Cemented vs. uncemented reverse shoulder arthroplasty for proximal humeral fractures: a systematic review and meta-analysis

Background The purpose of this systematic review was to compare functional outcomes, complications, and revision rates between cemented and uncemented reverse shoulder arthroplasty (RSA) for proximal humeral fractures (PHF). Methods A systematic search was performed in April 2021 within PubMed, Scopus Web of Science, and Cochrane Library databases for clinical studies reporting outcomes of RSA performed for PHF. Included studies were published in English, had a minimum one-year follow-up, specified whether the humeral stem was cemented (cRSA) or uncemented (ucRSA), and were evidence level I-IV. Data including range of motion (ROM), functional status, American Shoulder and Elbow Surgeons (ASES) score, Constant score, visual analog scale (VAS) score, tuberosity healing, complications, and reoperations were extracted. DerSimonian-Laird random-effects models with subgroup stratification analyses were applied to investigate differences in outcomes between patients with cRSA and ucRSA. Results A total of 45 studies comprising 1,623 patients were included. The overall pooled age was 75.9±3.4 years. Mean follow-up of 34.6 (range, 12–108) months. There were no significant differences in ROM, VAS score, Constant score, rate of tuberosity healing, or reoperation rates between cRSA and ucRSA cohorts. The mean postoperative ASES score in the cRSA cohort (73.9, 95% CI 71.4 – 76.5) was significantly lower than the ucRSA cohort (82.9, 95% CI 75.9 – 90.0, p=0.013). The incidence of postoperative all-cause complications was significantly lower in the cRSA cohort (5.5%, 95% CI 4.0% – 6.9%) compared with the ucRSA cohort (9.7%, 95% CI 4.5% – 14.9%, p=0.044). Conclusion The use of uncemented humeral stems in RSA for PHF confers similar functional results to the use of cemented stems in terms of pain, range of motion, functional scores, and tuberosity healing. Although the rate of complications was significantly higher in the uncemented cohort compared to the cemented cohort (9.7% vs 5.5% respectively), the rate of reoperations was similar between the groups (1.6% vs 1.9% respectively). The uncemented reverse prosthesis seems to be a valid alternative for the management of patients with complex proximal humerus fractures.