Short-term outcomes of reverse total shoulder arthroplasty for proximal humerus fractures in patients under 70 versus patients 70 and over

Background

This study aims to compare the short-term outcomes of reverse total shoulder arthroplasty (rTSA) in patients with proximal humerus fractures stratified by age into young and elderly cohorts.

Methods

This retrospective review analyzed patients with a minimum 1-year follow-up who underwent RTSA for proximal humerus fractures, categorizing patients <70 years as young and ≥70 as elderly. The operative and postoperative courses were recorded, including discharge location, range of motion (ROM), and need for revision surgery. Patient-reported outcomes such as Single Assessment Numeric Evaluation (SANE) and Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores were collected. A P value ≤.05 was statistically significant.

Results

The study consisted of 52 patients (<70 years, n = 22; ≥70 years, n = 30). The <70 group had a higher ROM in forward flexion (141° ± 26° vs. 123° ± 35°; P = .05). ROM in external rotation (34° ± 14° vs. 35° ± 22°; P = .86) and abduction (102° ± 29° vs. 107° ± 46°; P = .79) were similar between the groups. The revision rate was similar between the 2 groups, at 9.1% in the under-70 cohort and 13.3% in the 70 and over cohort (P = .73). Postoperative PROMIS - upper extremity scores were similar between age groups, with mean scores of 35.0 ± 5.7 for the <70 group and 35.3 ± 8.7 for the ≥70 group (P = .96). There was no statistically significant difference in postoperative PROMIS – Physical Function scores, with mean values of 44.8 ± 10.2 in the <70 group and 37.6 ± 9.3 in the ≥70 group (P = .06). In addition, there was no statistically significant difference in postoperative PROMIS – pain interference scores, with mean values of 55.2 ± 9.6 in the <70 group and 54.2 ± 7.7 in the ≥70 group (P = .78). Postoperative SANE scores demonstrated no significant difference between the younger and older cohorts, with mean scores of 73.7 ± 24.4 and 80.0 ± 11.4, respectively (P = .58).

Conclusion

There was no difference in short-term postoperative PROMIS – upper extremity, PROMIS – Physical Function, SANE, ROM in external rotation or abduction, pain, and revision rates between patients <70 and ≥70 undergoing RTSA. However, the <70 RTSA group had higher short-term ROM in forward flexion.