Extended proximal humeral cement technique in reverse shoulder arthroplasty

Background: The purpose of this retrospective study was to report outcomes, humeral loosening, and complication rates of reverse shoulder arthroplasty utilizing an extended proximal humeral cement technique. Methods: A total of 60 shoulders in 57 patients underwent reverse shoulder arthroplasty with an extended proximal humeral cement technique. Indications for surgery included rotator cuff tear arthropathy and patients with healed proximal humerus fractures with associated arthritis. The mean follow-up was 4.3 years (range 2.1-8.0) years. Survivorship, complications, radiographic findings, and patient characteristics were collected and analyzed. Results: Stress shielding, as represented by cortical bone resorption, was observed in 59 of 60 (98.3%) shoulders. Radiolucent lines were most commonly observed in the proximal portion of the stem. Scapular notching was observed in 29 of 60 (48.3%) shoulders with 28 of 60 (46.7%) exhibiting grade 1 notching and 1 (1.7%) presenting with grade 2 notching. There were no patients with grade 3 or 4 scapular notching. Partial or complete resorption of the greater tuberosity was observed in 56 of 60 (93.3%) shoulders. No stems were deemed “at risk” for loosening and no subsidence was observed in any patient. There was no correlation between radiolucent lines and scapula notching (P = .0906) or cortical bone resorption and stem size (P = .3907). In addition, there was no correlation between length of follow-up and radiolucent lines or stress shielding (P 0.8762). One revision was performed for infection postoperatively (survivorship of 98.3%). Conclusion: The extended proximal humeral cement technique demonstrated good mid-term survival rates with low complications and no loosening or subsidence. This technique can be considered in scenarios where there is concern for humeral component implant stability.