Reserve Total Shoulder Replacement for Geriatric Three- and Four-part Proximal Humerus Fractures - Propensity Score Matched Comparison to Internal Fixation at 2 Years

Abstract

Introduction: The present study aimed to investigate 2-year results of patients aged >60 years with proximal humerus fractures treated with reverse total shoulder arthroplasty (rTSA) compared with those treated with locking plate internal fixation (IF). We hypothesise that the functional outcome after rTSA is comparable to that after IF. Methods: All patients presenting with proximal humerus fractures undergoing surgical treatment were prospectively recruited. We included only patients with 3- or 4-part anatomical neck of humerus fractures. There were 13 patients treated with rTSA and 30 with IF. All patients followed a protocol-driven rehabilitation programme with outcome assessment at 3, 6, 12, and 24 months. Constant score, quick Disabilities of the Arm Shoulder and Hand (qDASH), range of motion, rate of complications, and revision surgery were recorded and compared. Propensity score matching was used to select 13 matching patients from the IF group according to age and sex. Results: Thirteen rTSA patients were age- and sex-matched with 13 IF patients. At a mean follow-up of 3, 6, 12 and 24 months, average constant shoulder score was 34.7, 51.5, 65.5, and 68.4, respectively, for rTSA and 39.6, 50.1, 58.2, and 63.6, respectively, for IF. Mean qDASH scores were 49.0, 18.2, 7.9, and 5.6, respectively, for rTSA and 31.7, 21.9, 21.5, and 17.4, respectively, for IF. Mean shoulder abduction range was 62.9°, 90.1°, 113.0° and 109.0°, respectively, for rTSA and 71.0°, 85.6°, 90.0° and 93.6°, respectively, for IF. All above findings had no statistically significant difference. There were significantly more complications observed for IF (n=7) than rTSA (n=1) [p=0.015] but a similar rate of re-operations for IF (n=3) and rTSA (n=1) [p=0.297]. Conclusion: The 2-year outcomes of rTSA are comparable to those of IF, with a lower complication rate.