High tuberosity healing rate associated with better functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis

Background Reverse shoulder arthroplasty (RSA) is a common treatment for proximal humeral fractures. (PHF) in the elderly. This study evaluates the functional outcome and the influence of. tuberosity healing (TH) following RSA with 135 degrees humeral inclination and a neutral glenosphere without lateralization for PHFs. Methods In this retrospective case series, all patients with an acute PHF treated with primary RSA with 135 degrees humeral inclination and a standard glenosphere without lateralization during a four-year period were followed up. Constant score (CS), patient satisfaction (subjective shoulder value (SSV)), TH and glenoid notching were analyzed. Results 38 patients with a mean age of 77 +/- 8 years were available for follow-up at 34 +/- 5 months. The mean adjusted CS was 61 +/- 9 points. TH of the greater tuberosity (GT) was 82% and resulted in significantly improved abduction (117 degrees vs. 81 degrees; P < 0.001), forward flexion (139 degrees vs. 99 degrees; p < 0.001), external rotation (28 degrees vs. 10 degrees; p = 0.002), CS (65 vs. 41 points; p < 0.001) and patient satisfaction (SSV 79% vs. 48%; p < 0.001). TH of the LT was 87% without affecting internal rotation or overall outcome. The complication- and revision rate was 5%; implant survival was 100%. Scapular notching occurred in 3 (8%) cases (all grade 1). Conclusion RSA with 135 degrees humeral inclination and a standard glenosphere for PHF leads to good functional outcome in combination with a high rate of TH and a low rate of scapular notching. The short-term revision rate is low and the results are predictable and continuous. TH is associated with improved ROM, patient satisfaction and functional outcome.