Increased complication rates of salvage reverse total shoulder arthroplasty (RTSA) after failed locked plate fixation compared with primary RTSA in the treatment of proximal humeral fractures in elderly patients

• Published in: Journal of shoulder and elbow surgery 2023-08, Vol.32 (8), p.1574-1583
• Main Authors: Koeppe, Jeanette, Stolberg-Stolberg, Josef, Rischen, Robert, Freistuehler, Moritz, Faldum, Andreas, Raschke, Michael J., Katthagen, J. Christoph
• Format: Article
• Language: English
• Subjects: complication rates; geriatric surgery; health service research; multivariable regression analysis; Proximal humeral fracture; real-world data analysis; reverse total shoulder arthroplasty
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2022.12.020

Common surgical treatment options for proximal humeral fractures in elderly patients include locked plate fixation (LPF) and reverse total shoulder arthroplasty (RTSA). It was hypothesized that secondary RTSA after LPF would be associated with higher complication rates and costs compared with primary RTSA. We analyzed the health insurance data of patients aged ≥65 years who received RTSA for the treatment of a proximal humeral fracture between January 2013 and September 2019 with a pre-study phase of 5 years. Multivariable Cox, logistic, and linear regression models were used to evaluate the association between treatment group and complications, hospital length of stay, charges, and mortality rate during a 34-month follow-up period. A total of 14,220 patients underwent primary RTSA and 1282 patients underwent secondary RTSA after prior surgery using LPF for the treatment of proximal humeral fractures. After adjustment for patient characteristics, more surgical complications were observed after secondary RTSA during index hospitalization (odds ratio, 4.62; 95% confidence interval [CI], 4.00-5.34; P