Delayed reverse total shoulder arthroplasty for humerus fractures linked with poor results
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SAN DIEGO — Delaying reverse total shoulder arthroplasty for treatment of proximal humeral fractures could result in additional surgery and potentially poor outcomes, according to a presenter.
“The majority of primary reverse total shoulder arthroplasty (RTSA) procedures occur acutely; however, treatment may be delayed for a variety of reasons including inaccessibility to surgical care or an initial attempt at nonoperative treatment,” Henry Seidel, MD, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.
In their retrospective study, Seidel and colleagues analyzed 4,245 acute RTSAs and 892 delayed RTSAs. Acute RTSA was defined as surgery earlier than 4 weeks from injury, while delayed RTSA was defined as surgery later than 4 weeks from injury.
Researchers found patients in the delayed RTSA cohort experienced significantly a higher 1-year revision rate (4.48%) compared with patients treated with acute RTSA (1.74%). According to the abstract, patients in the delayed RTSA group had a 6.05% rate of dislocation, a 2.91% rate of bleeding complications and a 3.36% rate of mechanical complications. In comparison, patients in the acute RTSA group had a 2.8% rate of dislocation, a 1.77% rate of bleeding complications and a 1.91% rate of mechanical complications.
After multivariate analysis, Seidel and colleagues concluded that delayed RTSA was associated with increased risk for revision and dislocation, while no statistically significant differences were found for bleeding complications and mechanical complications.
“Ultimately, this investigation found that the timing of surgery may be an important consideration when counseling patients regarding postoperative expectation,” Seidel said. “The benefit of avoiding surgery all together through nonoperative management should be weighted against the potential risk for increased revision and complications with delayed primary RTSA treatment,” he added.
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Seidel H, et al. Paper 476. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Aug. 31 - Sept. 3, 2021; San Diego.
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