Reverse shoulder prosthesis:

A salvage option when proximal humeral

fractures treatment fails

G. Porcellini

N. Lollino

F. Campi

F. Pegreffi

P. PaladiniUnit of Shoulder Surgery

Cervesi HospitalCattolica - Italy

Reverse shoulder prosthesis: a salvage option when proximal humeral fractures treatment fails

G. Porcellini, N. Lollino, F. Campi, F. Pegreffi, P. Paladini

My disclosure is in the Final Program Book and in the AAOS database.

I have no potential conflicts with this presentation.

Displaced proximal humeral fractures are a real challenge!

Avascular necrosisNonunionArthritisMalunionImplant failure

Revision surgery mandatory

Releave pain

Restore shoulder function

Are the outcomes of a reverse shoulder prosthesis influenced by previous surgery?

Patients and Methods

• 15 Patients with Complex Humeral fractures– Mean age 67 (+/- 2 years)

• Group A– 8 Patients (ORIF)

• Group B– 7 Patients (Cemented Hemi-arthroplasty)

• More than one year from previous surgery– Evaluated scores:

• Constant Score• Flexion• VAS• Dash

Patients and Methods: Inclusion criteria

• Patients with previous hemiarthroplasty:– a) on X-ray and Ultrasound examination:

• - tuberosity resorption;• - radiolucencies around the stem of the

prosthesis• - glenoid and acromial arthritis• - not-reparable rotator cuff deficiency

– b) on clinical examination• - pain in everyday activities;• - ROM extremely limited (pseudoparalytic

shoulder)

Patients and Methods: Inclusion criteria

• Patients with previous ORIF:– a) on x-ray and on ultrasound exam

• - avascular necrosis• - malunion with malposition of the

tuberosities• - nonunion• - not-reparable rotator cuff deficiency

– b) on clinical examination• - pain in everyday activities;• - ROM extremely limited (pseudoparalytic shoulder)

Results

p> 0,05

Results

p> 0,05

Complications

Radial nerve palsy after hemiarthroplasty revision (1 patient)

Radial nerve surgical exploration

Postoperative haematomas (2 patients)

Results

No statistically differences between patients of group A and group B

1 excellent (14,3%) 5 satisfactory (71,4%) 1 unsatisfactory (14,3%)

group A

group B 3 excellent (37,5%) 2 satisfactory (25%) 3 unsatisfactory (37,5%)

Groups did not significantly differ about surgical time. (p>0,05)

Conclusion

Wall B, Nové-Josserand L, O'Connor DP, Edwards TB, Walch G.:Reverse total shoulder arthroplasty: a review of results according to etiology.J Bone Joint Surg Am. (2007) Jul;89(7):1476-1485

Outcomes of revision surgery with reverse shoulder prosthesis

good but less satisfactory than primary reverse implant

Outcomes independent from first treatment !!!

p > 0,05

Reverse shoulder prosthesis:

A salvage option when proximal humeral fractures

treatment fails

G. Porcellini

N. Lollino

F. Campi

F. Pegreffi

P. PaladiniUnit of Shoulder Surgery

Cervesi HospitalCattolica - Italy

THANKS