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International Orthopaedics

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01-04-2016 | Original Paper

Reverse shoulder arthroplasty for acute proximal humeral fractures in the geriatric patient: results, health-related quality of life and complication rates

Authors: Yaiza Lopiz, Javier García-Coiradas, Laura Serrano-Mateo, Carlos García-Fernández, Fernando Marco

Published in: International Orthopaedics | Issue 4/2016

Abstract

Purpose

Reverse shoulder arthroplasty (RSA) in fractures is especially indicated in patients of advanced age, although the influence of age on functional outcomes, health-related quality of life (HRQoL) and complication rate is unknown. We hypothesized that complication rate would decrease in the geriatric population because of their reduced activity, improving the perceived HRQoL.

Methods

Retrospective study of 42 patients with proximal humeral fractures treated with RSA, divided into two groups: <80 years (<80y)(n = 16) and ≥80 years (≥80y)(n = 26). The assessment tools used were radiological images (functional outcome) with the Constant-Murley score(CMS); disabilities of the arm, shoulder and hand (DASH) score; and HRQoL with the EQ-5D index. Mean follow-up time was 32.6 months.

Results

Mean CMS adjusted for age and sex (R-CMS) was 68 % ± 29 %. Patients in the ≥80y group had a lower total CMS, 33 vs 64 (p = 0.027). Mean active range of motion at 24 months <80y/≥80y was: forward flexion: 126°/110°; abduction: 117°/105°; external rotation: 22°/20°; and internal rotation: L3/sacrum. Mean EQ-VAS was 74 ± 16 in the <80y group, and 63 ± 12.6 in the ≥80y group. Mean DASH was 29.5 ± 9.2. The EQ-5D “self-care” item in the >80y group was the most affected. The “pain/discomfort” item was lower for the two age groups than for the reference population. There were 9.5 % complications: one prosthesis dislocation, one periprosthetic fracture and two surgical wound haematoma.

Conclusions

Our results indicate that age is a critical factor for RSA success. Lower functional outcomes have been obtained in patients older than 80y, although the EQ-5D results in our sample were similar or even better than the referred population.

Level of Evidence: Level III

Neer CS (1970) Displaced proximal humerus fractures: part 1. Classification and evaluation. J Bone Joint Surg Am 52A:1077–1089

Mansat P, Bonnevialle N (2015) Treatment of fracture sequelae of the proximal humerus: anatomical vs reverse shoulder prosthesis. Int Orthop 39:349–45. doi:10.1007/s00264-014-2651-0 CrossRefPubMed

Nikola C, Hrvoje K, Nenad M (2015) Reverse shoulder arthroplasty in acute fractures provides better results than in revision procedures for fracture. Int Orthop 39:343–348. doi:10.1007/s00264-014-2649-7 CrossRefPubMed

Boyle MJ, Youn SM, Frampton CM, Ball CM (2013) Functional outcomes of reverse shoulder arthroplasty compared with hemiarthroplasty for acute proximal humeral fractures. J Shoulder Elbow Surg 22(1):32–37. doi:10.1016/j.jse.2012.03.006 CrossRefPubMed

Bufquin T, Hersan A, Hubert L, Massin P (2007) Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly: a prospective review of 43 cases with a short-term follow-up. J Bone Joint Surg (Br) 89(4):516–520. doi:10.1302/0301-620x.89b4.18435 CrossRef

Cazeneuve JF, Cristofari DJ (2011) Long term functional outcome following reverse shoulder arthroplasty in the elderly. Orthop Traumatol Surg Res 97(6):583–589. doi:10.1016/j.otsr.2011.03.025 CrossRefPubMed

Gallinet D, Adam A, Gasse N, Rochet S, Obert L (2013) Improvement in shoulder rotation in complex shoulder fractures treated by reverse shoulder arthroplasty. J Shoulder Elbow Surg 22(1):38–44. doi:10.1016/j.jse.2012.03.011 CrossRefPubMed

Gallinet D, Clappaz P, Garbuio P, Tropet Y, Obert L (2009) Three or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis: a comparative study of 40 cases. Orhop Traumatol Surg Res 95(1):48–55. doi:10.1016/j.otsr.2008.09.002 CrossRef

Klein M, Juschka M, Hinkenjann B, Scherger B, Ostermann PA (2008) Treatment of comminuted fractures of the proximal humerus in elderly patients with the Delta III reverse shoulder prosthesis. J Orthop Trauma 22(10):698–704. doi:10.1097/BOT.0b013e31818afe40 CrossRefPubMed

10.

Sirveaux F, Navez GN, Favard L et al (2006) Reverse prosthesis for acute proximal humerus fracture, the multicentric study. In: Walch G, Goileau P, Mole D et al (eds) Reverse shoulder arthroplasty, clinical results-complications-revision. Sauramps Medical, Montpellier, pp 73–80

11.

Valenti P, Katz D, Kilinc A, Elkholti K, Gasiunas V (2012) Mid-term outcome of reverse shoulder prostheses in complex proximal humeral fractures. Acta Orthop Belg 78(4):442–449PubMed

12.

Young SW, Segal BS, Turner PC, Poon PC (2010) Comparison of functional outcomes of reverse shoulder arthroplasty versus hemiarthroplasty in the primary treatment of acute proximal humerus fracture. ANZ J Surg 80:789–793. doi:10.1111/j.1445-2197.2010.05342.x CrossRefPubMed

13.

Dubert T, Voche P, Dumontier C, Dinh A (2001) The DASH questionnaire. French translation of a trans-cultural adaptation. Chir Main 20:294–302. doi:10.1016/s1297-3203(01)00049-x CrossRefPubMed

14.

Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMed

15.

Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198CrossRefPubMed

16.

Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Molé D (2004) Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff: results of a multicentre study of 80 shoulders. J Bone Joint Surg (Br) 86-B:388–395. doi:10.1302/0301-620x.86b3.14024 CrossRef

17.

Blonna D, Scelsi M, Marini E, Bellato E, Tellini A, Rossi R, Bonasia DE, Castoldi F (2012) Can we improve the reliability of the Constant-Murley score? J Shoulder Elbow Surg 21(1):4–12. doi:10.1016/j.jse.2011.07.014 CrossRefPubMed

18.

Fialka C, Oberleitner G, Stampfl P, Brannath W, Hexel M, Vécsei V (2005) Modification of the constant-Murley shoulder score-introduction of the individual relative constant score individual shoulder assessment. Injury 36(10):1159–1165. doi:10.1016/j.injury.2004.12.023 CrossRefPubMed

19.

Brooks R (1996) EuroQol: the current state of play. Health Policy 37:53–72CrossRefPubMed

20.

The EuroQol Group (1990) EuroQol – a new facility for the measurement of health-related quality of life. Health Policy 16(3):199–208. doi:10.1016/0168-8510(90)90421-9 CrossRef

21.

Badia X, Roset M, Montserrat S, Herdman M, Segura A (1999) La versión española del EuroQol: descripción y aplicaciones. Med Clin 112(1):79–86

22.

Herdman M (2000) La medición de la calidad de vida relacionada con la salud. Med Clin 114(3):22–25

23.

Kontakis G, Tosounidis T, Galanakis I, Megas P (2008) Prosthetic replacement for proximal humeral fractures. Inj Int J Care Injured 39(12):1345–1358. doi:10.1016/j.injury.2008.09.003 CrossRef

24.

Wang J, Zhu Y, Zhang F, Chen W, Tian Y, Zhang Y (2015) Meta-analysis suggests that reverse shoulder arthroplasty in proximal humerus fractures is a better option than hemiarthroplasty in the elderly. Int Orthop. doi:10.1007/s00264-015-281-x

25.

Cazeneuve JF, Cristofari DJ (2009) Delta III reverse shoulder arthroplasty: radiological outcome for acute complex fractures of the proximal humerus in elderly patients. Orthop Traumatol Surg Res 95(5):325–329. doi:10.1016/j.otsr.2009.03.018 CrossRefPubMed

26.

Levy JC, Badman B (2011) Reverse shoulder prosthesis for acute four-part fracture: tuberosity fixation using a horseshoe graft. J Orthop Trauma 25(5):318–324. doi:10.1097/bot.0b013e3181f22088 CrossRefPubMed

27.

Cazeneuve JF, Cristofari DJ (2010) The reverse shoulder prosthesis in the treatment of fractures of the proximal humerus in the elderly. J Bone Joint Surg (Br) 92(4):535–539. doi:10.1302/0301-620X.92B4.22450 CrossRef

28.

Boileau P, Winter M, Cikes A, Han Y, Carles M, Walch G et al (2013) Can surgeons predict what makes a good hemiarthroplasty for fracture? J Shoulder Elbow Surg 22(11):1495–1506. doi:10.1016/j.jse.2013.04.018 CrossRefPubMed

29.

Kabir K, Burger C, Fischer P, Weber O, Florczyk A, Goost H et al (2009) Health status as an important outcome factor after hemiarthroplasty. J Shoulder Elbow Surg 18(1):75–82. doi:10.1016/j.jse.2008.06.008 CrossRefPubMed

30.

Kralinger F, Schwaiger R, Wambacher M, Farrell E, Menth-Chiari W, Lajtai G et al (2004) Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients. J Bone Joint Surg (Br) 86:217–219. doi:10.1302/0301-620x.86b2.14553 CrossRef

31.

Wretenberg P, Ekelund A (1997) Acute hemiarthroplasty after proximal humerus fracture in old patients. A retrospective evaluation of 18 patients followed for 2–7 years. Acta Orthop Scand 68:121–123CrossRefPubMed

32.

Garrigues G, Johnston P, Pepe M, Tucker BS, Ramsey ML, Austin LS (2012) Hemiarthroplasty versus reverse total shoulder arthroplasty for acute proximal humerus fractures in elderly patients. Orthopedics 35(5):e703–e708. doi:10.3928/01477447-20120426-25 CrossRefPubMed

33.

Reitman RD, Kerzhner E (2011) Reverse shoulder arthroplasty as treatment for comminuted proximal humeral fractures in elderly patients. Am J Orthop (Belle Mead NJ) 40(9):458–461

34.

Lenarz C, Shishani Y, McCrum C, Nowinski RJ, Edwards TB, Gobezie R (2011) Is reverse shoulder arthroplasty appropriate for the treatment of fractures in the older patient? Clin Orthop Relat Res 469:3324–3331. doi:10.1007/s11999-011-2055-z CrossRefPubMedPubMedCentral

35.

Cazeneuve JF, Cristofari DJ (2006) Grammont reversed prosthesis for acute complex fracture of the proximal humerus in an elderly population with 5 to 12 years follow-up. Rev Chir Orthop Reparatrice Appar Mot 92(6):543–548. doi:10.1016/s0035-1040(06)75911-6 CrossRefPubMed

36.

Zumstein MA, Pinedo M, Old J, Boileau P (2011) Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 20(1):146–157. doi:10.1016/j.jse.2010.08.001, ReviewCrossRefPubMed

37.

García-Fernández C, Lópiz-Moralez Y, Rodríguez A, López-Durán L, Marco-Martínez F (2015) Periprosthetic humeral fractures associated with reverse total shoulder arthroplasty: incidence and management. Int Orthop. doi:10.1007/s00264-015-2972-7 PubMed

38.

Scarlat MM (2013) Complications with reverse total shoulder arthroplasty and recent evolutions. Int Orthop 37(5):843–851. doi:10.1007/s00264-013-1832-6 CrossRefPubMedPubMedCentral

39.

Wall B, Nové-Josserand L, O’Connor DP, Edwards TB, Walch G (2007) Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am 89(7):1476–1485CrossRefPubMed

Title: Reverse shoulder arthroplasty for acute proximal humeral fractures in the geriatric patient: results, health-related quality of life and complication rates
Authors: Yaiza Lopiz
Javier García-Coiradas
Laura Serrano-Mateo
Carlos García-Fernández
Fernando Marco
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 4/2016
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-015-3085-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Reverse shoulder arthroplasty for acute proximal humeral fractures in the geriatric patient: results, health-related quality of life and complication rates

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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