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Reverse Total Shoulder Arthroplasty
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Medialized vs. Lateralized Reverse Total Shoulder Arthroplasty for Proximal Humerus Fractures: A Systematic Review

Kara E Holt1, Victoria E Bindi1, Timothy R Buchanan1

  • 1College of Medicine, University of Florida, Gainesville, Florida.

JBJS Reviews
|January 21, 2025
PubMed
Summary

Lateralized reverse shoulder arthroplasty (RSA) implants do not offer significant functional advantages over medialized designs for proximal humerus fractures (PHFs). While lateralized implants showed better greater tuberosity healing, overall functional outcomes were comparable.

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Reconstructive Surgery

Background:

  • Reverse shoulder arthroplasty (RSA) is a common treatment for proximal humerus fractures (PHFs).
  • Lateralized RSA implants have shown benefits in non-traumatic cases, but their impact on PHFs, particularly tuberosity healing, is less understood.
  • Potential for increased tension on the tuberosity fracture site with lateralized components in PHFs necessitates investigation.

Purpose of the Study:

  • To systematically review and meta-analyze clinical outcomes of RSA for PHFs.
  • To compare the effect of medialized versus lateralized implant designs on functional results and tuberosity healing.
  • To determine if implant design influences outcomes in RSA for proximal humerus fractures.

Main Methods:

  • Systematic review adhering to PRISMA guidelines.
  • Searched PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane for relevant clinical studies.
  • Primary outcomes included postoperative range of motion (external rotation, forward elevation, abduction), Constant score, greater tuberosity (GT) healing rate, and complication incidence.

Main Results:

  • Lateralized RSA cohorts (n=478) had higher mean Constant scores (66) than medialized cohorts (n=1,494) (59, p=0.006).
  • No significant differences were found in postoperative external rotation, forward elevation, or abduction between lateralized and medialized designs.
  • The rate of GT healing was significantly higher in lateralized RSAs (88%) compared to medialized RSAs (72%, p < 0.001). Medialized design was associated with lower odds of GT healing (OR=0.27, p=0.007).

Conclusions:

  • Lateralized RSA implants do not provide significant functional benefits over medialized implants in the context of proximal humerus fractures.
  • While lateralized designs may improve tuberosity healing rates, this did not translate to superior overall functional outcomes.
  • Implant design's influence on functional outcomes in RSA for PHFs requires careful consideration, with tuberosity healing being a key factor.