Reverse shoulder arthroplasty for fracture: how does a contemporary lateralized prosthesis compare with a Grammont-style implant?

BACKGROUND

Reverse shoulder arthroplasty is considered for displaced geriatric proximal humerus fractures (PHFs). This study compared clinical and radiographic outcomes of "Grammont-style" medialized and contemporary lateralized implants, hypothesizing that contemporary implants yield greater range of motion and tuberosity healing.

METHODS

This retrospective single-institution case series reviewed 74 shoulders (74 patients) treated for acute PHFs from 2008-2020. Patients received a medialized reverse shoulder arthroplasty (M-rTSA) (Delta Xtend; n = 31) or lateralized reverse shoulder arthroplasty (L-rTSA) prosthesis (ReUnion RFX; n = 43). Outcomes included visual analog scale pain scores, American Shoulder and Elbow Surgeons scores, and range of motion. Tuberosity healing was classified radiographically as anatomic, malunion, nonunion, partial migration, or resorption.

RESULTS

The mean follow-up was 34.2 and 19.9 months for the M-rTSA and L-rTSA groups, respectively, with no significant demographic differences. L-rTSA shoulders demonstrated greater external rotation (45° vs. 31°; P = .02). Healing rates of 48% and 86% were observed for M-rTSA and L-rTSA shoulders, respectively. There were no significant differences in forward elevation, complications, or American Shoulder and Elbow Surgeons or pain scores. Anatomic tuberosity healing was associated with better rotation and pain scores.

CONCLUSION

Lateralized implants were associated with improved tuberosity healing and external rotation compared to Grammont-style implants for acute PHFs. Tuberosity healing was correlated with better clinical outcomes.