"Trabecular titanium metaglene is associated with improved clinical outcomes in reverse shoulder arthroplasty for proximal humeral fractures in elderly patients".

Abstract

There is currently conflicting evidence regarding the effectiveness of reverse shoulder arthroplasty (RSA) in the treatment of proximal humeral fractures. Trabecular titanium (TT) is a highly porous biomaterial increasingly adopted in joint arthroplasty, particularly in cases with poor bone stock and compromised bone quality. This study aims to evaluate the effectiveness of TT and the clinical and radiological outcomes in the treatment of complex proximal humeral fractures using RSA as the first choice in elderly patients. We evaluated the differences and advantages of outcomes in the use of TT metaglene compared with standard implants. Our study is a retrospective observational comparative analysis of clinical and radiographic short-term results. Reverse shoulder arthroplasty using either a TT metaglene or a standard implant was performed according to international guidelines. Patients were clinically evaluated for range of motion (ROM) and strength of the shoulder; Visual Analogue Scale (VAS), Quick Disability of the Arm Shoulder and Hand score (QuickDASH), and Constant score were used. They were also assessed with radiographs for the presence of glenoid or humeral loosening, radiolucent lines. Data were collected and analyzed using Student's t-test and Pearson's chi-square test. 47 consecutive patients were treated for proximal humeral fractures with RSA. 32 patients were included in clinical and radiographic follow-up. Mean follow-up is 30.8 months ± 5.8 months. At final clinical evaluation, in the overall cohort, the mean VAS score is 2.4 ± 2.1, the mean QuickDASH is 22.6 ± 9.4, and the mean Constant Score is 48 ± 14.2. The mean abduction weight-bearing capacity is 1.9 ± 0.9 kg. Patients treated with TT demonstrated improved shoulder elevation, abduction, strength, and Constant score compared with standard implants. At radiographic evaluation, there were no cases of scapular notching or loosening; complete tuberosity healing and integration were achieved in 12 cases (37.5%). TT metaglene has shown good results at short-term follow-up. No relevant major postoperative complications emerged; it may represent a valuable option for functional recovery in elderly patients and for patients with poor bone stock. The TT implant demonstrates superior clinical results compared with the standard implant. III.