Cemented vs Uncemented Reverse Shoulder Arthroplasty for Acute Proximal Humeral Fractures

Abstract Background The purposes of this study were: (1) to compare postoperative range of motion (ROM) and functional outcomes in patients with PHFs operated with cemented or uncemented RSA (2) to compare the rate of tuberosity healing between cemented and uncemented stems (3) to determine if there are significant differences in functional outcomes between patients with healed and unhealed tuberosities (4) to compare complications and revisions rates in patients with cemented and uncemented RSA. Methods A cemented reverse shoulder arthroplasty (cRSA) was performed early in the study period which represented a historic cohort (January 2015–January 2017), followed by a transition to the uncemented reverse shoulder arthroplasty (uRSA) later in the study period (February 2017–February 2019). We excluded 22 cases from postoperative evaluation because of fracture sequelae, age Results The mean follow-up was 41 months (range, 24 – 72 months) and the mean age was 74 years (range, 65-84 years). The mean postoperative active elevation and internal rotation, external rotation in abduction and adduction were 1300 (±150), 270 (±5), 280 (±10) and 160 (±6) respectively. The mean postoperative VAS, ASES, Constant and SANE scores were 1.8 (±0.8), 74 (±6), 58 (±11) and 74% (±8) respectively. There were no significant differences in the final ROM and functional scores between the cemented and uncemented groups. The rate of tuberosities healing did not vary significantly in relation to whether the stem was cemented or not. The subgroup of patients with tuberosity healing presented significantly better active elevation, external rotation and Constant scores than the subgroup of patients without tuberosity healing. There were 5 complications (7%), and no cases of aseptic humeral stem loosening Conclusion In the short term (mean 41 months), there were not significant differences in the postoperative ROM, functional outcomes, complications and revisions between patients operated with cemented or uncemented RSA for proximal humeral fractures. Patients with healed tuberosities presented significantly better ROM and functional scores than patients without tuberosity healing. The cementation of the stem did not significantly affect the rate of tuberosity healing.