Shoulder hemiarthroplasty for proximal humeral fractures: analysis of clinical and radiographic outcomes at midterm follow-up: a series of 51 patients.

Shoulder hemiarthroplasty has historically been the gold standard treatment for proximal humeral fractures not suitable to open reduction and internal fixation. In the last decades, reverse shoulder arthroplasty has gained more and more importance. Aim of this study is to retrospectively analyze subjective and objective outcomes of a group of consecutive patients. Fifty-one patients were evaluated with a mean follow-up of 18 months (range 12-60). For all the cases, the same surgical technique was performed in all cases. Range of motion, Constant-Murley score, ponderate Constant-Murley score, visual analog score and a patients' self-assessment scale were calculated. Anatomic tuberosities healing, stem positioning or mobilization were evaluated on postoperative X-rays and follow-up CT-scans. Statistical analysis was performed to calculate a correlation between subjective and objective results. Thirty-five patients (75%) declared to be satisfied of the operated shoulder. The mean CMS was 50 (17-91), the mean pCMS 72 (16-111). The mean forward flexion measured was 98° (40°-170°), the mean external rotation with adducted arm 22° (0°-60°), the mean internal rotation at sacrum (gluteus-T12). Four implants needed revision. Forty-seven stems were correctly positioned; 84.3% of tuberosities was anatomic or low positioned and consolidated in 74.5% of cases. Statistical analysis revealed significant correlation between CMS, pCMS, VAS and subjective satisfaction and between anatomic tuberosities healing and 3-part fractures. HA implant is a valid and reliable technique for the treatment of proximal humeral fracture. From our data, patients' satisfaction depends upon pain relief more than upon restore of function.

Does preoperative subscapularis fatty muscle infiltration really matter in anterosuperior rotator cuff tears repair outcomes? A prospective multicentric study.

INTRODUCTION: Anterosuperior (AS) rotator cuff tear describes a combined tear of the subscapularis and the supraspinatus tendons. We hypothesized that results after AS tendon repairs might be influenced by the size of the subscapularis rupture and the preoperative subscapularis muscle fatty infiltration. METHODS: A prospective multicentric study of 53 AS rotator cuff tears from five centers was performed (January 2008-January 2009). Subscapularis tendon retraction and fatty infiltration were assessed preoperatively. An ultrasonographic healing control was performed 1 year after surgery. RESULTS: Patients were on average 60 years (range, 43-75 years) and were operated on average 16 months (range, 2-72 months) after the beginning of their symptoms. The incidence of AS tears was found to be 18%. Average follow-up was 15 months (range, 12-24). The Constant-Murley (CM) score for the patients with AS ruptures improved significantly from 49 points (range, 35-51 points) preoperatively to 73 points postoperatively (range, 50-95 points)(P=0.0205). CM score gains were 26 for Lafosse group 1 ruptures and 29 for Lafosse group 2 & 3 with pre- and postoperative P values at P<0.0000001 and P<0.000001, respectively. The last follow-up CM score according to the subscapularis fatty infiltration was 70 (range, 48-95) for groups 0-1, 70 (range, 56-87) for group 2, and 56 (range, 53-88) for groups 3-4 with pre- and postoperative P values at P<0.001, P<0.001, and P<0.004, respectively. The global retear rate was 6%. DISCUSSION: Our study showed that the CM score after repairs of AS rotator cuff tears was lower in advanced subscapularis fatty infiltration. However, gains in CM scores were similar whatever the initial subscapularis fatty infiltration. The rate of tendon healing was correlated with subscapularis fatty infiltration. Subscapularis tendon rupture size was not significantly correlated with outcomes. LEVEL OF EVIDENCE: Level III.