Clinical Outcome and Quality of Life after Modular Reverse Total Shoulder Arthroplasty in Comparison with Joint-Preserving Locking Plate Osteosynthesis in Aged Patients: A Retrospective Comparison Study

Abstract

Objectives: Proximal humeral fractures (PHFs) show a high incidence in aged patients. While nondisplaced fractures achieve good results by conservative treatment, surgical procedures are discussed controversially. Next to open reduction and internal fixation (ORIF), the primary use of reverse shoulder arthroplasty (RSA) has become increasingly important. The aim of this study was to investigate the clinical function, activities of daily living (ADL), as well as pain assessment in patients with PHFs, treated by ORIF or RSA.

Methods: A retrospective comparison study was assessed. From November 2011 to March 2016, 34 patients (17 matched pairs) that had undergone either ORIF or RSA of the proximal humerus, were included in this study. Pain was measured by numeric rating scale (NRS). ADL were obtained by Katz-Index and SF-12. Moreover, shoulder function was assessed using the Oxford Shoulder Score (OSS). The maximum range of motion (ROM) was also recorded. From November 2011 to March 2016, 34 patients (17 matched pairs) that had undergone either ORIF (Figure or RSA of the proximal humerus) were included in this study. For statistical analyses, Student’s t-test, Wilcoxon test, and Chi-Quadrat test were used. Statistical significance was indicated with p < 0.05.

Results: Totally 34 patients with an average age of 76.6 years were included. Surgical treatment was performed on average 5.2 days after diagnosis, differing significantly between the two groups (RSA/ORIF: 6.9/3.5 days) The operation time of RSA (97 min) was significantly longer than for ORIF (78 min). Pain assessment, as well as the Katz-Index and the SF-12, showed no significant differences. Moreover, clinical shoulder function showed no significant discrepancies between the two surgical techniques.

Conclusions: Aged patients with PHFs treated with RSA display similar results regarding clinical function, ADL as well as pain perception compared with ORIF. However, revision surgery rate was lower in patients who underwent RSA. Thus, the surgical treatment of PHFs by RSA represents an excellent alternative, especially with regard to an aging patient population.

Keywords

Aged Patients / Locking Plate Osteosynthesis / Osteoporosis / Proximal Humeral Fracture / Reoperation / Reverse Total Shoulder Arthroplasty

References

[1] Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006; 37: 691–697.

[2] Petros RSB, Ribeiro FR, Tenor Junior AC, Brasil Filho R, Filardi Junior CS, Molin DCD. Proximal humerus fracture with locking plate: functional and radiographic results. Acta Ortop Bras. 2019; 27: 164–168.

[3] Neer CS. Four-segment classification of proximal humeral fractures: purpose and reliable use. J Shoulder Elbow Surg. 2002; 11: 389–400.

[4] Neer CS. Displaced proximal humeral fractures: part I. Classification and evaluation. 1970. Clin Orthop. 2006; 442: 77–82.

[5] Handoll HH, Keding A, Corbacho B, Brealey SD, Hewitt C, Rangan A. Five-year follow-up results of the PROFHER trial comparing operative and non-operative treatment of adults with a displaced fracture of the proximal humerus. Bone Jt J. 2017; 99-B: 383–392.

[6] Fjalestad T, Hole MØ, Hovden IAH, Blücher J, Strømsøe K. Surgical treatment with an angular stable plate for complex displaced proximal humeral fractures in elderly patients: a randomized controlled trial. J Orthop Trauma. 2012; 26: 98–106.

[7] Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg. 2011; 20: 747–755.

[8] Maier D, Jaeger M, Izadpanah K, Strohm PC, Suedkamp NP. Proximal humeral fracture treatment in adults. JBJS. 2014; 96: 251–261.

[9] Hanson B, Neidenbach P, de Boer P, Stengel D. Functional outcomes after nonoperative management of fractures of the proximal humerus. J Shoulder Elbow Surg. 2009; 18: 612–621.

[10] Bhandari M, Matthys G, McKee MD. Four part fractures of the proximal Humerus. J Orthop Trauma. 2004; 18: 126–127.

[11] Hirschmann MT, Fallegger B, Amsler F, Regazzoni P, Gross T. Clinical longer-term results after internal fixation of proximal humerus fractures with a locking compression plate (PHILOS). J Orthop Trauma. 2011; 25: 286–293.

[12] Siffri PC, Peindl RD, Coley ER, Norton J, Connor PM, Kellam JF. Biomechanical analysis of blade plate versus locking plate fixation for a proximal Humerus fracture: comparison using cadaveric and synthetic Humeri. J Orthop Trauma. 2006; 20: 547–554.

[13] Jost B, Spross C, Grehn H, Gerber C. Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elbow Surg. 2013; 22: 542–549.

[14] Ricchetti ET, Warrender WJ, Abboud JA. Use of locking plates in the treatment of proximal humerus fractures. J Shoulder Elbow Surg. 2010; 19: 66–75.

[15] Smith AM, Mardones RM, Sperling JW, Cofield RH. Early complications of operatively treated proximal humeral fractures. J Shoulder Elbow Surg. 2007; 16: 14–24.

[16] Lill H, Ellwein A, Katthagen C, Voigt C. Osteoporotic fractures of the proximal humerus. Chir Z Alle Geb Oper Medizen. 2012; 83: 858–865.

[17] Cazeneuve JF, Cristofari D-J. The reverse shoulder prosthesis in the treatment of fractures of the proximal humerus in the elderly. J Bone Joint Surg Br. 2010; 92-B: 535–539.

[18] Ingraham AM, Cohen ME, Raval MV, Ko CY, Nathens AB. Variation in quality of care after emergency general surgery procedures in the elderly. J Am Coll Surg. 2011; 212: 1039–1048.

[19] Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006; 203: 865–877.

[20] Monson K, Litvak DA, Bold RJ. Surgery in the aged population: surgical oncology. Arch Surg. 2003; 138: 1061–1067.

[21] Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short Form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res. 2011; 63: S240–S252.

[22] Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc. 1983; 31: 721–727.

[23] Ware JE, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996; 34: 220–233.

[24] Hudak PL, Amadio PC, Bombardier C, Beaton D, Cole D, Davis A, et al. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and head). Am J Ind Med. 1996; 29: 602–608.

[25] Dawson J, Fitzpatrick R, Carr A. Questionnaire on the perceptions of patients about shoulder surgery. J Bone Joint Surg Br. 1996; 78: 593–600.

[26] Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillmann P, et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma. 2009; 23: 163–172.

[27] Du S, Ye J, Chen H, Li X, Lin Q. Interventions for treating 3-or 4-part proximal humeral fractures in elderly patient: a network meta-analysis of randomized controlled trials. Int J Surg Lond Engl. 2017; 48: 240–246.

[28] Yahuaca BI, Simon P, Christmas KN, Patel S, Gorman RA II, Mighell MA, et al. Acute surgical management of proximal humerus fractures: ORIF vs. hemiarthroplasty vs. reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2020; 29: S32–S40.

[29] Fraser AN, Bjørdal J, Wagle TM, Karlberg AC, Lien OA, Eilertsen L, et al. Reverse shoulder arthroplasty is superior to plate fixation at 2 years for displaced proximal humeral fractures in the elderly: a multicenter randomized controlled trial. J Bone Joint Surg Am. 2020; 102: 477–485.

[30] Klug A, Harth J, Hoffmann R, Gramlich Y. Surgical treatment of complex proximal humeral fractures in elderly patients: a matched-pair analysis of angular-stable plating vs. reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2020; 29: 1796–1803.

[31] Ferreira Neto AA, Malavolta EA, Assunção JH, Trindade EM, Gracitelli MEC. Reverse shoulder arthroplasty: clinical results and quality of life evaluation. Rev Bras Ortop. 2017; 52: 298–302.

[32] Leite LMB, Lins-Kusterer L, Belangero PS, Patriota G, Ejnisman B. Quality of life in patients who have undergone reverse shoulder arthroplasty. Acta Ortopédica Bras. 2019; 27: 269–272.

[33] Lopiz Y, García-Coiradas J, Serrano-Mateo L, García-Fernández C, Marco F. Reverse shoulder arthroplasty for acute proximal humeral fractures in the geriatric patient: results, health-related quality of life and complication rates. Int Orthop. 2016; 40: 771–781.

[34] Handoll H, Brealey S, Rangan A, Keding A, Corbacho B, Jefferson L, et al. The ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation) trial -a pragmatic multicentre randomised controlled trial evaluating the clinical effectiveness and cost-effectiveness of surgical compared with non-surgical treatment for proximal fracture of the humerus in adults. Health Technol Assess. 2015; 19(24):1–280.

[35] Boesmueller S, Wech M, Gregori M, Domaszewski F, Bukaty A, Fialka C, et al. Risk factors for humeral head necrosis and non-union after plating in proximal humeral fractures. Injury. 2016; 47: 350–355.

[36] Mohr J, Bockmann B, Bücking B, Zettl, R, Kühne CA, Ruchholtz S. Plattenosteosynthese von proximalen Humerusfrakturen. Obere Extrem. 2012; 7: 144–149.

[37] Klein M, Juschka M, Hinkenjann B, Scherger B, Ostermann PA. Treatment of comminuted fractures of the proximal humerus in elderly patients with the Delta III reverse shoulder prosthesis. J Orthop Trauma. 2008; 22: 698–704.

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2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.