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Uncemented Reverse Total Shoulder Arthroplasty as Initial Treatment for Comminuted Proximal Humerus Fractures

Wright, Jon O., MD1; Ho, Anthony, MD1; Kalma, Jeremy, MD1; Koueiter, Denise, MS1; Esterle, Jason, MD2; Marcantonio, David, MD2; Wiater, J. Michael, MD1; Wiater, Brett, MD1

doi: 10.1097/BOT.0000000000001465
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Objectives: To determine if uncemented implants would provide similar outcomes while avoiding the complications associated with cement in the treatment of elderly patients with proximal humerus fractures (PHFs) with primary reverse total shoulder arthroplasty (RTSA).

Design: Case series

Setting: A single Level I trauma center

Patients/Participants: A prospectively-obtained cohort of 30 patients who underwent uncemented RTSA as initial treatment for a comminuted PHF: 4 male, 26 female; average age 71 ± 11 years.

Intervention: Uncemented reverse total shoulder arthroplasty.

Main Outcome Measures: 1) Radiographic analysis, 2) Postoperative clinical range of motion (ROM), and 3) Functional outcome scores: the American Shoulder and Elbow Surgeons Shoulder (ASES) score and the Simple Shoulder Test (SST) score.

Results: Radiographic analysis showed 97% achieved stable humeral stem fixation and 70% had healing of the tuberosities in anatomic position. Average ROM was 130 ± 31° of forward flexion, 32 ± 18° of external rotation, and internal rotation to the mid-lumbar spine. Average ASES score was 82.0 ± 13.5 (with an average pain rating of 0.8 ± 1.3), and average SST score was 69.4 ± 19.1%.

Conclusions: Our data show that treatment of comminuted PHFs in elderly patients with uncemented RTSA can consistently produce good clinical outcomes with a low rate of complications and suggest that cement may not be necessary for RTSA in the trauma setting.

Level of Evidence: Level IV, Case Series

1Department of Orthopedic Surgery, Beaumont Health, Royal Oak, MI, USA

2Department of Radiology, Beaumont Health, Royal Oak, MI, USA

Corresponding Author: Brett Wiater 3535 W 13 Mile Road Suite 744 Royal Oak, MI 48073 Email: brett.wiater@beaumont.org Phone: 248-898-5000

Conflicts of Interest and Source of Funding: No external funding. J. Michael Wiater reports personal fees from Catalyst OrthoScience, Smith & Nephew, and Zimmer, stock or stock options from Catalyst OrthoScience LLC, Coracoid Solutions, LLC, Mpirik, and Hoolux Medical LLC, and research support from Biomet, DJ Orthopaedics and Zimmer, outside the submitted work. No other authors have conflicts of interest

IRB Approval: Study number 2015-124, approved by the Beaumont Health Institutional Review Board

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