The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

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

Document Type : RESEARCH PAPER

Authors
Kevin Y. Wang 1
Amil R. Agarwal 2
Matthew J. Best 3
John G. Mawn 1
Pramod Kamalapathy 4
Uma Srikumaran 1
1 Johns Hopkins Department of Orthopedic Surgery, Charter Drive, Columbia, USA
2 Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, Washington DC, USA
3 Massachusetts General Hospital, Department of Orthopedic Surgery, Boston, MA, USA
4 Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA, USA
10.22038/abjs.2022.62599.3045
Abstract
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 90 -day 
complications as well as 2-year and 5-year implant survival between patients undergoing RTSA for CTA 
and patients undergoing RTSA for PHF.
Methods: Patients with at least a 5-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) 9 and 10 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)>30). All-cause revision at the 2-year and 5-year postoperative time intervals were 
assessed. Reimbursements for the surgical care episode up to the 30-day, 90-day, and 1-year postoperative 
intervals were also assessed. Bivariate analysis was performed with a significance set at P<0.05.
Results: In total, 802 PHF patients were matched with 802 CTA patients. Compared to CTA patients, PHF patients 
undergoing RTSA were significantly at increased risk of atrial fibrillation, anemia, and heart failure within 90 days of 
surgery. Notably, there was no significant difference in all-cause revision surgery at 2-year and 5-year postoperative 
intervals or hospital reimbursements at the 30-day, 90-day, and 1-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
Keywords
CTA
PHF
Reverse total shoulder arthroplasty
RTSA
Proximal humeral fractures
Rotator cuff tear arthropathy
Surgical indications
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The Archives of Bone and Joint Surgery
Volume 11, Issue 3
March 2023
Pages 166-172

  • Receive Date 13 January 2022
  • Revise Date 27 August 2022
  • Accept Date 28 August 2022