Outcomes at mean 8-year follow-up after reverse total shoulder arthroplasty for failed fracture treatment

Proximal humerus fractures are a common challenge in patients with initial treatment ranging from nonoperative management, to open reduction and internal fixation, to arthroplasty. Initial treatment failure is not uncommon, and revision to reverse total shoulder arthroplasty (rTSA) has emerged as a viable salvage option, though long-term outcomes in these patients are variable and remain underreported. This study aimed to evaluate long-term outcomes and failure rates of rTSA after failed initial proximal humerus management (nonoperative and operative). We hypothesized that rTSA for sequelae of fracture after failed treatment would lead to durable and beneficial outcome as well as a low failure rate.

After institutional review board approval, a retrospective review was conducted of patients who underwent rTSA for sequelae of fracture for failed treatment between 2007 and 2020, with a minimum of 24 months' follow-up. Outcomes included American Shoulder and Elbow Surgeons (ASES), Quick Disabilities of the Arm, Shoulder, and Hand, Single Assessment Numeric Evaluation, 12-Item Short-Form Health Survey (Physical Component Summary/Mental Component Summary), pain scores, range of motion and complication/failure rates. Statistical analyses were performed using paired tests, with significance set at P < .05.

Sixteen shoulders (84.2%) of 15 patients were included in the final analysis. The mean follow-up was 100.8 ± 48.1 months. Significant improvements were observed in ASES (from 45.8 to 69.6; P = .002), Quick Disabilities of the Arm, Shoulder, and Hand (from 47.9 to 29.5; P = .002), daily pain visual analog scale (from 5 to 1; P = .003), and maximum pain visual analog scale (from 8 to 5; P = .01). ASES patient acceptable symptom state and minimal clinically important difference thresholds were achieved by 62.5% and 43.8% of patients, respectively. Also, patient satisfaction was high (median 8/10). External rotation (20.7 ± 18.7 vs. 34.6 ± 19.2; P = .048) and forward flexion (66.3 ± 35.7 vs. 125.7 ± 33.2; P < .001) significantly improved from pre-operatively to post-operatively. The overall complication and failure rates were low (1 case each; 6.3% each).

rTSA performed for sequelae of fracture to failed initial treatment (nonoperative or operative) of proximal humerus fractures was associated with substantial and durable improvement in pain and patient-reported function as well as restoration of range of motion, with a low rate of subsequent construct revision in this cohort. These findings support rTSA for sequelae of fracture as a suitable treatment option when initial management fails in this patient population.