Short-term outcomes of reverse total shoulder arthroplasty for proximal humerus fractures in patients under 70 versus patients 70 and over.
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2025-09
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Background
This study aims to compare the short-term outcomes of reverse total shoulder arthroplasty (rTSA) in patients with proximal humerus fractures stratified by age into young and elderly cohorts.Methods
This retrospective review analyzed patients with a minimum 1-year follow-up who underwent RTSA for proximal humerus fractures, categorizing patients <70 years as young and ≥70 as elderly. The operative and postoperative courses were recorded, including discharge location, range of motion (ROM), and need for revision surgery. Patient-reported outcomes such as Single Assessment Numeric Evaluation (SANE) and Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores were collected. A P value ≤.05 was statistically significant.Results
The study consisted of 52 patients (<70 years, n = 22; ≥70 years, n = 30). The <70 group had a higher ROM in forward flexion (141° ± 26° vs. 123° ± 35°; P = .05). ROM in external rotation (34° ± 14° vs. 35° ± 22°; P = .86) and abduction (102° ± 29° vs. 107° ± 46°; P = .79) were similar between the groups. The revision rate was similar between the 2 groups, at 9.1% in the under-70 cohort and 13.3% in the 70 and over cohort (P = .73). Postoperative PROMIS - upper extremity scores were similar between age groups, with mean scores of 35.0 ± 5.7 for the <70 group and 35.3 ± 8.7 for the ≥70 group (P = .96). There was no statistically significant difference in postoperative PROMIS - Physical Function scores, with mean values of 44.8 ± 10.2 in the <70 group and 37.6 ± 9.3 in the ≥70 group (P = .06). In addition, there was no statistically significant difference in postoperative PROMIS - pain interference scores, with mean values of 55.2 ± 9.6 in the <70 group and 54.2 ± 7.7 in the ≥70 group (P = .78). Postoperative SANE scores demonstrated no significant difference between the younger and older cohorts, with mean scores of 73.7 ± 24.4 and 80.0 ± 11.4, respectively (P = .58).Conclusion
There was no difference in short-term postoperative PROMIS - upper extremity, PROMIS - Physical Function, SANE, ROM in external rotation or abduction, pain, and revision rates between patients <70 and ≥70 undergoing RTSA. However, the <70 RTSA group had higher short-term ROM in forward flexion.Type
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Adu-Kwarteng, Kwabena, Alaowei Y Amanah, Jay M Levin, Eoghan T Hurley, Zachary S Aman, Yaw D Boachie-Adjei, Christopher S Klifto, Oke Anakwenze, et al. (2025). Short-term outcomes of reverse total shoulder arthroplasty for proximal humerus fractures in patients under 70 versus patients 70 and over. JSES international, 9(5). pp. 1603–1607. 10.1016/j.jseint.2025.04.028 Retrieved from https://hdl.handle.net/10161/34797.
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Scholars@Duke
Jay Micael Levin
Yaw Boachie-Adjei
Christopher Scott Klifto
Christopher S. Klifto grew up outside Philadelphia. He graduated from Carnegie Mellon University where he received a degree in Chemical and Biomechanical Engineering. He received his medical degree from Rutgers-Robert Wood Johnson Medical School, and completed his Orthopaedic residency and Hand and Upper Extremity fellowship at NYU- Hospital for Joint Diseases.
Dr. Klifto is an orthopaedic surgeon specializing in upper extremity. He treats orthopaedic conditions for the shoulder and elbow including arthritis, rotator cuff injuries, labral tears, frozen shoulder, sports injuries, fractures, tendon injuries, cubital tunnel syndrome. He treats patients both conservatively and surgically; meeting with each patient, hearing their goals and determining the best plan of care together. He specializes in shoulder surgeries such as reverse total shoulder arthroplasty, anatomic shoulder arthroplasty and shoulder hemiarthroplasty. He also performs rotator cuff repair, shoulder labral reconstruction, and shoulder arthroscopy. He treats upper extremity fractures including shoulder and clavicle, humeral shaft, and elbow injuries. He chose orthopaedics from having injuries himself over the years, so he understands what patients are going through when they see him and treat them with as much compassion and respect as possible. "I am very involved in Research, with a particular focus in the shoulder. The research here at Duke is second to none; the best minds are here in one area, all collaborating and trying to figure out how to get better. The most gratifying part of my job is to see patients get back to the level of activity where they would like to be.”
He is a Clinical Associate Professor at Duke University. He has published articles in nationally recognized publications on many conditions of the upper extremity and continues to actively conduct clinical research and contribute to national textbooks.
Dr. Klifto serves as the division lead of shoulder and elbow surgery at the Durham VA in addition to his clinical practice at Duke Orthopaedics/North Carolina Orthopaedic Clinic.
Dr. Klifto lives in Durham with his wife Meredith, an Ophthalmologist. He has three wonderful daughters (Madeline, Anna, and Grace) and a labradoodle named Goose that are the joys of his life. He enjoys golf, fishing, skiing, tennis, kite boarding and professional and collegiate sports.
Oke Adrian Anakwenze
Complex shoulder and elbow surgeon, researcher and innovator.
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