The treatment of proximal humerus nonunions in older patients with reverse shoulder arthroplasty

Introduction: Experience with treating proximal humeral nonunions with reverse total shoulder arthroplasty is limited. We report our results. Patients: Eighteen patients with proximal humeral atrophic nonunion were treated with reverse total shoulder prosthesis. There were 12 women and 6 men, with a mean age of 78.8 years (range, 75-84 years). The mean follow up after reverse arthroplasty was 28 months (range, 24-32 months). Extensive proximal humeral bone loss that was found in six cases was treated adding a proximal humeral allograft. A long humeral stem was always used. Results: The mean Constant score increased from 26% preoperatively to 55% postoperatively (p < 0.0001). The average anterior elevation increased from 35 degrees to 90 degrees (p < 0.0001), abduction from 35 degrees to 85 degrees (p < 0.0001), external rotation from 15 degrees to 30 degrees (p < 0.0001) and internal rotation from 25 degrees to 55 degrees (p < 0.0001). The average subjective shoulder score increased from 10% preoperatively to 50% postoperatively (p < 0.0001). All but 4 patients would undergo the same procedure again if faced with the same problem. Eight patients were very satisfied, 6 satisfied and 4 unhappy with the operation. We had one case of transitory axillary nerve palsy and two cases of infection. Two prosthetic dislocations occurred; they were successfully treated by revision with a larger polyethylene glenosphere of 44 mm. Conclusions: Reverse total shoulder arthroplasty improves function and motion in patients with proximal humeral fracture sequelae. However, the rate of dislocation is high. (C) 2012 Elsevier Ltd. All rights reserved.