Restricted accessReview articleFirst published online 2023-11
Outcomes after salvage reverse shoulder arthroplasty for failed primary fixation or hemiarthroplasty for proximal humerus fractures: A systematic review
Salvage reverse shoulder arthroplasty (RSA) for failed proximal humerus fractures (PHFs) fixation and hemiarthroplasty (HA) may maximize outcomes in the absence of tuberosity healing or a chronically torn rotator cuff. The purpose of this systematic review was to examine the improvement in clinical outcomes for patients after revision RSA was performed for failed PHFs fixation or HA.
Methods
An electronic database search of SCOPUS, PubMed, Embase, MEDLINE, SPORTDiscus, CINAHL, and ClinicalTrials.gov was performed. A meta-analysis was carried out to determine weighted mean outcome differences between two primary intervention cohorts (failed fixation: open reduction and internal fixation, intramedullary nail, or K-wire vs. failed HA).
Results
Fifteen studies were included (primary fixation: 208 patients; HA: 162 patients). Patients improved meaningfully in all clinical outcomes after revision surgery (constant: 18.5–48.3; abduction: 44–95; forward flexion: 47–107; external rotation: 5–10), with a 16.2% complication and 9.4% revision rate. The failed fixation group performed significantly better than the failed HA group in postoperative constant (fixation: 53.3 vs. HA: 45.1, p = 0.016) and shoulder abduction (fixation: 102 vs. HA: 87, p = 0.026).
Conclusions
RSA is a successful revision intervention for primary PHF operative failures with the greatest benefit for failures of primary fixation versus HA.
Court-BrownCMGargA,McQueenMM. The epidemiology of proximal humeral fractures. Acta Orthop2001; 72: 365–371.
2.
BellJ-ELeungBCSprattKF,et al.Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. J Bone Joint Surg2011; 93: 121–131.
3.
BarrettJABaronJAKaragasMR,et al.Fracture risk in the U.S. Medicare population. J Clin Epidemiol1999; 52: 243–249.
4.
BahrsCStojicevicTTanjaS, et al.Trends in epidemiology and patho-anatomical pattern of proximal humeral fractures. Int Orthop2014; 38: 1697–1704.
5.
CalvoEMorcilloDForuriaAM,et al.Nondisplaced proximal humeral fractures: high incidence among outpatient-treated osteoporotic fractures and severe impact on upper extremity function and patient subjective health perception. J Shoulder Elbow Surg2011; 20: 795–801.
6.
GregoryTMVandenbusscheEAugereauB. Surgical treatment of three and four-part proximal humeral fractures. Orthop Traumatol Surg Res2013; 99: S197–S207.
7.
SproulRCIyengarJJDevcicZ,et al.A systematic review of locking plate fixation of proximal humerus fractures. Injury2011; 42: 408–413.
8.
BerkesMBLittleMTMLorichDG. Open reduction internal fixation of proximal humerus fractures. Curr Rev Musculoskelet Med2013; 6: 47–56.
9.
GoldmanRTKovalKJCuomoF,et al.Functional outcome after humeral head replacement for acute three- and four-part proximal humeral fractures. J Shoulder Elbow Surg1995; 4: 81–86.
10.
NeerCS. Articular replacement for the humeral head. J Bone Joint Surg Am1955; 37: 215–228.
11.
CadetERAhmadCS. Hemiarthroplasty for three- and four-part proximal humerus fractures. J Am Acad Orthop Surg2012; 20: 17–27.
12.
SchairerWWNwachukwuBULymanS,et al.Arthroplasty treatment of proximal humerus fractures: 14-year trends in the United States. Phys Sportsmed2017; 45: 92–96.
13.
KlugAGramlichYWincheringerD,et al.Trends in surgical management of proximal humeral fractures in adults: A nationwide study of records in Germany from 2007 to 2016. Arch Orthop Trauma Surg2019; 139: 1713–1721.
14.
SayeghMJNixonRAPerfettiDC,et al.Changing trends in the management of proximal humerus fractures in New York State. J Orthop2020; 21: 127–130.
15.
AgudeloJSchürmannMStahelP, et al.Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma2007; 21: 676–681.
16.
ClavertPAdamPBevortA,et al.Pitfalls and complications with locking plate for proximal humerus fracture. J Shoulder Elbow Surg2010; 19: 489–494.
17.
OwsleyKCGorczycaJT. Fracture displacement and screw cutout after open reduction and locked plate fixation of humeral fractures. J Bone Joint Surg Am2008; 90: 233–240.
18.
GerberCWernerCMLVienneP. Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br2004; 86: 848–855.
19.
RobinsonCMStirlingPHCGoudieEB,et al.Complications and long-term outcomes of open reduction and plate fixation of proximal humeral fractures. J Bone Joint Surg Am2019; 101: 2129–2139.
20.
LevyJFrankleMMighellM,et al.The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture. J Bone Joint Surg Am2007; 89: 292–300.
21.
HerschelRWieserKMorreyME,et al.Risk factors for glenoid erosion in patients with shoulder hemiarthroplasty: an analysis of 118 cases. J Shoulder Elbow Surg2017; 26: 246–252.
22.
Sebastia-ForcadaELizaur-UtrillaACebrian-GomezR,et al.Outcomes of reverse total shoulder arthroplasty for proximal humeral fractures. J Orthop Trauma2017; 31: e236–e240.
23.
MoeckelBHDinesDMWarrenRF,et al.Modular hemiarthroplasty for fractures of the proximal part of the humerus. J Bone Joint Surg Am1992; 74: 884–889.
24.
BufquinTHersanAHubertL,et al.Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly. J Bone Joint Surg Br2007; 89: 516–520.
25.
PlausinisDKwonYW,ZuckermanJD. Complications of humeral head replacement for proximal humeral fractures. Instr Course Lect2005; 54: 371–380.
26.
SinghAPadillaMNybergEM, et al.Cement technique correlates with tuberosity healing in hemiarthroplasty for proximal humeral fracture. J Shoulder Elbow Surg2017; 26: 437–442.
27.
MansatPBonnevialleN. Treatment of fracture sequelae of the proximal humerus: anatomical vs reverse shoulder prosthesis. Int Orthop2015; 39: 349–354.
28.
YahuacaBISimonPChristmasKN,et al.Acute surgical management of proximal humerus fractures: ORIF vs. hemiarthroplasty vs. reverse shoulder arthroplasty. J Shoulder Elbow Surg2020; 29: S32–S40.
29.
MartinezAACalvoABejaranoC,et al.The use of the Lima reverse shoulder arthroplasty for the treatment of fracture sequelae of the proximal humerus. J Orthop Sci2012; 17: 141–147.
30.
CicakNNikolaCKlobucarH,et al.Reverse shoulder arthroplasty in acute fractures provides better results than in revision procedures for fracture sequelae. Int Orthop2015; 39: 343–348.
31.
PatelDNYoungBOnyekweluI,et al.Reverse total shoulder arthroplasty for failed shoulder arthroplasty. J Shoulder Elbow Surg2012; 21: 1478–1483.
32.
LenarzCShishaniYMcCrumC,et al.Is reverse shoulder arthroplasty appropriate for the treatment of fractures in the older patient? Early observations. Clin Orthop Relat Res2011; 469: 3324–3331.
33.
HoltonJYousriTArealisG,et al.The role of reverse shoulder arthroplasty in management of proximal humerus fractures with fracture sequelae: a systematic review of the literature. Orthop Rev2016; 9: 6977.
34.
NamdariSHorneffJGBaldwinK. Comparison of hemiarthroplasty and reverse arthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am2013; 95: 1701–1708.
35.
TorchiaMTAustinDCCozzolinoN,et al.Acute versus delayed reverse total shoulder arthroplasty for the treatment of proximal humeral fractures in the elderly population: a systematic review and meta-analysis. J Shoulder Elbow Surg2019; 28: 765–773.
36.
AustinDCTorchiaMTCozzolinoNH,et al.Decreased reoperations and improved outcomes with reverse total shoulder arthroplasty in comparison to hemiarthroplasty for geriatric proximal humerus fractures. J Orthop Trauma2019; 33: 49–57.
PetkovicDKovacevicDLevineWN,et al.Management of the failed arthroplasty for proximal humerus fracture. J Am Acad Orthop Surg2019; 27: 39–49.
39.
RuggCMCoughlanMJ,LansdownDA. Reverse total shoulder arthroplasty: biomechanics and indications. Curr Rev Musculoskelet Med2019; 12: 542–553.
40.
HigginsJPTThompsonSGDeeksJJ,et al.Measuring inconsistency in meta-analyses. Br Med J2003; 327: 557–560.
41.
CumpstonMLiTPageMJ,et al.Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev2019; 10: ED000142.
42.
GopalakrishnanSGaneshkumarP. Systematic reviews and meta-analysis: understanding the best evidence in primary healthcare. J Family Med Prim Care2013; 2: 9–14.
43.
StangA. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol2010; 25: 603–605.
44.
HolschenMFranetzkiBWittK-A,et al.Conversions from anatomic shoulder replacements to reverse total shoulder arthroplasty: do the indications for initial surgery influence the clinical outcome after revision surgery?Arch Orthop Traum Surg2017; 137: 167–172.
45.
HolschenMSiemesM-KWittK-A,et al.Five-year outcome after conversion of a hemiarthroplasty when used for the treatment of a proximal humeral fracture to a reverse total shoulder arthroplasty. Bone Jt J2018; 100-B: 761–766.
46.
HolschenMPallmannJSchornD,et al.Simultaneous removal of a locking plate and implantation of a reversed shoulder prosthesis in elderly patients suffering from fracture sequelae of the proximal humerus. Musculoskelet Surg2020; 104: 295–301.
47.
MerollaGTartaroneASperlingJW,et al.Early clinical and radiological outcomes of reverse shoulder arthroplasty with an eccentric all-polyethylene glenosphere to treat failed hemiarthroplasty and the sequelae of proximal humeral fractures. Int Orthop2017; 41: 141–148.
48.
JostBSprossCGrehnH,et al.Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elbow Surg2013; 22: 542–549.
49.
DezfuliBKingJJFarmerKW,et al.Outcomes of reverse total shoulder arthroplasty as primary versus revision procedure for proximal humerus fractures. J Shoulder Elbow Surg2016; 25: 1133–1137.
50.
HusseyMMHusseySEMighellMA. Reverse shoulder arthroplasty as a salvage procedure after failed internal fixation of fractures of the proximal humerus: outcomes and complications. Bone Jt J2015; 97-B: 967–972.
51.
ShannonSFWagnerERHoudekMT,et al.Reverse shoulder arthroplasty for proximal humeral fractures: outcomes comparing primary reverse arthroplasty for fracture versus reverse arthroplasty after failed osteosynthesis. J Shoulder Elbow Surg2016; 25: 1655–1660.
52.
García-FernándezCLopizYRizoB, et al.Reverse total shoulder arthroplasty for the treatment of failed fixation in proximal humeral fractures. Injury2018; 49: S22–S26.
53.
GrubhoferFWieserKMeyerDC,et al.Reverse total shoulder arthroplasty for failed open reduction and internal fixation of fractures of the proximal humerus. J Shoulder Elbow Surg2017; 26: 92–100.
54.
SchliemannBTheisenCKöstersC,et al.Reverse total shoulder arthroplasty for type I fracture sequelae after internal fixation of proximal humerus fractures. Arch Orthop Trauma Surg2017; 137: 1677–1683.
55.
GohlkeFRolfO. Revision of failed fracture hemiarthroplasties to reverse total shoulder prosthesis through the transhumeral approach: method incorporating a pectoralis-major-pedicled bone window. Oper Orthop Traumatol2007; 19: 185–208.
56.
CastagnaADelcoglianoMCaroFd, et al.Conversion of shoulder arthroplasty to reverse implants: clinical and radiological results using a modular system. Int Orthop2013; 37: 1297–1305.
57.
FerrelJRTrinhTQFischerRA. Reverse Total shoulder arthroplasty versus hemiarthroplasty for proximal humeral fractures. J Orthop Trauma2015; 29: 60–68.
AnakwenzeOAZollerSAhmadCS,et al.Reverse shoulder arthroplasty for acute proximal humerus fractures: a systematic review. J Shoulder Elbow Surg2014; 23: e73–e80.
60.
Mata-FinkAMeinkeMJonesC,et al.Reverse shoulder arthroplasty for treatment of proximal humeral fractures in older adults: a systematic review. J Shoulder Elbow Surg2013; 22: 1737–1748.
61.
HettrichCMPermeswaranVNGoetzJE,et al.Mechanical tradeoffs associated with glenosphere lateralization in reverse shoulder arthroplasty. J Shoulder Elbow Surg2015; 24: 1774–1781.
62.
HelmkampJKBullockGSAmiloNR,et al.The clinical and radiographic impact of center of rotation lateralization in reverse shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg2018; 27: 2099–2107.
63.
FriedmanRJBarcelDAEichingerJK. Scapular notching in reverse total shoulder arthroplasty. J Am Acad Orthop Sur2019; 27: 200–209.
64.
HyunYSHuriGGarbisNG,et al.Uncommon indications for reverse total shoulder arthroplasty. Clin Orthop Surg2013; 5: 243–255.
65.
FloydSBCampbellJChapmanCG,et al.Geographic variation in the treatment of proximal humerus fracture: an update on surgery rates and treatment consensus. J Orthop Surg Res2019; 14: 22.
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