Holt Kara E, Bindi Victoria E, Buchanan Timothy R, Reddy Akshay R, Tishad Abtahi, Desai Persis, Hones Keegan M, Wright Thomas W, Schoch Bradley S, King Joseph J, Hao Kevin A
College of Medicine, University of Florida, Gainesville, Florida.
Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida.
JBJS Rev. 2025 Jan 21;13(1). doi: e24.00160. eCollection 2025 Jan 1.
Reverse shoulder arthroplasty (RSA) is increasingly used in the treatment of proximal humerus fractures (PHFs) with reliable clinical improvement. Lateralized RSA implants have conferred superior outcomes compared with the original Grammont design in patients with nontraumatic indications. However, in the setting of a PHF, lateralized components can place increased tension across the tuberosity fracture site and potentially compromise tuberosity healing and outcomes. This systematic review and meta-analysis sought to determine the effect of implant design on clinical outcomes after RSA for PHFs.
A systematic review was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane were queried for clinical studies on RSA performed for PHFs that reported implant manufacturer details. Our primary outcomes included postoperative external rotation (ER), forward elevation (FE), abduction, Constant score, rate of greater tuberosity (GT) healing, and the incidence of complications compared between medialized vs. lateralized global implant design.
Globally lateralized RSA cohorts (478 RSAs total with cumulative lateral offset achieved through humeral or glenoid lateralization or both humeral and glenoid lateralization) were found to have a greater mean postoperative Constant score compared with globally medialized (medialized glenoid and medialized humerus) RSA cohorts with 1,494 total medialized RSAs (66 vs. 59, p = 0.006), but there was no significant difference regarding mean postoperative ER (30° vs. 22°, p = 0.078), FE (117° vs. 119°, p = 0.708), or abduction (103° vs. 107°, p = 0.377). On meta-regression, neither implant design nor tuberosity status significantly influenced postoperative ER, FE, abduction, or Constant score on meta-regression independent of mean follow-up and age at surgery. The rate of GT healing was greater in lateralized compared with medialized RSAs (88% vs. 72%, p < 0.001). On meta-regression, medialized RSA design was associated with a 73% lower odds of GT healing (odds ratio = 0.27, 95% confidence interval = 0.11-0.68, p = 0.007) independent of mean follow-up and age at surgery.
Lateralized RSA implants conferred no significant functional benefit over medialized implants when used in patients with PHFs.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
反肩关节置换术（RSA）越来越多地用于治疗肱骨近端骨折（PHF），临床疗效可靠。与原始Grammont设计相比，在非创伤性适应症患者中，外偏位RSA植入物的疗效更佳。然而，在PHF的情况下，外偏位组件会增加结节骨折部位的张力，并可能影响结节愈合及预后。本系统评价和荟萃分析旨在确定植入物设计对PHF患者RSA术后临床疗效的影响。
按照系统评价和荟萃分析的首选报告项目指南进行系统评价。检索PubMed/MEDLINE、EMBASE、科学网和Cochrane数据库，查找关于PHF患者RSA的临床研究，这些研究需报告植入物制造商的详细信息。我们的主要结局包括术后外旋（ER）、前屈上举（FE）、外展、Constant评分、大结节（GT）愈合率以及内侧化与外侧化整体植入物设计之间并发症的发生率比较。
发现全球外偏位RSA队列（共478例RSA，通过肱骨或关节盂外偏位或肱骨和关节盂同时外偏位实现累积外偏距）与全球内侧化（关节盂内侧化和肱骨内侧化）RSA队列（共1494例内侧化RSA）相比，术后平均Constant评分更高（分别为66分和59分，p = 0.006），但术后平均ER（30°对22°，p = 0.078）、FE（117°对119°，p = 0.708）或外展（103°对107°，p = 0.377）无显著差异。在meta回归分析中，独立于平均随访时间和手术年龄，植入物设计和结节状态均未显著影响术后ER、FE、外展或Constant评分。外侧化RSA的GT愈合率高于内侧化RSA（88%对72%，p < 0.001）。在meta回归分析中，独立于平均随访时间和手术年龄，内侧化RSA设计与GT愈合几率降低73%相关（优势比 = 0.27，95%置信区间 = 0.11 - 0.68，p = 0.007）。
在PHF患者中使用时，外侧化RSA植入物与内侧化植入物相比，在功能上无显著优势。
治疗性IV级。有关证据级别的完整描述，请参阅作者指南。
