Influence of Humeral Component Cement and Bone Grafting on Greater Tuberosity Healing and Functional Outcomes After Reverse Shoulder Arthroplasty for Proximal Humerus Fractures: A Systematic Review and Meta-Analysis.

Autor:	Kaiser AHA; College of Medicine, University of Florida, Gainesville, Florida., Buchanan TR; College of Medicine, University of Florida, Gainesville, Florida., Bindi VE; College of Medicine, University of Florida, Gainesville, Florida., Holt KE; College of Medicine, University of Florida, Gainesville, Florida., Reddy AR; College of Medicine, University of Florida, Gainesville, Florida., Tishad A; College of Medicine, University of Florida, Gainesville, Florida., Hones KM; Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida., Wright JO; Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida., Wright TW; Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida., Schoch BS; Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, Florida., King JJ; Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida., Hao KA; Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida.
Jazyk:	angličtina
Zdroj:	JBJS reviews [JBJS Rev] 2024 Dec 11; Vol. 12 (12). Date of Electronic Publication: 2024 Dec 11 (Print Publication: 2024).
DOI:	e24.00148
Abstrakt:	Background: Reverse shoulder arthroplasty (RSA) is increasingly used in the treatment of displaced proximal humerus fractures (PHFs) with reliable clinical improvement. However, the preferred techniques for humeral stem fixation are varied and may be influenced by patient and injury characteristics, including bone quality and fracture pattern. This systematic review and meta-analysis sought to determine the effect of humeral component cementing and bone grafting on tuberosity healing rates and functional outcomes after RSA for PHFs. Methods: A systematic review was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane were queried for clinical studies on RSA performed for PHFs that reported on the use of cemented humeral stems and autograft bone. The primary outcome was the rate of greater tuberosity healing between the various techniques. Secondarily, the authors compared clinical outcomes including postoperative external rotation, forward elevation, abduction, Constant score, and the incidence of complications and revision surgery. Outcomes were compared based on the use of an uncemented press-fit stem, a fully cemented stem without bone graft, or a partially cemented stem with humeral head autograft (i.e., black and tan technique). Results: Forty-eight studies reporting on 1,797 RSAs were included (mean patient age, 75 years; follow-up, 34 months; 81% female). Tuberosity healing was highest in the uncemented cohort, then the black and tan cohort, and lowest in the cemented cohort (80% vs. 70% vs. 61%, p = 0.006). No significant differences in postoperative range of motion, Constant score, complication rates, or revision rates were found. Conclusion: Uncemented fixation with a press-fit stem was associated with superior greater tuberosity healing rates; however, functional outcomes and complications did not differ among techniques. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B182). (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)
Databáze:	MEDLINE
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