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Reverse Shoulder Arthroplasty for Proximal Humerus Fractures in Octogenarians: A Propensity-Matched Analysis of Implant Complications
Adam M Gordon, MD, MBA, Jake M Schwartz, MD, Ramin M Sadeghpour, MD; Jack M Choueka, MD
Maimonides Medical Center, Brooklyn, NY
INTRODUCTION: Octogenarian patients are generally characterized by a higher burden of comorbidities and an increased risk of perioperative complications. However, the risk of implant complications, including shoulder dislocations, aseptic loosening, and periprosthetic fractures, may differ between octogenarians (patients ?80 years) and those under 80 years undergoing reverse shoulder arthroplasty (RSA). The purpose of this study was to compare the incidence of implant complications and revision rates following RSA for proximal humerus fractures in octogenarians (patients ?80 years) versus patients under 80 years.
METHODS: A retrospective analysis was performed using a nationwide database (2010-2022). Octogenarian patients (N=1,317) who underwent RSA for proximal humerus fractures were identified and matched to patients < 80 years of age (N= 6,414) in a 1:5 ratio by sex, and comorbidities. Patients were excluded if they had a concurrent infectious etiology, malignancy, or revision involving the proximal humerus. Overall comorbidity burden was assessed between groups by the Elixhauser Comorbidity Index (ECI). Two-year implant complications, including shoulder dislocations, aseptic loosenings, periprosthetic joint infections (PJIs), periprosthetic fractures, and all-cause shoulder arthroplasty revisions, were compared between the two groups. Pearson chi square analyses compared categorical demographic variables. Multivariable logistic regressions were used to compute odds ratios (OR) with 95% confidence intervals (CI) for each implant complication, adjusting for sex, COPD, diabetes mellitus, hypertension, depression, congestive heart failures, obesity, tobacco use. The younger aged cohort were the reference cohort for statistical analyses. A p-value of <0.05 was considered statistically significant.
RESULTS: Both groups of patients who underwent RSA for proximal humerus fractures were appropriately matched with no differences. Octogenarian patients had no difference in overall comorbidity burden (ECI: 7.0 vs. 6.9; P = 0.546) compared to younger aged patients. At 2 year follow-up, there was no significant difference in PJIs (OR: 0.68, P = 0.135), periprosthetic fractures (OR: 1.13, P = 0.820), shoulder dislocations (OR: 0.81, P = 0.355), aseptic loosenings (OR: 1.47, P = 0.177), or revisions (OR: 0.78, P = 0.231) between octogenarians and controls.
DISCUSSION: In conclusion, reverse shoulder arthroplasty appears to be a safe and effective treatment option for proximal humerus fractures in patients aged 80 years and older, with no increased risk of major implant complications or revisions at 2-year follow-up compared to younger patients. These findings support the continued use of RSA in appropriately selected elderly individuals and may aid surgeons in counseling patients and guiding perioperative decision-making.
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