Optimal timing of reverse total shoulder arthroplasty for proximal humerus fractures

Abstract

Background: Reverse total shoulder arthroplasty (rTSA) has recently emerged as a popular operative management option for complex proximal humeral fractures (PHFxs) in the elderly. Although rTSA seemingly provides satisfactory clinical and functional outcomes in patients with complex PHFs, little is known about the clinical and functional outcomes of patients with delayed rTSA treatment of PHFx. The purpose of our study was to compare postoperative clinical outcomes and complications in patients treated with rTSA for acute PHFx vs. chronic PHFxs.

Methods: A retrospective review was conducted to identify all patients who underwent primary rTSA for the treatment of a PHFx from January 2010 to December 2022. Patients were separated into 2 groups based on the timing from PHFx injury to surgery: 1) acute (<6 weeks from date of injury to rTSA) PHFx group and 2) chronic (≥6 weeks) PHFx group. Preoperative and postoperative clinical outcomes including range of motion, Simple Shoulder Test, Constant score, University of California Los Angeles shoulder rating scale, Shoulder Pain and Disability Index, Shoulder Arthroplasty Smart Score, and American Shoulder and Elbow Surgeons shoulder score were recorded and assessed using paired t-test.

Results: Sixty-one patients (Acute Group = 43 patients, Chronic Group = 18 patients) were analyzed. Patient demographics were comparable between both groups. Patients in the acute group had surgery significantly earlier than those in the chronic group (2.0 weeks vs. 49.6 weeks, P < .001). There were no significant differences in range of motion, clinical and functional outcome scores, or complications between the 2 groups. The overall complication rate was 2%. The only complication occurred in the acute group and was a shoulder dislocation secondary to a fall. No significance in complication rates was found between the 2 groups (P = .518).

Conclusions: Patients treated in the acute or chronic setting with an rTSA result in comparable clinical and functional outcomes with minimal complications. Ultimately, patients and surgeons can work together for optimal timing of rTSA for PHFxs in the elderly without sacrificing improvements in function or patient-reported outcomes.

Keywords: Proximal humerus fracture; functional outcomes; malunion; patient-reported outcomes; reverse total shoulder arthroplasty; surgical timing; trauma.