Outcomes for Reverse Total Shoulder Arthroplasty After Failed Open Reduction Internal Fixation versus Primary Reverse Total Shoulder Arthroplasty for Proximal Humerus Fractures

Abstract Background The purpose of this study is to determine the clinical and radiographic outcomes of reverse total shoulder arthroplasty (RTSA) after failed open reduction internal fixation (ORIF) for proximal humerus fracture (PHF) and compare them to outcomes of primary RTSA for PHF. Methods We performed a retrospective comparative study of patients who underwent RTSA between 2008 and 2015 at our institution by one of two fellowship-trained shoulder and elbow surgeons for an acute PHF or for continued pain or functional limitations following ORIF of a PHF. We compared the American Shoulder and Elbow Surgeons (ASES) scores, Simple Shoulder Test (SST) scores, range-of-motion, and radiographic measurements between cohorts. Results In total, there were 20 patients treated with RTSA after failed ORIF and 30 patients treated acutely with RTSA for PHF. The average ASES score was significantly greater for primary RTSA (82.0±13.5) than for delayed RTSA (64.0±27.2, P=0.016). The average SST score for primary RTSA (69.4%±19.1%) was significantly higher than the average for delayed RTSA (49.1%±8.9%, P=0.020). Forward elevation achieved postoperatively was significantly greater for patients treated with primary RTSA versus those with delayed RTSA (130±31° vs 107±31°, P=0.035). No difference was detected between groups in postoperative external rotation (P=0.152) or internal rotation (P=0.872). In patients with primary RTSA the tuberosities healed in an anatomic position in 70% of the fractures, which was significantly less than for delayed RTSA in which 100% of fractures had anatomic healing of the tuberosities (P=0.007). Conclusions In an elderly population, primary RTSA for PHF resulted in better clinical outcomes compared to RTSA following failed ORIF in this retrospective cohort study. Level of Evidence Level III; Retrospective Comparative Study