Prior surgical fixation of proximal humerus fractures is associated with increased complications following subsequent reverse shoulder arthroplasty |
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| Affiliation: | 1. Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA;2. Southern Oregon Orthopaedics, Medford, OR, USA;1. Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore;2. Department of Orthopaedic Surgery, Singapore General Hospital, Singapore;3. Mount Elizabeth Medical Centre, Singapore;4. Mayo Clinic, Rochester, MN, USA;1. Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA;2. Boston Sports and Shoulder Center, Waltham, MA, USA;3. MedStar Union Memorial Hospital, Baltimore, MD, USA;1. Orthopaedics Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Ontario, Canada;2. Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada;3. Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Ontario, Canada;4. Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada;5. Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada;1. Michigan State University, Department of Orthopaedic Surgery, East Lansing, MI, USA;2. University of Illinois at Chicago College of Medicine, Chicago, IL, USA;3. Wayne State University School of Medicine, Detroit, MI, USA;4. Steadman Philippon Research Institute, Vail, CO, USA;5. Mayo Clinic, Department of Orthopedic Surgery, Minneapolis, MN, USA |
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| Abstract: | BackgroundThe objective of this study was to compare complication rates between patients undergoing reverse shoulder arthroplasty (RSA) after a prior open reduction and internal fixation (ORIF) for proximal humerus fracture (PHF) to those undergoing RSA as a primary treatment for PHFs, glenohumeral osteoarthritis, or rotator cuff tear arthropathy (CTA).MethodsPatients who underwent RSA between 2015 and 2020 were identified in the Mariner database. Patients were separated into 3 mutually exclusive groups: (1) RSA for osteoarthritis, rotator cuff tear, or CTA (Control-RSA); (2) RSA as a primary treatment for PHF (PHF-RSA); and (3) RSA for patients with prior ORIF of PHFs (ORIF-RSA). Ninety-day medical and 2-year postoperative surgical complications were identified. In addition, patients in the PHF-RSA group were subdivided into those undergoing RSA for PHF within 3 months of the fracture (acute) vs. those treated greater than 3 months from diagnosis (delayed). Multivariate regression was performed to control for differences in comorbidities and demographics.ResultsA total of 30,824 patients underwent primary RSA for arthritis or CTA, 5389 patients underwent RSA as a primary treatment for a PHF, and 361 patients underwent RSA after ORIF of a PHF. ORIF before RSA was associated with an increased risk of overall revision (odds ratio OR] 2.45, P = .002), infection (OR 2.40, P < .001), instability (OR 2.43, P < .001), fracture (OR 3.24, P = .001), minor medical complications (OR 1.59, P = .008), and readmission (OR 2.55, P = .001) compared with the Control-RSA cohort. RSA as a primary treatment for PHF was associated with an increased risk of 2-year revision (OR 1.60, P < .001), infection (OR 1.51, P < .001), instability (OR 2.84, P < .001), and fracture (OR 2.54, P < .001) in addition to major medical complications (OR 2.02, P < .001), minor medical complications (OR 1.92, P < .001), 90-day emergency department visits (OR 1.26, P < .001) and 90-day readmission (OR 2.03, P < .001) compared with the Control-RSA cohort. The ORIF-RSA group had an increased risk of periprosthetic infection (OR 1.94, P = .002) when compared with the PHF-RSA cohort. There were no differences in medical or surgical complications in the RSA-PHF cohort between patients treated in an acute or delayed fashion.ConclusionRSA following ORIF of a PHF is associated with increased complications compared with patients undergoing RSA for nonfracture indications. Prior ORIF of a PHF is also an independent risk factor for postoperative infection after RSA compared with patients who undergo RSA as a primary operation for fracture. The timing of RSA as a primary operation for PHF does not appear to impact the rates of postoperative medical and surgical complications. |
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| Keywords: | Reverse shoulder arthroplasty Proximal humerus fracture Complications Prosthetic joint infection Cuff tear arthropathy Open reduction and internal fixation |
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