Key result
Healed greater tuberosities after reverse shoulder arthroplasty were associated with significantly better Constant scores (MD 8.44) compared to non-healed tuberosities, and fracture-dedicated prostheses yielded higher healing rates (82.7% vs 63.0%).
Why the study?
It was unclear whether greater tuberosity healing affects functional outcomes and shoulder range of motion after reverse shoulder arthroplasty, and whether prosthesis design impacts tuberosity healing rates.
Does a fracture-dedicated prosthesis improve the healing rate of the greater tuberosity and functional outcomes in patients undergoing reverse shoulder arthroplasty for complex proximal humeral fractures?
Meta-Analysis (n=1,005)
Does a fracture-dedicated prosthesis improve the healing rate of the greater tuberosity and functional outcomes in patients undergoing reverse shoulder arthroplasty for complex proximal humeral fractures?
Mean Difference: 8.44 (95% CI 4.24–12.65)
p-value: p=<0.0001
Fracture-dedicated prostheses in reverse shoulder arthroplasty promote greater tuberosity healing, which is associated with improved functional outcomes and range of motion.
GT healing after RSA for PHF improves ROM and Constant scores; supports fracture-dedicated prostheses to increase healing rates.
Introduction: Reverse shoulder arthroplasty (RSA) is becoming popular in the treatment of complex proximal humeral fractures (PHFs). Greater tuberosity healing may influence functional outcomes and range of motion (ROM) of shoulder after RSA. In addition, the design of prosthesis may impact the healing rate of greater tuberosity. The purpose of this study is to know: (1) does the healing of greater tuberosity affect the functional outcomes and ROM of shoulder? and (2) does the design of prosthesis affect the healing rate of greater tuberosity? Materials and Methods: PubMed, Ovid/Embase, and the Cochrane Library were searched for studies comparing the clinical outcomes between the healed groups and the non-healed groups after RSA. Results: For functional outcomes, the results showed that the healed group had better Constant scores (CSs) (p < 0.0001). For ROM, the healed group showed better flexion (p < 0.0001), abduction (p = 0.02), and external rotation (p < 0.00001) of shoulder. For the design of prosthesis, the mean healing rate of greater tuberosity (82.7%) in patients with fracture-dedicated prosthesis was higher than those (63.0%) in patients with standard prosthesis. Subgroup analyses showed that the CS (p = 0.12) and abduction (p = 0.96) of patients using fracture-dedicated prostheses were not different between the healed groups and the non-healed groups. Meta-regression showed that there was no significant relationship between the design of prosthesis and CS (p = 0.312), flexion (p = 0.422), or external rotation (p = 0.776). Conclusion: Our meta-analysis showed that the healed groups could obtain better functional outcomes and ROM than the non-healed groups. In addition, fracture-dedicated prostheses promoted the healing rate of greater tuberosity. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020157276 , PROSPERO: CRD42020157276.
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He et al. (2021) conducted a meta-analysis in Acute proximal humeral fractures (n=1,005). Healed greater tuberosity vs. Non-healed greater tuberosity was evaluated on Constant score (CS) (MD 8.44, 95% CI 4.24-12.65, p=<0.0001). Healed greater tuberosities after reverse shoulder arthroplasty were associated with significantly better Constant scores (MD 8.44) compared to non-healed tuberosities, and fracture-dedicated prostheses yielded higher healing rates (82.7% vs 63.0%).
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