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. 2024 Sep 20;25(1):752.
doi: 10.1186/s12891-024-07870-8.

Mid- to long-term outcome of reverse total shoulder arthroplasty as revision procedure for failed hemiarthroplasty after proximal humerus fracture

Alp Paksoy  1 , Doruk Akgün  2 , Jan-Philipp Imiolczyk  2 , Henry Gebauer  2 , Lucca Lacheta  3 , Markus Scheibel  2   4 , Agahan Hayta  2 , Philipp Moroder  4
Affiliations

Mid- to long-term outcome of reverse total shoulder arthroplasty as revision procedure for failed hemiarthroplasty after proximal humerus fracture

Alp Paksoy et al. BMC Musculoskelet Disord. .

Abstract

Background: Insufficient tuberosity healing is the most common reason for poor outcome after treatment of proximal humerus fractures (PHFs) using hemiarthroplasty (HA). In these cases, revision to reverse total shoulder arthroplasty (RTSA) can improve function and reduce pain in the short term, however, long-term results remain scarce. Aim of this study was to evaluate the clinical and radiological mid- to long-term results in patients with a revision RTSA after failed HA for PHF.

Methods: In this retrospective study all patients that received a revision to RTSA after failed fracture HA between 2006 and 2018 were included. A total of 49 shoulders in 48 patients (38 female, 10 male; mean age 82 ± 9 years) were identified in our database. A total of 20 patients (17 female, 3 male; mean age was 79 ± 9 years) were available for follow-up examination after a mean time period of approximately eight years (3-14 years) after revision surgery. At final follow-up, patients were assessed using a subjective shoulder value (SSV), range of motion (ROM), visual analogue score (VAS), the Constant Score (CS) and the 12-Item Short Form Survey (SF-12).

Results: At final follow-up, mean CS was 55 ± 19 (19-91), VAS averaged 3 ± 3 (0-8) and mean SSV was 61 ± 18% (18-90%). Mean SF-12 was 44 (28-57) with a mean physical component summary (PCS) of 38 (21-56) and a mean mental component summary (MCS) of 51 (29-67). On average active forward flexion (FF) was 104° (10-170°), active abduction (ABD) was 101° (50-170°), active external rotation (ER) was 19° (10-30°) and active internal rotation (IR) of the lumbosacral transition was reached. Three patients presented with a periprosthetic humeral fracture after RTSA implantation and underwent a reoperation (15%) during follow-up period.

Conclusions: Revision RTSA results in promising clinical results in patients after initial failed HA after PHF. A complication and reoperation rate of 15% is tolerable in consideration of satisfactory functional and psychological outcome.

Trial registration: Retrospectively registered.

Keywords: Arthroplasty; Grammont reverse prosthesis; Hemiarthroplasty; Infection; Long-term follow-up; Periprosthetic fracture; Prosthesis; Proximal humerus fracture; Reoperation; Reverse shoulder arthroplasty; Revision; Trauma.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study participants
Fig. 2
Fig. 2
Radiographs obtained during the course of reverse total shoulder arthroplasty revision procedure for failed hemiarthroplasty after proximal humerus fracture. A A 66-year-old patient from our cohort fell on to her right shoulder at home, hemiarthroplasty was indicated in this case. B Prosthesis failure due to tuberosity and rotator cuff insufficiency with postoperative persistent pain and stiffness. C Implantation of a reverse total shoulder endoprosthesis was performed
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