Shoulder arthroplasty for proximal humerus fractures in the elderly: The path from Neer to Grammont

  • Federico A. Grassi | federico.grassi@med.uniupo.it Orthopaedic and Trauma Unit, Department of Health Sciences, University Hospital University of East Piedmont, Novara, Italy.
  • Riccardo Alberio Orthopaedic and Trauma Unit, Department of Health Sciences, University Hospital University of East Piedmont, Novara, Italy.
  • Chiara Ratti Orthopaedic and Trauma Unit, Department of Medicine, Surgery and Health Sciences, University Hospital University of Trieste, Italy.
  • Michele F. Surace Interdisciplinary Research Centre for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
  • Piero Piazza Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Piermarco Messinese Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Maristella F. Saccomanno Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Giulio Maccauro Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Luigi Murena Orthopaedic and Trauma Unit, Department of Medicine, Surgery and Health Sciences, University Hospital University of Trieste, Italy.

Abstract

Shoulder replacement is indicated for the surgical treatment of proximal humeral fractures in elderly patients, when severe comminution and osteoporosis jeopardize the chances of success of any fixation technique. Two different implants are available for this purpose: anatomical hemiarthroplasty (HA) and reverse total shoulder arthroplasty (RTSA). HA for fractures was popularized by Charles Neer in the ‘50s and for several decades remained the only reliable implant for these injuries. However, many authors reported inconsistent results with HA as a consequence of the high rate of tuberosity and rotator cuff failure. In 1987, Paul Grammont designed the first successful RTSA, which was the end result of a long thought process on functional surgery of the shoulder. This implant was initially used to treat cuff tear arthropathy and shoulder pseudoparalysis, but indications have gradually expanded with time. Since RTSA does not rely on a functional cuff for shoulder elevation, it was felt that results in fractures could be improved by this prosthesis. In this study, the salient features of these implants are described to understand the rationale behind both approaches and highlight their pros and cons. Several clinical studies comparing HA vs RTSA for proximal humeral fractures have been published during the last two decades. A literature review is carried out to analyze and compare outcomes of both implants, analyzing clinical results, radiographic findings and complications. The final goal is to provide an overview of the different factors to consider for making a choice between these two prostheses.

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Published
2020-06-25
Keywords:
Shoulder hemiarthroplasty, reverse shoulder arthroplasty, proximal humeral fractures, osteoporosis, elderly.
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How to Cite
Grassi, F. A., Alberio, R., Ratti, C., Surace, M. F., Piazza, P., Messinese, P., Saccomanno, M. F., Maccauro, G., & Murena, L. (2020). Shoulder arthroplasty for proximal humerus fractures in the elderly: The path from Neer to Grammont. Orthopedic Reviews, 12(1s). https://doi.org/10.4081/or.2020.8659

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