Reverse Total Shoulder Arthroplasty for Posttraumatic Sequelae

Objectives:The sequelae of proximal humeral fractures can produce severe shoulder dysfunction. We assessed the results of reverse shoulder arthroplasty (RSA) for these complex problems.Design:Retrospective multicenter study.Setting:Tertiary care referral hospitals.Patients:A total of 26 patients were identified who had undergone RSA for the sequelae of proximal humeral fractures. Twenty patients had follow-up beyond 2 years, averaging 44 months (range, 27-97). Patients with revision prosthetic surgery were not included in the study. The average age at surgery was 67 years (range, 31-89).Intervention:All patients underwent RSA. In addition, 4 shoulders required allografts to compensate for bone loss, and 1 shoulder concomitant internal fixation of a humeral shaft nonunion.Main Outcome Measurements:The main outcome measurement was the Neer scale. Pain relief, range of motion, and American shoulder and elbow surgeon and Simple shoulder test shoulder outcome scores were also assessed.Results:Overall results in the 20 patients were considered excellent in 8 shoulders, satisfactory in 6, and unsatisfactory in 6. There was significant improvement in the visual analog pain score to 1.9 (P = 0.005), forward elevation to 137 degrees (P < 0.001), and external rotation to 39 degrees (P = 0.0002). The mean American shoulder and elbow surgeon score was 65 and the mean Simple shoulder test 6. Complications included 1 deep infection, 2 transient brachial plexopathies, and 2 cases of dislocation.Conclusions:Reconstruction of the deformed proximal humerus from fracture sequelae with RSA is complex and often requires advanced surgical techniques. Complications are not infrequent and may require further surgery. Nevertheless, satisfactory results can be achieved in most patients.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.