Tagliero Lauren E, Esper Ronda, Sperling John W, Morrey Mark E, Barlow Jonathan D, Sanchez-Sotelo Joaquin
Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
J Shoulder Elbow Surg. 2025 Mar;34(3):828-836. doi: 10.1016/j.jse.2024.05.020. Epub 2024 Aug 14.
Proximal humerus nonunion is a challenging complication of fractures that can be treated surgically with either open reduction internal fixation (ORIF) or reverse total shoulder arthroplasty (RTSA). The few studies published on this subject have shown high rates of complications and revision surgery when RTSA has been performed for proximal humerus nonunion. The purpose of this study was to determine the rates of complications and revision of this procedure at our institution, as well as to identify any variables that may impact risks of complications and reoperations.
A single-institution retrospective review of all patients who underwent RTSA for proximal humerus nonunion between 2005 and 2021 was performed. Nonunion was defined as imaging evidence of lack of union, at least 90 days after the index fracture. Patients with less than 1 year of clinical follow-up were excluded. Fifty patients were included, with the majority being female (78%). The mean age at time of RTSA was 71 (range: 54-86) years and most patients were initially treated nonoperatively (74%). Mean total follow-up was 49 (range: 11-130) months. Demographic and surgical variables were recorded. Primary outcomes were complications and reoperations. Complications were divided into surgical (those directly related to RTSA), or other (those unrelated to RTSA). Secondary outcomes included visual analog scale pain scores and range of motion.
A total of 17 shoulders (34%) sustained complications after revision shoulder arthroplasty, with 10 (20%) requiring reoperation. Six patients (12%) sustained dislocations and 5 (10%) had radiographic evidence of humeral loosening. No variables examined, including nonoperative vs. surgical management of the index fracture, prosthesis type, or management of tuberosities, influenced the risk of dislocation. Survivorship free from reoperation at 2 years was 73%. Younger age at time of RTSA and the presence of diabetes mellitus both increased the risk of reoperation significantly (P = .013 and P = .037, respectively). There was a trend towards increased risk of reoperation in patients who were treated with initial ORIF (hazard ratio = 2.95); however, this did not reach statistical significance (P = .088). Three patients (6%) sustained a periprosthetic fracture after a fall.
RTSA provides improved pain and function for properly selected patients with proximal humerus nonunion. Dislocation, humeral loosening, and reoperation rates remain high when RTSA is performed for nonunion compared to other diagnoses. In this study, younger age and diabetes mellitus increased the odds of reoperation. Every effort must be made to optimize implant stability and humeral component fixation when RTSA is performed for proximal humerus nonunion.
肱骨近端骨不连是骨折的一种具有挑战性的并发症，可通过切开复位内固定术（ORIF）或反式全肩关节置换术（RTSA）进行手术治疗。关于这一主题发表的少数研究表明，当对肱骨近端骨不连进行RTSA手术时，并发症和翻修手术的发生率很高。本研究的目的是确定在我们机构中该手术的并发症和翻修率，并识别任何可能影响并发症和再次手术风险的变量。
对2005年至2021年间所有因肱骨近端骨不连接受RTSA手术的患者进行单机构回顾性研究。骨不连定义为在初次骨折至少90天后缺乏骨愈合的影像学证据。临床随访时间少于1年的患者被排除。纳入50例患者，大多数为女性（78%）。RTSA手术时的平均年龄为71岁（范围：54 - 86岁），大多数患者最初接受非手术治疗（74%）。平均总随访时间为49个月（范围：11 - 130个月）。记录人口统计学和手术变量。主要结局是并发症和再次手术。并发症分为手术相关（与RTSA直接相关）或其他（与RTSA无关）。次要结局包括视觉模拟评分疼痛评分和活动范围。
总共17例肩部（34%）在翻修肩关节置换术后出现并发症，其中10例（20%）需要再次手术。6例患者（12%）发生脱位，5例（10%）有肱骨松动的影像学证据。所检查的任何变量，包括初次骨折的非手术与手术治疗、假体类型或结节处理，均未影响脱位风险。2年无再次手术的生存率为73%。RTSA手术时年龄较小和患有糖尿病均显著增加再次手术的风险（分别为P = 0.013和P = 0.037）。最初接受ORIF治疗的患者有再次手术风险增加的趋势（风险比 = 2.95）；然而，这未达到统计学显著性（P = 0.088）。3例患者（6%）在跌倒后发生假体周围骨折。
对于适当选择的肱骨近端骨不连患者，RTSA可改善疼痛和功能。与其他诊断相比，对骨不连进行RTSA手术时，脱位、肱骨松动和再次手术率仍然很高。在本研究中，年龄较小和糖尿病增加了再次手术的几率。在对肱骨近端骨不连进行RTSA手术时，必须尽一切努力优化植入物稳定性和肱骨组件固定。
