Uncemented versus cemented humeral fixation during reverse total shoulder arthroplasty for proximal humerus fracture

Over time, the use of reverse total shoulder arthroplasty (RTSA) treating proximal humerus fractures (PHFs) and fracture sequelae has grown significantly due to its demonstrated effectiveness over open reduction internal fixation (ORIF) and hemiarthroplasty (HA). Cemented humeral stems have been widely utilized in RTSA for PHF, however cementless alternatives have become increasingly popular. This study seeks to analyze outcomes and complications in patients undergoing RTSA for fracture with uncemented and cemented stems at mid-term follow-up.

Patient records were queried for all patients who underwent reverse total shoulder arthroplasty for fracture with between January 7, 2009 and January 10, 2019 and completed a minimum follow-up of 2 years. Demographics characteristics, post-operative functional measurements, complications, and radiographs were assessed. A 5-year Kaplan-Meier survival analysis was performed.

A total of 23 patients encompassing 11 cemented and 12 uncemented stems met the inclusion criteria. The mean age of the uncemented cohort was 70.0 ± 9.8 years with a mean follow-up of 2.6 ± 1.3 years while the mean age of the cemented cohort was 68.9 ± 9.2 years with a mean follow-up of 2.9 ± 1.1 years. No differences in strength, range of motion, or survival between groups were observed. Two patients in the cemented cohort demonstrated humeral component loosening on follow-up radiographs.

Uncemented and cemented humeral fixation during RTSA for proximal humerus fracture leads to similar outcomes, and thus both are safe and effective methods of achieving humeral fixation in fracture patients.