Should tuberosities be reattached in patients over 80 years old treated with Reverse Shoulder Arthroplasty after proximal humeral fractures?

Healing rate of tuberosity reattachment seems to be impaired as age increases in patients treated with hemiarthroplasty (HA) in proximal humeral fractures (PHF). Reverse Shoulder Arthroplasty (RSA) has shown better tuberosity healing rate when compared to hemiarthroplasty, but little information is known on how ageing affects tuberosity healing rate. The aim of this study was to evaluate the clinical and radiological outcomes of reverse shoulder arthroplasty after proximal humeral fracture in patients over 80 years old when compared with patients under this age. We performed a retrospective study including 75 consecutive patients treated with a RSA because of a PHF. Patients were divided in two groups according to their age: 50 patients under 80 years and 25 equal or over 80. Constant Score was recorded at 2 years follow-up. Healing rate of greater tuberosity was assessed in AP X-Ray exam. Influence of age, gender, glenosphere size, ASA and scapular notching in tuberosity healing were also analyzed. No significant differences were noted in tuberosity healing between groups, obtaining a 78% healing rate in patients under eighty and 72% in patients over eighty (p=0.07). Clinically relevant differences were noted in mean final Constant Score in patients under the age of 80 (63.55) compared to patients over 80 (57.23) (p=0.02). Functional outcomes of patients over 80, measured according to the Constant Murley Score, were slightly better when tuberosity healed without reaching significance, with a mean value for external rotation of 5.07 vs 4.8 and internal rotation of 5.23 vs 4.1. Gender, laterality, glenosphere size and ASA score had no effect in tuberosity healing. No differences in complication rate were noted between groups. Tuberosity healing in RSA for PHF is not impaired in patients over 80 years old. Functional results in patients over 80 with healed tuberosities are slightly better than in those without healing. Since there are no differences in complication rate and results are slightly better, tuberosity reattachment is recommended in patients over 80 years old treated with a RSA after PHF.