Tuberosity healing improves functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis

IntroductionReverse shoulder arthroplasty (RSA) is a common treatment for proximal humeral fractures (PHFs) in the elderly. This study evaluates the influence of tuberosity healing (TH) on functional outcome following a 135 degrees humeral inclination RSA for PHFs.MethodsRetrospectively, all patients with an acute PHF treated with a 135 degrees humeral inclination RSA at four centers during a three-year period were followed up. Constant score (CS), TH and glenoid notching were analyzed.ResultsSixty-four of 100 patients (64%) with a mean age of 767 years were available for follow-up at 228 months. The mean-adjusted CS was 72%. TH of the greater tuberosity (GT) was 77% and resulted in significantly improved forward flexion (128 degrees vs. 92 degrees; p=0.003), external rotation (33 degrees vs. 17 degrees; p=0.03) and adjusted CS (78% vs. 54%, p<0.005). GT healing rate was 86% with neutral, 70% with lateralized and 33% with an inferior eccentric glenosphere. TH of the lesser tuberosity was 79%. There was 8% complication and 3% revision rate; implant survival was 100%.ConclusionRSA with 135 degrees humeral inclination for PHFs leads to good functional outcome, reproducible results and a high rate of TH. The short-term revision rate is low. TH is associated with improved ROM and functional outcome.Level of evidenceIII.