Treatment of proximal humerus fractures using reverse shoulder arthroplasty: do the inclination of the humeral component and the lateral offset of the glenosphere influence the clinical outcome and tuberosity healing?
Humeral inclination
Lateral offset
Proximal humerus fracture
Reverse shoulder arthroplasty
Scapular notching
Shoulder prosthesis
Tuberosity healing
Journal
Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
received:
08
07
2021
accepted:
24
11
2021
pubmed:
4
1
2022
medline:
28
10
2022
entrez:
3
1
2022
Statut:
ppublish
Résumé
The employment of reverse shoulder arthroplasty for dislocated proximal humerus fractures of elderly patients becomes increasingly relevant. The standard inclination angle of the humeral component was 155°. Lately, there is a trend towards smaller inclination angles of 145° or 135°. Additionally, there has been an increased focus on the lateralization of the glenosphere. This retrospective comparative study evaluates clinical and radiological results of patients treated for proximal humerus fractures by reverse shoulder arthroplasty with different inclination angles of the humeral component, which was either 135° or 155°. Additionally, a different lateral offset of the glenosphere, which was either 0 mm or 4 mm, was used. For this retrospective comparative analysis, 58 out of 66 patients treated by reverse total shoulder arthroplasty for proximal humerus fractures were included. The minimum follow-up was 24 months. Thirty (m = 3, f = 27; mean age 78 years; mean FU 35 months, range 24-58 months) were treated with a standard 155° humeral component and a glenosphere without lateral offset (group A), while 28 patients (m = 2, f = 26; mean age 79 years; mean FU 30 months, range 24-46 months) were treated with a 135° humeral component and a glenosphere with a 4 mm lateral offset (group B). We determined range of motion, Constant score, and the American Shoulder and Elbow Surgeons Shoulder score as clinical outcomes and evaluated tuberosity healing as well as scapula notching. Neither forward flexion (A = 128°, B = 121°; p = 0.710) nor abduction (A = 111°, B = 106°; p = 0.327) revealed differences between the groups. The mean Constant Score rated 63 in group A, while it was 61 in group B (p = 0.350). There were no differences of the ASES Score between the groups (A = 74, B = 72; p = 0.270). There was an increased risk for scapula notching in group A (47%) in comparison to group B (4%, p = 0.001). Healing of the greater tuberosity was achieved in 57% of group A and in 75% of group B (p = 0.142). The healing rate of the lesser tuberosity measured 33% in group A and 71% in group B (p = 0.004). Both inclination angles of the humeral component are feasible options for the treatment of proximal humerus fractures in elderly patients. Neither the inclination angle nor the lateral offset of the glenosphere seem to have a relevant influence on the clinical outcome. The healing rate of the lesser tuberosity was higher in implants with a decreased neck-shaft angle. There is an increased risk for scapula notching, if a higher inclination angle of the humeral component is chosen. III. Retrospective comparative study.
Identifiants
pubmed: 34977963
doi: 10.1007/s00402-021-04281-5
pii: 10.1007/s00402-021-04281-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3817-3826Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Murray IR, Amin AK, White TO et al (2011) Proximal humeral fractures: current concepts in classification, treatment and outcomes. J Bone Joint Surg Br 93:1–11
pubmed: 21196536
doi: 10.1302/0301-620X.93B1.25702
Palvanen M, Kannus P, Niemi S et al (2006) Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 442:87–92
pubmed: 16394745
doi: 10.1097/01.blo.0000194672.79634.78
Roux A, Decroocq L, El Batti S et al (2012) Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res 98:715–719
pubmed: 23000039
doi: 10.1016/j.otsr.2012.05.013
Bahrs C, Stojicevic T, Blumenstock G et al (2014) Trends in epidemiology and patho-anatomical pattern of proximal humeral fractures. Int Orthop 38:1697–1704
pubmed: 24859897
pmcid: 4115093
doi: 10.1007/s00264-014-2362-6
Laux CJ, Grubhofer F, Werner CML et al (2017) Current concepts in locking plate fixation of proximal humerus fractures. J Orthop Surg Res 12:137
pubmed: 28946902
pmcid: 5613450
doi: 10.1186/s13018-017-0639-3
Sebastia-Forcada E, Cebrian-Gomez R, Lizaur-Utrilla A et al (2014) Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study. J Shoulder Elbow Surg 23:1419–1426
pubmed: 25086490
doi: 10.1016/j.jse.2014.06.035
Cuff DJ, Pupello DR (2013) Comparison of hemiarthroplasty and reverse shoulder arthroplasty for the treatment of proximal humeral fractures in elderly patients. J Bone Joint Surg Am 95:2050–2055
pubmed: 24257664
doi: 10.2106/JBJS.L.01637
Ohl X, Bonnevialle N, Gallinet D et al (2018) How the greater tuberosity affects clinical outcomes after reverse shoulder arthroplasty for proximal humeral fractures. J Shoulder Elbow Surg 27:2139–2144
pubmed: 30082121
doi: 10.1016/j.jse.2018.05.030
Cazeneuve JF, Cristofari DJ (2011) Long term functional outcome following reverse shoulder arthroplasty in the elderly. Orthop Traumatol Surg Res 97:583–589
pubmed: 21917540
doi: 10.1016/j.otsr.2011.03.025
Cazeneuve JF, Cristofari DJ (2014) Grammont reversed prosthesis for acute complex fracture of the proximal humerus in an elderly population with 5 to 12 years follow-up. Orthop Traumatol Surg Res 100:93–97
pubmed: 24456760
doi: 10.1016/j.otsr.2013.12.005
Grubhofer F, Wieser K, Meyer DC et al (2016) Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly. J Shoulder Elbow Surg 25:1690–1698
pubmed: 27090009
doi: 10.1016/j.jse.2016.02.024
Ross M, Hope B, Stokes A et al (2015) Reverse shoulder arthroplasty for the treatment of three-part and four-part proximal humeral fractures in the elderly. J Shoulder Elbow Surg 24:215–222
pubmed: 25168347
doi: 10.1016/j.jse.2014.05.022
Schmalzl J, Jessen M, Sadler N et al (2020) High tuberosity healing rate associated with better functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135 degrees prosthesis. BMC Musculoskelet Disord 21:35
pubmed: 31948484
pmcid: 6966803
doi: 10.1186/s12891-020-3060-8
Zumstein MA, Pinedo M, Old J et al (2011) Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 20:146–157
pubmed: 21134666
doi: 10.1016/j.jse.2010.08.001
Boileau P, Watkinson DJ, Hatzidakis AM et al (2005) Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg 14:147S-161S
pubmed: 15726075
doi: 10.1016/j.jse.2004.10.006
Ladermann A, Denard PJ, Boileau P et al (2015) Effect of humeral stem design on humeral position and range of motion in reverse shoulder arthroplasty. Int Orthop 39:2205–2213
pubmed: 26381907
doi: 10.1007/s00264-015-2984-3
Ladermann A, Denard PJ, Collin P et al (2020) Effect of humeral stem and glenosphere designs on range of motion and muscle length in reverse shoulder arthroplasty. Int Orthop 44:519–530
pubmed: 31900574
doi: 10.1007/s00264-019-04463-2
Gobezie R, Shishani Y, Lederman E et al (2019) Can a functional difference be detected in reverse arthroplasty with 135 degrees versus 155 degrees prosthesis for the treatment of rotator cuff arthropathy: a prospective randomized study. J Shoulder Elbow Surg 28:813–818
pubmed: 30773441
doi: 10.1016/j.jse.2018.11.064
Gutierrez S, CaT C, Luo ZP et al (2008) Range of impingement-free abduction and adduction deficit after reverse shoulder arthroplasty. Hierarchy of surgical and implant-design-related factors. J Bone Joint Surg Am 90:2606–2615
pubmed: 19047705
doi: 10.2106/JBJS.H.00012
Werner BS, Chaoui J, Walch G (2017) The influence of humeral neck shaft angle and glenoid lateralization on range of motion in reverse shoulder arthroplasty. J Shoulder Elbow Surg 26:1726–1731
pubmed: 28528016
doi: 10.1016/j.jse.2017.03.032
O’sullivan J, Ladermann A, Parsons BO et al (2020) A systematic review of tuberosity healing and outcomes following reverse shoulder arthroplasty for fracture according to humeral inclination of the prosthesis. J Shoulder Elbow Surg 29:1938–1949
pubmed: 32815808
doi: 10.1016/j.jse.2020.03.032
Boileau P, Moineau G, Roussanne Y et al (2017) Bony increased offset-reversed shoulder arthroplasty (BIO-RSA). JBJS Essent Surg Tech 7:e37
pubmed: 30233972
pmcid: 6132994
doi: 10.2106/JBJS.ST.17.00006
Werthel JD, Walch G, Vegehan E et al (2019) Lateralization in reverse shoulder arthroplasty: a descriptive analysis of different implants in current practice. Int Orthop 43:2349–2360
pubmed: 31254018
doi: 10.1007/s00264-019-04365-3
Greiner S, Schmidt C, Herrmann S et al (2015) Clinical performance of lateralized versus non-lateralized reverse shoulder arthroplasty: a prospective randomized study. J Shoulder Elbow Surg 24:1397–1404
pubmed: 26163281
doi: 10.1016/j.jse.2015.05.041
Ferle M, Pastor MF, Hagenah J et al (2019) Effect of the humeral neck-shaft angle and glenosphere lateralization on stability of reverse shoulder arthroplasty: a cadaveric study. J Shoulder Elbow Surg 28:966–973
pubmed: 30626537
doi: 10.1016/j.jse.2018.10.025
Kim SJ, Jang SW, Jung KH et al (2019) Analysis of impingement-free range of motion of the glenohumeral joint after reverse total shoulder arthroplasty using three different implant models. J Orthop Sci 24:87–94
pubmed: 30268356
doi: 10.1016/j.jos.2018.08.016
Ladermann A, Tay E, Collin P et al (2019) Effect of critical shoulder angle, glenoid lateralization, and humeral inclination on range of movement in reverse shoulder arthroplasty. Bone Joint Res 8:378–386
pubmed: 31537995
pmcid: 6719532
doi: 10.1302/2046-3758.88.BJR-2018-0293.R1
Fortane T, Beaudouin E, Lateur G et al (2020) Tuberosity healing in reverse shoulder arthroplasty in traumatology: Use of an offset modular system with bone graft. Orthop Traumatol Surg Res 106:1113–1118
pubmed: 32807699
doi: 10.1016/j.otsr.2020.04.018
Sirveaux F, Roche O, Mole D (2010) Shoulder arthroplasty for acute proximal humerus fracture. Orthop Traumatol Surg Res 96:683–694
pubmed: 20692881
doi: 10.1016/j.otsr.2010.07.001
Neer CS 2nd (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 52:1077–1089
pubmed: 5455339
doi: 10.2106/00004623-197052060-00001
Meinberg EG, Agel J, Roberts CS et al (2018) Fracture and dislocation classification compendium-2018. J Orthop Trauma 32(Suppl 1):S1–S170
pubmed: 29256945
doi: 10.1097/BOT.0000000000001063
Thomas M, Dieball O, Busse M (2003) Normal values of the shoulder strength in dependency on age and gender–comparison with the constant, UCLA, ASES scores and SF36 health survey. Z Orthop Ihre Grenzgeb 141:160–170
pubmed: 12695952
doi: 10.1055/s-2003-38662
Sirveaux F, Favard L, Oudet D et al (2004) Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders. J Bone Joint Surg Br 86:388–395
pubmed: 15125127
doi: 10.1302/0301-620X.86B3.14024
Middernacht B, Van Tongel A, De Wilde L (2016) A critical review on prosthetic features available for reversed total shoulder arthroplasty. Biomed Res Int 2016:3256931
pubmed: 28105417
pmcid: 5220426
doi: 10.1155/2016/3256931
Langohr GD, Giles JW, Athwal GS et al (2015) The effect of glenosphere diameter in reverse shoulder arthroplasty on muscle force, joint load, and range of motion. J Shoulder Elbow Surg 24:972–979
pubmed: 25547853
doi: 10.1016/j.jse.2014.10.018
Virani NA, Cabezas A, Gutierrez S et al (2013) Reverse shoulder arthroplasty components and surgical techniques that restore glenohumeral motion. J Shoulder Elbow Surg 22:179–187
pubmed: 22621793
doi: 10.1016/j.jse.2012.02.004
Jain NP, Mannan SS, Dharmarajan R et al (2019) Tuberosity healing after reverse shoulder arthroplasty for complex proximal humeral fractures in elderly patients-does it improve outcomes? A systematic review and meta-analysis. J Shoulder Elbow Surg 28:e78–e91
pubmed: 30593437
doi: 10.1016/j.jse.2018.09.006
Klein M, Juschka M, Hinkenjann B et al (2008) Treatment of comminuted fractures of the proximal humerus in elderly patients with the Delta III reverse shoulder prosthesis. J Orthop Trauma 22:698–704
pubmed: 18978545
doi: 10.1097/BOT.0b013e31818afe40
Reitman RD, Kerzhner E (2011) Reverse shoulder arthoplasty as treatment for comminuted proximal humeral fractures in elderly patients. Am J Orthop (Belle Mead NJ) 40:458–461
Gallinet D, Clappaz P, Garbuio P et al (2009) Three or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis: a comparative study of 40 cases. Orthop Traumatol Surg Res 95:48–55
pubmed: 19251237
doi: 10.1016/j.otsr.2008.09.002
Valenti P, Katz D, Kilinc A et al (2012) Mid-term outcome of reverse shoulder prostheses in complex proximal humeral fractures. Acta Orthop Belg 78:442–449
pubmed: 23019775
Simovitch RW, Roche CP, Jones RB et al (2019) Effect of tuberosity healing on clinical outcomes in elderly patients treated with a reverse shoulder arthroplasty for 3- and 4-part proximal humerus fractures. J Orthop Trauma 33:e39–e45
pubmed: 30688837
doi: 10.1097/BOT.0000000000001348
Reuther F, Petermann M, Stangl R (2019) Reverse shoulder arthroplasty in acute fractures of the proximal humerus: does tuberosity healing improve clinical outcomes? J Orthop Trauma 33:e46–e51
pubmed: 30277991
doi: 10.1097/BOT.0000000000001338
Sabesan VJ, Lima DJL, Yang Y et al (2020) The role of greater tuberosity healing in reverse shoulder arthroplasty: a finite element analysis. J Shoulder Elbow Surg 29:347–354
pubmed: 31606318
doi: 10.1016/j.jse.2019.07.022
Oh JH, Shin SJ, Mcgarry MH et al (2014) Biomechanical effects of humeral neck-shaft angle and subscapularis integrity in reverse total shoulder arthroplasty. J Shoulder Elbow Surg 23:1091–1098
pubmed: 24480326
doi: 10.1016/j.jse.2013.11.003
Lenarz C, Shishani Y, Mccrum C et al (2011) Is reverse shoulder arthroplasty appropriate for the treatment of fractures in the older patient? Early observations. Clin Orthop Relat Res 469:3324–3331
pubmed: 21879403
pmcid: 3210274
doi: 10.1007/s11999-011-2055-z
Ball CM (2020) Delta Xtend reverse shoulder arthroplasty - results at a minimum of five years. Shoulder Elbow 12:114–123
pubmed: 32313561
doi: 10.1177/1758573219832283
Mollon B, Mahure SA, Roche CP et al (2017) Impact of scapular notching on clinical outcomes after reverse total shoulder arthroplasty: an analysis of 476 shoulders. J Shoulder Elbow Surg 26:1253–1261
pubmed: 28111179
doi: 10.1016/j.jse.2016.11.043
Nicholson GP, Strauss EJ, Sherman SL (2011) Scapular notching: Recognition and strategies to minimize clinical impact. Clin Orthop Relat Res 469:2521–2530
pubmed: 21128030
doi: 10.1007/s11999-010-1720-y
Friedman RJ, Barcel DA, Eichinger JK (2019) Scapular notching in reverse total shoulder arthroplasty. J Am Acad Orthop Surg 27:200–209
pubmed: 30260909
doi: 10.5435/JAAOS-D-17-00026
Raiss P, Edwards TB, Deutsch A et al (2014) Radiographic changes around humeral components in shoulder arthroplasty. J Bone Joint Surg Am 96:e54
pubmed: 24695931
doi: 10.2106/JBJS.M.00378
Ladermann A, Gueorguiev B, Charbonnier C et al (2015) Scapular notching on kinematic simulated range of motion after reverse shoulder arthroplasty is not the result of impingement in adduction. Medicine (Baltimore) 94:e1615
doi: 10.1097/MD.0000000000001615
Kramer M, Baunker A, Wellmann M et al (2016) Implant impingement during internal rotation after reverse shoulder arthroplasty. The effect of implant configuration and scapula anatomy: a biomechanical study. Clin Biomech (Bristol, Avon) 33:111–116
doi: 10.1016/j.clinbiomech.2016.02.015
De Biase CF, Ziveri G, Delcogliano M et al (2013) The use of an eccentric glenosphere compared with a concentric glenosphere in reverse total shoulder arthroplasty: two-year minimum follow-up results. Int Orthop 37:1949–1955
pubmed: 23748462
pmcid: 3779548
doi: 10.1007/s00264-013-1947-9