A systematic review of tuberosity healing and outcomes following reverse shoulder arthroplasty for fracture according to humeral inclination of the prosthesis

Background: Proximal humerus fractures are common in the elderly population and are often treated with reverse shoulder arthroplasty (RSA). The purpose of this systematic review was to compare tuberosity healing and functional outcomes in patients undergoing RSA with humeral inclinations of 135 degrees, 145 degrees, and 155 degrees. Methods: A systematic review was performed of RSA for proximal humerus fracture using Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. Radiographic and functional outcome data were extracted to evaluate tuberosity healing according to humeral inclination. Analysis was also performed of healed vs. nonhealed tuberosities. Results: A total of 873 patients in 21 studies were included in the analysis. The mean age was 77.5 years (range of 58-97) and the mean follow-up was 26.2 months. Tuberosity healing was 83% in the 135 degrees group compared with 69% in the 145 degrees group and 66% in the 155 degrees group (P=.030). Postoperative abduction was highest in the 155 degrees group (P<.001). No significant difference was found in forward flexion, external rotation, or postoperative Constant score between groups. Patients with tuberosity healing demonstrated 18 degrees higher forward flexion (P=.008) and 16 degrees greater external rotation (P<.001) than those with unhealed tuberosities. Conclusion: RSA for fracture with 135 degrees humeral inclination is associated with higher tuberosity healing rates compared with 145 degrees or 155 degrees. Postoperative abduction is highest with a 155 degrees implant, but there is no difference in in postoperative forward flexion, external rotation, or Constant score according to humeral inclination. Patients with healed tuberosities have superior postoperative forward flexion and external rotation than those with unhealed tuberosities. Level of evidence: Level IV; Systematic Review (C) 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.