Reverse Shoulder Arthroplasty for Proximal Humerus Fractures: A Review of Current Evidence

McLean AS, Price N, Graves S, Hatton A, Taylor FJ. Nationwide trends in management of proximal humeral fractures: an analysis of 77,966 cases from 2008 to 2017. J Shoulder Elb Surg. 2019;28(11):2072–8.

Article  Google Scholar 

Hasty EK, Jernigan EW 3rd, Soo A, Varkey DT, Kamath GV. Trends in Surgical Management and costs for Operative Treatment of Proximal Humerus fractures in the Elderly. Orthopedics. 2017;40(4):e641–7.

Article  PubMed  Google Scholar 

Han RJ, Sing DC, Feeley BT, Ma CB, Zhang AL. Proximal humerus fragility fractures: recent trends in nonoperative and operative treatment in the Medicare population. J Shoulder Elb Surg. 2016;25(2):256–61.

Article  Google Scholar 

Boin MA, Virk MS, Paszicsnyek A, Kriechling P, Razaeian S, Ernstbrunner L, et al. Reverse total shoulder arthroplasty for Proximal Humeral fractures and Sequalae compared to non-fracture indications: a matched cohort analysis of Outcome and complications. Clin Orthop Relat Res. 2022;6(10):2421–9.

Google Scholar 

•Handoll HH, Elliott J, Thillemann TM, Aluko P, Brorson S. Interventions for treating proximal humeral fractures in adults. Cochrane database Syst Rev. 2022;6(6):CD000434. Like most systematic reviews carried out under the Cochrane seal, this one provides interesting information comparing different surgical and nonoperative treatment options for proximal humerus fractures.

Alrabaa RG, Ma G, Truong NM, Lansdown DA, Feeley BT, Zhang AL et al. Trends in Surgical Treatment of Proximal Humeral fractures and Analysis of Postoperative complications over a Decade in 384,158 patients. JB JS open access. 2022;7(4).

Shrader MW, Sanchez-Sotelo J, Sperling JW, Rowland CM, Cofield RH. Understanding proximal humerus fractures: image analysis, classification, and treatment. J Shoulder Elb Surg. 2005;14(5):497–505.

Article  Google Scholar 

Foruria AM, de Gracia MM, Larson DR, Munuera L, Sanchez-Sotelo J. The pattern of the fracture and displacement of the fragments predict the outcome in proximal humeral fractures. J Bone Joint Surg Br. 2011;93(3):378–86.

Article  CAS  PubMed  Google Scholar 

••Lopiz Y, Alcobía-Díaz B, Galán-Olleros M, García-Fernández C, Picado AL, Marco F. Reverse shoulder arthroplasty versus nonoperative treatment for 3- or 4-part proximal humeral fractures in elderly patients: a prospective randomized controlled trial. J Shoulder Elb Surg. 2019;28(12):2259–71. A well-designed RCT that concludes that patients over 80 years of age do not benefit from surgical treatment. Furthermore, unlike in HA, non-union of the tuberosities in RSA does not dramatically affect the results.

Sebastiá-Forcada E, Cebrián-Gómez R, Lizaur-Utrilla A, Gil-Guillén V. Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study. J Shoulder Elb Surg. 2014;23(10):1419–26. RCT that shows us how in patients over 70 years of age RSA is superior compared to HA in both ROM and functional scores. Furthermore, unlike in HA, non-union of the tuberosities in RSA does not dramatically affect the results.

Article  Google Scholar 

••Fraser AN, Bjørdal J, Wagle TM, Karlberg AC, Lien OA, Eilertsen L et al. Reverse Shoulder Arthroplasty Is Superior to Plate Fixation at 2 Years for Displaced Proximal Humeral Fractures in the Elderly: A Multicenter Randomized Controlled Trial. J Bone Joint Surg Am. 2020;102(6):477–85. The Delphi study determined that after two years of follow-up the results were better and more predictable with RSA compared to ORIF, especially the worse the fracture is.

Boin MA, Virk MS. CORR ® Synthesis: what is the role of reverse shoulder arthroplasty for the treatment of proximal Humerus fractures in patients older Than 65 years? Clin Orthop Relat Res. 2021;479(11):2421–9.

Article  PubMed  PubMed Central  Google Scholar 

Haws BE, Samborski SA, Karnyski S, Soles G, Gorczyca JT, Nicandri GT, et al. Superior Outcomes with Reverse Shoulder Arthroplasty versus Nonoperative Management for Proximal Humerus fractures: a matched cohort analysis. J Orthop Trauma. 2023;37(6):e247–52.

Article  PubMed  Google Scholar 

Jonsson EÖ, Ekholm C, Salomonsson B, Demir Y, Olerud P. Reverse total shoulder arthroplasty provides better shoulder function than hemiarthroplasty for displaced 3- and 4-part proximal humeral fractures in patients aged 70 years or older: a multicenter randomized controlled trial. J Shoulder Elb Surg. 2021;30(5):994–1006. Recent RCT showing how RSA is superior in all aspects compared to HA for proximal humerus fractures in patients over 70 years of age. However, it seems that over 80 years of age the results are similar in both groups.

Article  Google Scholar 

Laas N, Engelsma Y, Hagemans FJA, Hoelen MA, van Deurzen DFP, Burger BJ. Reverse or Hemi Shoulder Arthroplasty in Proximal Humerus fractures: a single-blinded prospective Multicenter Randomized Clinical Trial. J Orthop Trauma. 2021;35(5):252–8.

Article  PubMed  Google Scholar 

Shukla DR, McAnany S, Kim J, Overley S, Parsons BO. Hemiarthroplasty versus reverse shoulder arthroplasty for treatment of proximal humeral fractures: a meta-analysis. J Shoulder Elb Surg. 2016;25(2):330–40.

Article  Google Scholar 

Austin DC, Torchia MT, Cozzolino NH, Jacobowitz LE, Bell J-E. Decreased reoperations and Improved Outcomes with Reverse Total Shoulder Arthroplasty in comparison to Hemiarthroplasty for Geriatric Proximal Humerus fractures: a systematic review and Meta-analysis. J Orthop Trauma. 2019;33(1):49–57.

Article  PubMed  Google Scholar 

Vall M, Natera L, Witney-Lagen C, Imam MA, Narvani AA, Sforza G, et al. Reverse shoulder replacement versus hemiarthroplasty for proximal humeral fracture in elderly patients: a systematic review. Musculoskelet Surg. 2022;106(4):357–67.

Article  CAS  PubMed  Google Scholar 

Han P-F, Yang S, Wang Y-P, Hou X-D, Li Y, Li X-Y. Reverse shoulder arthroplasty vs. hemiarthroplasty for the treatment of osteoporotic proximal humeral fractures in elderly patients: a systematic review and meta–analysis update. Exp Ther Med. 2022;24(4):1–12.

Article  Google Scholar 

Critchley O, McLean A, Page R, Taylor F, Graves S, Lorimer M, et al. Reverse total shoulder arthroplasty compared to stemmed hemiarthroplasty for proximal humeral fractures: a registry analysis of 5946 patients. J Shoulder Elb Surg. 2020;29(12):2538–47.

Article  Google Scholar 

Suroto H, Vega B, De, Deapsari F, Prajasari T, Wibowo PA, Samijo SK. Reverse total shoulder arthroplasty (RTSA) versus open reduction and internal fixation (ORIF) for displaced three-part or four-part proximal humeral fractures: a systematic review and meta-analysis. EFORT Open Rev. 2021;6(10):941–55.

Article  PubMed  PubMed Central  Google Scholar 

Klug A, Harth J, Hoffmann R, Gramlich Y. Surgical treatment of complex proximal humeral fractures in elderly patients: a matched-pair analysis of angular-stable plating vs. reverse shoulder arthroplasty. J Shoulder Elb Surg. 2020;29(9):1796–803.

Article  Google Scholar 

Luciani P, Procaccini R, Rotini M, Pettinari F, Gigante A. Angular stable plate versus reverse shoulder arthroplasty for proximal humeral fractures in elderly patient. Musculoskelet Surg. 2022;106(1):43–8.

Article  CAS  PubMed  Google Scholar 

Bjørdal J, Fraser AN, Wagle TM, Kleven L, Lien OA, Eilertsen L, et al. A cost-effectiveness analysis of reverse total shoulder arthroplasty compared with locking plates in the management of displaced proximal humerus fractures in the elderly: the DelPhi trial. J Shoulder Elb Surg. 2022;31(10):2187–95.

Article  Google Scholar 

Torchia MT, Austin DC, Cozzolino N, Jacobowitz L, Bell JE. 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 Elb Surg [Internet]. 2019;28(4):765–73. https://doi.org/10.1016/j.jse.2018.10.004.

Nelson PA, Kwan CC, Tjong VK, Terry MA, Sheth U. Primary Versus Salvage Reverse Total Shoulder Arthroplasty for Displaced Proximal Humerus fractures in the Elderly: a systematic review and Meta-analysis. J Shoulder Elb Arthroplast. 2020;4:2471549220949731.

PubMed  PubMed Central  Google Scholar 

•Lu V, Jegatheesan V, Patel D, Domos P. Outcomes of acute vs. delayed reverse shoulder arthroplasty for proximal humerus fractures in the elderly: a systematic review and meta-analysis. J shoulder Elb Surg. 2023;32(8):1728–39. Impressive systematic review and meta-analysis gathering data from almost 12000 patients, concluding that delayed RSA after a fracture (even failed nonoperative treatment or failed ORIF) have a higher complication and revision rate than acute RSA.

Jain NP, Mannan SS, Dharmarajan R, Rangan A. 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 Elb Surg. 2019;28(3):e78–91.

Article  Google Scholar 

Rivera AR, Cardona V. Reverse total shoulder arthroplasty for complex proximal humerus fracture in the elderly: clinical and radiological results. JSES Rev reports, Tech. 2023;3(2):131–6.

Sabah Y, Decroocq L, Gauci MO, Bonnevialle N, Lemmex DB, Chelli M et al. Clinical and radiological outcomes of reverse shoulder arthroplasty for acute fracture in the elderly. Int Orthop [Internet]. 2021;45(7):1775–81. https://doi.org/10.1007/s00264-021-05050-0.

Marin R, Feltri P, Ferraro S, Ippolito G, Campopiano G, Previtali D, et al. Impact of tuberosity treatment in reverse shoulder arthroplasty after proximal humeral fractures: a multicentre study. J Orthop Sci off J Japanese Orthop Assoc. 2023;28(4):765–71.

Google Scholar 

Fischer J, Welter J, Horn N, Graber S, Pape H-C, Jaberg L, et al. Is malunion of the greater tuberosity after reverse shoulder arthroplasty in patients with complex proximal humerus fracture associated with worse clinical outcomes? A prospective cohort study. Arch Orthop Trauma Surg. 2023;143(11):6527–33.

Article  PubMed  Google Scholar 

Miquel J, Santana F, Palau E, Vinagre M, Langohr K, Casals A et al. Retaining or excising the supraspinatus tendon in complex proximal humeral fractures treated with reverse prosthesis: a biomechanical analysis in two different designs. Arch Orthop Trauma Surg [Internet]. 2018;138(11):1533–9. https://doi.org/10.1007/s00402-018-3016-8.

Bonnevialle N, Ohl X, Clavert P, Favard L, Frégeac A, Obert L, et al. Should the supraspinatus tendon be excised in the case of reverse shoulder arthroplasty for fracture? Eur J Orthop Surg Traumatol. 2020;30(2):231–5.

Article  PubMed  Google Scholar 

Siebenbürger G, Fleischhacker E, Gleich J, Helfen T, Böcker W, Ockert B. Supraspinatus Tenotomy in Reverse Shoulder Arthroplasty for fractures: a comparative cohort study. Geriatr Orthop Surg Rehabil. 2021;12:21514593211019972.

Article  Google Scholar 

• He SK, Liao JP, Guo JH, Huang FG. Fracture-Dedicated Prosthesis Promotes the Healing Rate of Greater Tuberosity in Reverse Shoulder Arthroplasty: A Meta-Analysis. Front Surg. 2021;8(December):1–14. This meta-analysis shows that the healing rate of the tuberosities with fracture-specific stems is much higher than conventional stems. This better healing rate has a direct impact on functional results.

Onggo JR, Nambiar M, Onggo JD, Hau R, Pennington R, Wang KK. Improved functional outcome and tuberosity healing in patients treated with fracture stems than nonfracture stems during shoulder arthroplasty for proximal humeral fracture: a meta-analysis and systematic review. J Shoulder Elb Surg. 2021;30(3):695–705.

Article  Google Scholar 

Claro R, Ribau A, Fonte H, Amorim-Barbosa T, Barros LH, Sevivas N. Improved outcomes of older patients with acute and displaced proximal humerus fractures treated with window bone ingrowth fracture-specific stem reverse shoulder arthroplasty. BMC Geriatr [Internet]. 2023;23(1):1–10. https://doi.org/10.1186/s12877-023-04210-8.

• Rossi LA, Tanoira I, Ranalletta M, Kunze KN, Farivar D, Perry A et al. Cemented vs. uncemented reverse shoulder arthroplasty for proximal humeral fractures: a systematic review and meta-analysis. J shoulder Elb Surg. 2022;31(3):e101–19. In general, better (but discrete) functional results and tuberosity healing rate with uncemented stems. The complication rate, on the other hand, is higher, although the revision rate is similar.

Kao DS, Protzuk OA, O’Connell RS. Clinical outcomes of cemented vs. uncemented reverse total shoulder arthroplasty for proximal humerus fractures: a systematic review. Eur J Orthop Surg Traumatol. 2023;33(5):2063–8.

Article  PubMed  Google Scholar 

Lopiz Y, García-Fernandez C, Vallejo-Carrasco M, Garriguez-Pérez D, Achaerandio L, Tesoro-Gonzalo C et al. Reverse shoulder arthroplasty for proximal humeral fracture in the elderly. Cemented or uncemented stem? Int Orthop [Internet]. 2022;46(3):635–44. https://doi.org/10.1007/s00264-021-05284-y.

Rossi LA, Guillermina BM, Buljubasich M, Atala N, Tanoira I, Bongiovanni S, et al. Cemented versus uncemented reverse shoulder arthroplasty for acute proximal humeral fractures. J Shoulder Elb Surg. 2022;31(2):261–8.

Article  Google Scholar 

Kramer M, Olach M, Zdravkovic V, Manser M, Jost B, Spross C. Cemented vs. uncemented reverse total shoulder arthroplasty for the primary treatment of proximal humerus fractures in the elderly-a retrospective case-control study. BMC Musculoskelet Disord. 2022;23(1):1043.

Article  PubMed  PubMed Central  Google Scholar 

Parry S, Stachler S, Mahylis J. Lateralization in reverse shoulder arthroplasty: a review. J Orthop. 2020;22:64–7.

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