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Reverse Total Shoulder Arthroplasty
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Tuberosity Management in Reverse Shoulder Arthroplasty for Proximal Humerus Fractures.

Michael Hachadorian1, Adnan Cutuk, Jonah Hebert-Davies

  • 1From the Department of Orthopedic Surgery, University of Washington, Seattle, WA (Hachadorian), the Department of Orthopaedic Surgery, Veterans Health Administration (Cutuk), Non-Salaried Assistant Clinical Professor, University of California (Cutuk), the Department of Orthopaedic Surgery, University of California, Irvine, CA (Hebert-Davies) and the Department of Orthopedic Surgery, University of California, San Diego, CA (Kent).

The Journal of the American Academy of Orthopaedic Surgeons
|January 19, 2026
PubMed
Summary
This summary is machine-generated.

Reverse shoulder arthroplasty (RSA) offers predictable outcomes for complex proximal humerus fractures (PHFs) in older adults. Achieving tuberosity union after RSA surgery significantly improves patient-reported outcomes and range of motion.

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering

Background:

  • Reverse shoulder arthroplasty (RSA) is increasingly used for displaced three- and four-part proximal humerus fractures (PHFs) in patients over 65.
  • RSA was originally intended for rotator cuff-deficient shoulders but shows benefits in PHFs with tuberosity union.

Purpose of the Study:

  • To review current strategies for optimizing outcomes in patients undergoing RSA for PHFs.
  • To discuss indications, intraoperative decision-making, implant selection, and surgical techniques for RSA in PHFs.

Main Methods:

  • Literature review of studies on reverse shoulder arthroplasty for proximal humerus fractures.
  • Analysis of factors influencing outcomes, including tuberosity union and surgical techniques.

Main Results:

  • Studies indicate improved patient-reported outcomes and range of motion when tuberosity union is achieved after RSA for PHFs.
  • Optimal strategies for maximizing outcomes in PHFs treated with RSA are still under investigation.

Conclusions:

  • RSA is a viable option for complex PHFs in older patients, with tuberosity union being a key factor for success.
  • Further research and standardized techniques are needed to further optimize RSA outcomes for PHFs.