# Comparison of Clinical Outcomes Between Primary and Salvage Reverse Shoulder Arthroplasty for Proximal Humeral Fractures: A Retrospective Study

## TL;DR

This study compares the effectiveness of primary and salvage reverse shoulder arthroplasty for treating proximal humeral fractures, finding similar outcomes but higher risks in salvage cases.

## Contribution

The study provides new comparative clinical data on primary versus salvage reverse shoulder arthroplasty for proximal humeral fractures.

## Key findings

- Salvage RSA showed comparable postoperative range of motion and clinical scores to primary RSA.
- Salvage RSA had significant preoperative-to-postoperative improvements in function and motion.
- Salvage RSA had higher complication rates (14.3%) compared to primary RSA (3.6%).

## Abstract

This study provides a comparative analysis of clinical outcomes between primary and salvage reverse shoulder arthroplasty (RSA), offering valuable insights into the management of proximal humerus fracture (PHF). To evaluate the outcomes of patients treated with RSA as a primary procedure for acute PHF and to compare these with patients undergoing salvage RSA as a revision procedure for fracture sequelae of PHF.

A retrospective cohort study was conducted on 42 patients undergoing RSA for PHF between December 2014 and April 2022. The primary RSA group (n = 28, mean age 73.8 ± 4.5 years, 66–81 years) included patients with acute fractures, while the salvage RSA group (n = 14, mean age 62.1 ± 12.3 years, 47–83 years) comprised revision cases for fracture sequelae. Active range of motion (ROM), Visual Analog Scale (VAS), Constant score, and American Shoulder and Elbow Surgeons (ASES) scores were assessed for all patients. Outcomes between the two groups were compared, along with radiographic outcomes and complications recorded at each follow‐up. Categorical variables were analyzed using chi‐square or Fisher's exact tests, while continuous variables were compared using independent t‐tests or Mann–Whitney U tests based on data distribution.

At a mean follow‐up of 56 months (24–106 months), no significant differences in gender (p = 0.469) or follow‐up duration (p = 0.087) were observed. The salvage group exhibited comparable postoperative ROM (anterior flexion (AF): 101.4° ± 52.3° vs. 115.9° ± 29.1°; external rotation (ER): 26.4° ± 16.4° vs. 28.8° ± 14.1°; internal rotation (IR): 7 ± 2 vs. 7 ± 2; all p > 0.05) and clinical scores (VAS: 1.6 ± 1.9 vs. 1.2 ± 1.5; Constant: 74.1 ± 23.3 vs. 79.4 ± 15.9; ASES: 81.9 ± 15.4 vs. 84.0 ± 13.8; all p > 0.05) to the primary group. However, the salvage group demonstrated significant preoperative‐to‐postoperative improvements in AF (50.9°, p < 0.001), ER (5.4, p = 0.017), and functional scores (VAS: −4.6; Constant: + 36.9; ASES: + 45.8; all p < 0.05). Complications occurred in 14.3% of salvage cases (2 revisions for periprosthetic fracture and aseptic loosening) versus 3.6% in the primary group. No other major complications such as deep infection, instability, acromial stress fracture, or dislocation were recorded.

RSA achieves comparable functional and radiographic outcomes for both acute PHF and fracture sequelae over 4 years of follow‐up. Salvage RSA provides substantial clinical improvement but carries a higher complication risk, emphasizing the need for meticulous surgical technique and patient selection.

Compare outcomes of primary RSA (acute PHF) versus salvage RSA (fracture sequelae). Retrospective analysis of 42 patients (28 primary, 14 salvage) with > 2‐year follow‐up.