: rTSA for PHF in which anatomical tuberosity healing was not achieved (including nonunions and malunions of the tuberosities) Group 3: rTSA for RCA. We assessed range of motion, American Shoulder and Elbow Surgeons (ASES) score, visual analog scale, single numerical evaluation (SANE) score, complications and revisions.

Results: The mean follow-up for all 3 groups was 9.5 ± 1.5 years, and the mean age was 71.9 ± 7 years with no significant differences between the groups. There were 76 women (65%) no significant differences were observed in the ASES score between Group 1 82 (±7) and Group 3 83 (±7), with a difference between the 2 groups of 1 (95% CI: -4.5 to 2). In contrast, both groups were significantly superior to Group 2 73 (±4) (P < .001). Although there was no significant difference between the percentage of patients who achieved the Patient Acceptable Symptom State for the ASES between Group 1 (74%) and Group 3 (78%) both groups were significantly superior to Group 2 (65%) (P < .001). No significant differences were observed in the visual analog scale for pain among the 3 groups. No significant differences were observed in the SANE score between Group 1 78 (±9) and Group 3 80 (±8), with a difference between the 2 groups of 2 (95% confidence interval: 1.5-5.7). However, both groups were significantly superior to Group 2 69 (±9) (P < .001). Although there was no significant difference between the percentage of patients who achieved the Patient Acceptable Symptom State for the SANE between Group 1 (70%) and Group 3 (74%) both groups were significantly superior to Group 2 (61%) (P < .001) Regarding range of motion, Group 3 demonstrated significantly better flexion 140 (±10) compared to Groups 1 120 (±9) and 2 120 (±11) (P < .001), with no significant differences between Groups 1 and 2. Group 3 demonstrated significantly better external rotation 26 (±7) than Groups 1 20 (±6) and 2 16 (±8) (P < .001), with no significant differences between Groups 1 and 2. Similarly, for internal rotation, significant differences were found only between Groups 2 31 (±9) and 3 35 (±8) (P = .011). There were no significant differences between the groups regarding complications and revisions.

Conclusion: In the long term (mean follow-up of 9.5 years), there were no significant differences in functional outcomes, complications, or revision rates between patients over 65 years of age who underwent rTSA for the treatment of PHFs who achieved anatomical tuberosity healing and those treated for RCA. In contrast, in patients operated on for PHFs with rTSA where the tuberosities did not heal anatomically, although satisfactory results were obtained, the improvement in functional scores was significantly lower than in those with tuberosity consolidation or those operated on for RCA.

Keywords: Shoulder; arthropathy; arthroplasty; fracture; humeral; long-term; proximal; reverse.