A Comparison of Complications and Survivorship after Reverse Total Shoulder Arthroplasty for Proximal Humerus Fracture compared with Cuff Tear Arthropathy

Objectives: Traditionally used to treat rotator cuff tear arthropathy (CTA), reverse total shoulder arthroplasty (RTSA) is becoming increasingly utilized for the treatment of proximal humeral fractures (PHF). The purpose of this study was to use a matched cohort analysis to assess differences in ۹۰ -day complications as well as ۲-year and ۵-year implant survival between patients undergoing RTSA for CTA and patients undergoing RTSA for PHF.Methods: Patients with at least a ۵-year follow-up who underwent primary RTSA for either PHF or CTA were identified in a national database (PearlDiver Technologies) using current procedural terminology (CPT) and international classification of diseases (ICD) ۹ and ۱۰ codes. Patients with a surgical indication of PHF were matched with patients with a surgical indication of CTA based on age, sex, Charlson Comorbidity Index, smoking status, and obesity (body mass index (BMI)>۳۰). All-cause revision at the ۲-year and ۵-year postoperative time intervals were assessed. Reimbursements for the surgical care episode up to the ۳۰-day, ۹۰-day, and ۱-year postoperative intervals were also assessed. Bivariate analysis was performed with a significance set at P<۰.۰۵.Results: In total, ۸۰۲ PHF patients were matched with ۸۰۲ CTA patients. Compared to CTA patients, PHF patients undergoing RTSA were significantly at increased risk of atrial fibrillation, anemia, and heart failure within ۹۰ days of surgery. Notably, there was no significant difference in all-cause revision surgery at ۲-year and ۵-year postoperative intervals or hospital reimbursements at the ۳۰-day, ۹۰-day, and ۱-year postoperative intervals. Conclusion: Preoperative indication appears to be an important driver of healthcare utilization for RTSA, as PHF patients undergoing RTSA have a higher risk of short-term postoperative complications compared to CTA patients. However, there is no difference in hospital reimbursement for the two indications of RTSA, suggesting that current payment modalities may not appropriately adjust for risk based on the surgical indication. Level of evidence: III

کلیدواژه ها:

CTA ، PHF ، reverse total shoulder arthroplasty ، RTSA ، proximal humeral fractures ، rotator cuff tear arthropathy ، surgical indications