Acute Reverse Total Shoulder Arthroplasty Treatment for Proximal Humerus Fracture Displays Equal or Superior Outcomes to Delayed Treatment
Kuhlmann NA, Taylor KA, Franovic S, Zuckerman JD, Roche CP, Schoch BS, Wright TW, Flurin PH, Carofino BC, and Muh SJ. Acute Reverse Total Shoulder Arthroplasty Treatment for Proximal Humerus Fracture Displays Equal or Superior Outcomes to Delayed Treatment. Journal of Shoulder and Elbow Surgery 2020; 29(4):e161.
J Shoulder Elbow Surg
Background: Treatment of proximal humerus fractures (PHFs) via reverse total shoulder arthroplasty (RTSA) has shown early promise when compared to historical treatment modalities. Ideal surgical timing remains unclear. The purpose of this study was to compare the outcomes of early versus delayed RTSA for PHF. We hypothesized that acute RTSA would display superior outcomes compared to those receiving delayed surgical intervention. Methods: This multicenter study retrospectively analyzed 142 patients who underwent RTSA for fracture. Patients treated within 4 weeks of injury were placed in the acute group (n=102), and patients treated longer than 4 weeks after injury were placed in the chronic group (n=38). A comprehensive panel of patient reported outcome measures, VAS pain scores, range of motion, and patient satisfaction were evaluated. Results: The acute group had significantly better final follow-up SPADI scores (20.8 ± 23.9 vs. 30.7 ± 31.7) (p<0.05). The acute group demonstrated higher passive external rotation compared to the chronic group (47.8 ± 16.5 vs. 40.4 ± 16.1) (p<0.05). No further differences were detected in other postoperative range of motion measurements, subjective outcomes, or VAS scores. The acute group displayed significantly greater overall improvements (pre vs post) in all range of motion measurements as well as patient-reported outcome and VAS scores. Average follow-up was 51.4 months. Conclusion: Our results suggest that patients treated acutely display similar mid-term outcomes to those who receive delayed treatment. Surgeons may first give consideration to a period of nonoperative treatment.