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Acute vs delayed reverse shoulder arthroplasty had similar outcomes
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NEW YORK — Patients who had proximal humerus fractures treated with acute reverse shoulder arthroplasty had midterm outcomes similar to patients who had delayed treatment, according to results presented at the American Shoulder and Elbow Surgeons Annual Meeting.
Stephanie J. Muh, MD, and colleagues measured patient-reported outcomes, range of motion, complications and radiographic changes in 142 patients with proximal humerus fractures who underwent either acute (n=104) or delayed (n=38) reverse shoulder arthroplasty.
“The acute group had a reverse shoulder arthroplasty within 4 weeks of injury, and the delayed group had a reverse shoulder arthroplasty greater than 4 weeks from injury,” Muh said in her presentation here.
Muh noted Neer classification showed the delayed group had significantly more two-part fractures and the acute group had more three- and four-part fractures. She added patients in the acute group were significantly older, on average, compared with patients in the delayed group.
“However, we still had 82% of our patients who graded their outcomes as better or much better,” Muh said.
The groups also had significant differences in time between fractures and surgery, according to Muh. She noted delay in surgery was not found to be secondary to comorbidities. Muh said abduction, flexion, external rotation and internal rotation were not significantly different between the groups.
“On radiographic findings of radiolucent lines, as well as scapular notching, we also did not find any significant difference,” Muh said. “Finally, the overall complication rate between the two groups appears to be similar.” – by Casey Tingle
Reference:
Kuhlmann NA, et al. Paper 31. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 17-19, 2019; New York.
Disclosure: Muh reports she is a paid consultant for DePuy Synthes, Exactech Inc. and FX Shoulder.
Perspective
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Derek J. Cuff, MD
This retrospective multicenter study examined the use of reverse shoulder arthroplasty to treat proximal humeral fractures in either an acute (within 4 weeks) or delayed (after 4 weeks) fashion. There was a marked difference in the number of patients treated acutely (102 patients) vs. those treated in a delayed manner (38 patients), so the two cohorts were somewhat unbalanced. However, this study demonstrated similar outcomes for patients irrespective of whether or not they were treated in the acute or a delayed timeframe.
The authors conclude that attempting nonoperative treatment initially may not compromise the patients surgical result if they elect for surgery in a delayed fashion due to an unsatisfactory result from the initial nonoperative treatment.
In essence, the authors felt that no “bridges are burned” by trying to initially treat the patients' proximal humerus fracture without surgery, as delayed surgery did not decidedly affect patients’ outcome in a negative manner.
Venice, Florida
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