title: Reverse shoulder arthroplasty for acute proximal humeral fractures in the geriatric patient: results, health-related quality of life and complication rates.
abstract: OBJECTIVE
  Reverse shoulder arthroplasty (RSA) in fractures is especially indicated in patients of advanced age, although the influence of age on functional outcomes, health-related quality of life (HRQoL) and complication rate is unknown. We hypothesized that complication rate would decrease in the geriatric population because of their reduced activity, improving the perceived HRQoL.
  
  
  METHODS
  Retrospective study of 42 patients with proximal humeral fractures treated with RSA, divided into two groups: <80 years (<80y)(n = 16) and ≥80 years (≥80y)(n = 26). The assessment tools used were radiological images (functional outcome) with the Constant-Murley score(CMS); disabilities of the arm, shoulder and hand (DASH) score; and HRQoL with the EQ-5D index. Mean follow-up time was 32.6 months.
  
  
  RESULTS
  Mean CMS adjusted for age and sex (R-CMS) was 68 % ± 29 %. Patients in the ≥80y group had a lower total CMS, 33 vs 64 (p = 0.027). Mean active range of motion at 24 months <80y/≥80y was: forward flexion: 126°/110°; abduction: 117°/105°; external rotation: 22°/20°; and internal rotation: L3/sacrum. Mean EQ-VAS was 74 ± 16 in the <80y group, and 63 ± 12.6 in the ≥80y group. Mean DASH was 29.5 ± 9.2. The EQ-5D "self-care" item in the >80y group was the most affected. The "pain/discomfort" item was lower for the two age groups than for the reference population. There were 9.5 % complications: one prosthesis dislocation, one periprosthetic fracture and two surgical wound haematoma.
  
  
  CONCLUSIONS
  Our results indicate that age is a critical factor for RSA success. Lower functional outcomes have been obtained in patients older than 80y, although the EQ-5D results in our sample were similar or even better than the referred population.
  
  
  METHODS
  Level III.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, C/ Cotoblanco 11, 3° A, Majadahonda, 28222, Madrid, Spain. yaizalopiz@gmail.com.
authors.forename: Yaiza
authors.initials: Y
authors.lastname: Lopiz
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, C/ Cotoblanco 11, 3° A, Majadahonda, 28222, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: García-Coiradas
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, C/ Cotoblanco 11, 3° A, Majadahonda, 28222, Madrid, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Serrano-Mateo
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, C/ Cotoblanco 11, 3° A, Majadahonda, 28222, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: García-Fernández
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, C/ Cotoblanco 11, 3° A, Majadahonda, 28222, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Marco
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome
keywords: EQ-5D; HRQol; Proximal humeral fracture; RSA; Reverse total shoulder arthroplasty