2-year clinical and radiographic outcomes following uncemented reverse shoulder replacements for proximal humerus fractures.

Abstract

Uncertainty remains regarding the role and long-term outcomes following uncemented reverse shoulder replacements (RSR) in managing displaced proximal humerus fractures (PHF). While RSRs for trauma have traditionally undergone cemented fixation of the humeral component, there is increasing interest in uncemented RSRs. Our primary aim was to evaluate 2-year outcomes following uncemented RSR fixation for 3 and 4-part PHFs in the elderly. A secondary aim was to evaluate if timing of surgery affected outcomes. This cohort series evaluated 2-year outcomes for 42 patients with Neer 3 and 4-part PHFs treated with uncemented RSRs between October 2016 to December 2019. 38 patients (90%) had clinical and radiological follow-up at a minimum of two years. The primary outcomes compared postoperative range of movement (ROM), radiographic outcomes and patient reported outcome measures (PROMs). The PROMs collected included Oxford Shoulder Scores (OSS), satisfaction scores and the Friends and Family Test. The secondary outcome involved a sub analysis to see if outcomes were affected by treatment timing - within 2 weeks, 2-12 weeks and >12 weeks. The mean age of patients was 74.1 (range 58-89). There were 11 males and 31 females. No intra-operative fractures were sustained. There was one transient axillary neurapraxia, which fully resolved by 4 months. Three patients required postoperative transfusions. During the study follow-up period, no patients developed deep infections requiring a washout, dislocation, or underwent further surgery. At two-year follow-up, radiological follow-up demonstrated tuberosity union in 29/38 cases (76%). 8/38 patients (21%) demonstrated some glenoid notching (Sirveuax 1-2 only) on radiographic follow-up. There was no evidence of loosening. The mean OSS was 38 (range 15-48°). Mean range of movement achieved at 2-years was, forward flexion 122° (50-180°); abduction 116° (46-180°) and external rotation 25° (range 5-60°). 18 (47%) patients described their result as excellent, 17 (45%) as good and 3 (8%) as poor. When comparing the time form injury to treatment, there was no statistically significant difference in complications, or radiographic outcomes between the groups. Patients had a reduced forward flexion when treated between 2 and 12 weeks compared to the other groups (p=0.019) CONCLUSION: Uncemented RSR is a safe treatment option for the management of complex PHFs in the elderly. We report low complication rates, high patient satisfaction and good outcomes at 2-year follow-up.