Revision rates and patient-reported outcomes after acute vs. salvage reverse total shoulder arthroplasty for proximal humerus fractures: an analysis from the Dutch Arthroplasty Register
A van Noort, S van der Breggen, AA Macken, TDW Alta, IN Sierevelt, A Karelse, CPJ Visser, MPJ van den Bekerom
Reverse total shoulder arthroplasty (RTSA) is increasingly adopted for the treatment of
displaced proximal humerus fractures (PHFs), particularly in elderly patients and when
reliable fixation with osteosynthesis is unlikely to be achieved. Acute RTSA is performed as
the primary surgical treatment shortly after injury, whereas salvage RTSA is undertaken
after failed initial management, including non-operative treatment or osteosynthesis.
Although salvage procedures are often considered more complex, existing evidence
comparing acute and salvage RTSA remains inconsistent and is largely based on small
cohorts with limited follow-up, leaving long-term implant survival insufficiently understood.
This nationwide registry study uses data from the Dutch Arthroplasty Register (LROI) to
compare implant survival after acute versus salvage RTSA for proximal humerus fractures.
The primary outcome is revision-free implant survival. Secondary outcomes include the
distribution of revision indications and available patient-reported outcome measures. A
subgroup analysis will assess whether outcomes differ between salvage RTSA performed
after non-operative fracture management and salvage RTSA performed after failed
osteosynthesis.
By leveraging large-scale, population-based data with extended follow-up, this study aims
to clarify how treatment timing and prior fracture management relate to revision risk and
long-term implant performance following RTSA. The findings may support more informed,
evidence-based decision-making and help identify patient groups for whom early primary
RTSA may be most appropriate.