Abstract
The aim of this retrospective and mono centric study is to expose results and complications of the reverse concept in the elderly in case of trauma. We therefore ask whether clinically the patients recover a pre-broken state, whether the radiological follow-up shows critical images and whether the rate of complications is important.
We reviewed the outcome of forty-two patients operated consecutively by the same surgeon at a mean follow-up of 9.1 years (range, 1–19 years). There were four men and thirty-eight females, mean age 75 (range, 58–92 years), with 28 complex four-part fractures and 14 fracture-dislocations. There was no re-fixation of the tubercles because of a poor bone quality.
Six complications occurred: 2 complex sympathetic dystrophies treated by medication, 2 early dislocations (one superior because of an impingement in adduction between the humeral stem and the remnants of the tubercles solved by their ablation without further problems and one anterior caused by the voluntary 10° ante-version of the humeral component to improve internal rotation leading to the reorientation of the stem), 1 deep infection solved by debridement and drainage for an early postoperative Acinetobacter infection without further problems and one aseptic loosening of the base-plate with a broken screw and no wear at 12-year follow-up leading to implant a classic base-plate because of a fair bone stock and efficient primary grip after impaction.
The mean Constant score dropped from 55 at one year to 52 (20 to 84) at last revision which represented 67% of the mean score for the injured side. Mean adjusted Constant score was 68. Only 58% of the patients were satisfied or very satisfied because of poor rotations avoiding nourishment with utensils, dressing andpersonal hygiene. When the dominant arm was affected, the patients lost frequently their autonomy.
Two patients with 42-mm glenospheres had complete 2-mm radiolucent lines at four- and eight-year follow-up. Inferior spurs were seen in 15 cases (35%). They were stable after emergence without functional impact or radiographic evolution. They appeared at a mean of 2.5 years (range, 1–6 years). Scapular notching was seen in 23 cases (55% of the patients), all appeared before two-year follow-up. Eleven notches were stable with a sclerotic border and without critical humeral images. Twelve were progressive with a proximal humeral bone loss (n = 7) or a radiolucent line (n = 5). In these cases, there was a negative effect on the Constant score: 41 points instead of 57 for notches without critical images.
Our experience reported in the present study has somewhat weakened our enthusiasm for this procedure. 42% of the patients were unsatisfied because of poor rotations and the functional results were never equal to the pre-injury state. 33% of the radiological images found were critical. 14% of the patients had a severe complication. Such results do not allow us to validate in the long-term the concept of RSA in recent trauma of proximal humerus. So nowadays, our elective indication is a woman for a non-dominant arm, over seventy years old with poor physiology and important osteoporosis.
