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. 2022 Dec 1;23(1):1043.
doi: 10.1186/s12891-022-05994-3.

Cemented vs. uncemented reverse total shoulder arthroplasty for the primary treatment of proximal humerus fractures in the elderly-a retrospective case-control study

Manuel Kramer  1 , Martin Olach  2 , Vilijam Zdravkovic  2 , Melanie Manser  2 , Bernhard Jost  2 , Christian Spross  2
Affiliations

Cemented vs. uncemented reverse total shoulder arthroplasty for the primary treatment of proximal humerus fractures in the elderly-a retrospective case-control study

Manuel Kramer et al. BMC Musculoskelet Disord. .

Abstract

Background: Uncemented reverse total shoulder arthroplasty (RTSA) for the primary treatment of proximal humerus fractures (PHF) in elderly patients was introduced at our institution in 2017. Recent reports have raised concerns about increased rates of early bone resorption at the proximal humerus with uncemented fracture stems. The aim of this study was to find out whether there was any difference in functional or radiographic outcomes between cemented and uncemented RTSA for PHF.

Methods: Seventeen consecutive patients who underwent uncemented RTSA (group nC) in 2017 and 2018 were age and sex matched (propensity score matching 1:2) to 34 patients with cemented RTSA implanted between 2011 and 2016 (group C) for the primary treatment of PHF. These two groups were compared in terms of clinical and radiographic outcomes at 2 years after the index surgery.

Results: The mean bone quality was low in both groups: in group nC the deltoid tuberosity index (DTI) was 1.43 (1.22-1.72) and in group C 1.42 (1.22-1.67). At the final 2 year follow-up, the relative CS was 98.3% (71-118) in group nC and 97.9% (36-125) in group C (p = 0.927); the absolute CS was 70.2 (49-89) in group nC and 68.0 (30-94) in group C (p = 0.509). Lucent lines at the humeral site were seen in 8 cases (47%) in group nC and in 13 cases (38%) in group C (p = 0.056). Compared to 3% in group C, all patients in group nC showed at least grade 1 and 65% showed grade 3 bone resorption at the proximal humerus (p < 0.001).

Conclusion: Compared to cemented RTSA bone resorption at the proximal humerus was significantly more frequent in patients with uncemented RTSA for PHF. So far, this is rather a radiographic than a clinical finding, because both groups showed very satisfying functional outcomes and low revision rates at the 2 year follow-up.

Level of evidence iii: A retrospective case-control study.

Keywords: Arthroplasty; Fracture; Reverse; Shoulder; Stress shielding; Uncemented.

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Conflict of interest statement

One author (B.J.) received personal fees from Medacta SA as a consultant. However, this did not affect the outcome or the interpretation of the study. None of the other authors has any conflict of interest related to this study.

Figures

Fig. 1
Fig. 1
This flowchart shows the patient selection pathway and matching process. Reverse total shoulder arthroplasty (RTSA)
Fig. 2
Fig. 2
This example shows the typical progression of bone resorption effects on the lateral side of the humeral stem. You can see a good reduction of all bone fragments at 3 months after implantation (left), bone resorption effect grade 2 after one year (middle) and grade 3 after two years (right). A similar process, but less pronounced, can also be seen at the medial side
See this image and copyright information in PMC

References

    1. Han RJ, Sing DC, Feeley BT, et al. Proximal humerus fragility fractures : recent trends in nonoperative and operative treatment in the Medicare population. J Shoulder Elb Surg. 2016;25:256–61. 10.1016/j.jse.2015.07.015. - PubMed
    1. Spross C, Meester J, Mazzucchelli RA, et al. Evidence-based algorithm to treat patients with proximal humerus fractures—a prospective study with early clinical and overall performance results. J Shoulder Elb Surg. 2019;28:1022–1032. doi: 10.1016/j.jse.2019.02.015. - DOI - PubMed
    1. Spross C, Zdravkovic V, Manser M, et al. Outcomes of management of proximal humeral fractures with patient-specific, evidence-based treatment algorithms. J Bone Jt Surg - Ser A. 2021;20(103):1906–1916. doi: 10.2106/JBJS.20.01309. - DOI - PubMed
    1. Bell BJ, Leung BC, Spratt KF, et al. Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. Bone Jt J. 2011;93:121–131. doi: 10.2106/JBJS.I.01505. - DOI - PMC - PubMed
    1. Wiater JM Jr, JEM, Budge MD, et al. Clinical and radiographic results of cementless reverse total shoulder arthroplasty : a comparative study with 2 to 5 years of follow-up. J Shoulder Elb Surg. 2014;23:1208–14. 10.1016/j.jse.2013.11.032. - PubMed