Cow Hitch Cerclage Suture Fixation of the Greater Tuberosity in Reverse Total Shoulder Arthroplasty Performed for Proximal Humerus Fractures: A Retrospective Cohort Study With a Minimum Follow-up of 2 Years.

Abstract

Background: Reverse total shoulder arthroplasty (RTSA) is a well-established treatment option for complex proximal humeral fractures in older patients, with greater tuberosity (GT) healing being critical for achieving optimal clinical outcomes. We compared the clinical and radiological outcomes between 2 GT fixation techniques: the "cow hitch" (CH) cerclage suture fixation technique and conventional suture fixation technique.

Methods: This retrospective cohort study compared 20 consecutive patients who underwent RTSA using the CH cerclage suture fixation technique (CH group) with 29 consecutive patients who underwent RTSA using the conventional suture fixation technique (control group). Radiological healing of the GT was defined as the primary outcome parameter and assessed using standard radiographs at the last follow-up visit. Clinical outcomes were assessed as secondary outcome parameters and measured using the absolute and relative Constant-Murley scores (aCS and rCS), Subjective Shoulder Value (SSV), range of motion (ROM), and patient-reported outcome satisfaction (PROS).

Results: At a mean follow-up at 47 ± 30 (range, 24-120) months, the radiographic findings revealed a 95% healing rate of the GT in the CH group compared with a 66% healing rate in the control group (p = 0.03). No secondary displacement was observed in the CH group, whereas 5 cases (17%) were observed in the control group (p = 0.14). Overall, aCS, rCS, SSV, ROM (flexion, abduction, external rotation), and PROS were significantly higher in the CH group than in the control group (p-values: 0.03, 0.002, 0.004, 0.03, 0.01, 0.01, 0.047, respectively).

Conclusion: Compared with the conventional suture GT fixation technique, the CH cerclage suture fixation technique in RTSA performed for complex proximal humerus fractures resulted in higher healing rates with no secondary displacement of the GT, improved clinical outcomes, and enhanced patient satisfaction.

Level of evidence: Level III (Retrospective cohort study). See Instructions for Authors for a complete description of levels of evidence.