Background: The optimal treatment for complex proximal humerus fractures (PHFs) lacks consensus, with reverse total shoulder arthroplasty (RTSA) often being a final resort rather than a primary approach. This study aimed to compare outcomes and satisfaction rates of primary RTSA for PHFs versus salvage RTSA for previously unsuccessful treatments. We hypothesized that primary RTSA would yield superior clinical outcomes, functional scores, and patient satisfaction. Methods: A retrospective analysis of RSA procedures between 2011 and 2021 was conducted, focusing on primary RTSA for PHFs or salvage RTSA for failed osteosynthesis. Patients meeting inclusion criteria underwent clinical and radiological follow-up for at least two years. Demographic characteristics, outcomes scores, and range of motion (ROM) were assessed. Results: Of 63 patients, 42 underwent primary RTSA and 21 underwent salvage RTSA. The median follow-up was 50 months. Statistically significant differences favored primary RTSA in forward flexion, abduction, internal rotation, and Constant shoulder score. Patient satisfaction levels did not significantly differ between groups. Complications occurred in 7.15% of primary RTSA cases and 14.28% of salvage RTSA cases. Conclusions: Primary RTSA may yield slightly better outcomes and lower complication rates compared to salvage RTSA. Further prospective studies are necessary to validate these findings.

Introduction: Shoulder arthroplasty, encompassing Total Shoulder Arthroplasty (TSA) and Reverse Shoulder Arthroplasty (RSA), has become an essential treatment for severe glenohumeral arthritis and complex rotator cuff pathologies. This study evaluated and compared clinical outcomes and return-to-sport rates in TSA patients following standard rehabilitation protocol and RSA patients following fast rehabilitation protocol. Material and Methods: This retrospective study analyzed 44 patients (TSA: 13; RSA: 31) treated between 2020 and 2023 with at least 12 months of follow-up. Participants engaged in regular upper-extremity sports preoperatively. Patients in the TSA group followed a standard rehabilitation protocol, whereas those in the RSA group were assigned a new standardized fast rehabilitation protocol. Clinical outcomes were assessed using the Constant-Murley Score (CS), Visual Analogue Scale (VAS) for pain, and return-to-sport rates. Results: TSA patients showed a 100% return-to-sport rate, significantly higher than the 54.84% rate for RSA patients (p < 0.05). Functional outcomes were better in TSA (CS: 81 ± 13.18) compared to RSA (CS: 76.54 ± 8.3, p > 0.05). Within the RSA group, those who resumed sports had significantly higher CS scores (79.59 ± 7.41) than non-returners (73.21 ± 8.64, p < 0.05). Postoperative VAS was similarly low in both groups. Conclusion: TSA patients exhibited superior return-to-sport rates and functional outcomes compared to RSA patients, highlighting TSA's biomechanical advantages.

Background: In revision total knee arthroplasty (rTKA), clinical focus is mainly on the femoral and tibial components, while patellar complications are often underemphasized. However, patellar bone deficiency is a significant issue that can negatively affect surgical outcomes, especially in septic revisions. Objective: This review provides an overview of contemporary approaches to the evaluation and treatment of patellar bone loss in rTKA, emphasizing preoperative planning, classification frameworks, and treatment options. Methods: A narrative review of the literature was conducted. Studies published between 2000 and 2024 addressing preoperative assessment, surgical techniques, and outcomes in the management of patellar bone loss in rTKA were screened. Discussion: A recent consensus has addressed the evaluation, classification, and treatment of significant bone loss after total knee arthroplasty (TKA), providing specific recommendations for the management of patellar bone loss and extensor mechanism involvement in cases of severe bone deficiency. In this review, the principal surgical strategies described in the literature are summarized, including patellar component retention or revision, the use of biconvex inlay and trabecular metal implants, bone grafting, various augmentation techniques, resection arthroplasty, gull-wing osteotomy, and patellectomy. Conclusions: Despite various surgical strategies, no consensus exists on a universally superior approach. Ongoing research is essential to establishing standardized, evidence-based protocols for effective management of patellar bone loss in rTKA.

Proximal humeral bone loss represents a major challenge in both revisions reverse total shoulder arthroplasty (rTSA) and primary arthroplasty for acute complex fractures. When anatomical reconstruction of the tuberosities is not feasible, metaphyseal deficiency compromises implant stability, deltoid wrapping, and functional outcomes. Cementoplasty technique has emerged as a practical and cost-effective method to restore proximal humeral anatomy without the need for structural allografts or custom implants. This study evaluates the functional outcomes of a cementoplasty technique in patients undergoing revision rTSA or primary arthroplasty for acute complex fractures with proximal humeral bone loss ≤5 cm. A single-center retrospective cohort study was conducted on patients treated with cementoplasty between January 2017 and August 2025. Inclusion criteria were isolated proximal humeral bone loss ≤5 cm, intact deltoid function, and ≥6 months of follow-up. All procedures were performed by a single surgeon using a standardized reverse shoulder implant. Clinical outcomes, functional scores, radiographic findings, complications, and implant survivorship were assessed. Statistical analysis was performed using R, RStudio, and Rstatix. Continuous variables were reported as mean ± standard deviation, normality was assessed with the Shapiro–Wilk test, and group comparisons used t-tests or chi-square/Fisher exact tests. Significance was set at P< .05. Thirty-eight shoulders (24 revision rTSA; 14 acute multifragmentary proximal humeral fractures) were included (mean age 74.6 years; mean follow-up 27.3 months). Both groups demonstrated satisfactory recovery with no significant differences in pain, motion, or functional scores. Forward elevation exceeded 110° in both groups, and Constant and American Shoulder and Elbow Surgeons scores were comparable. No stem subsidence, loosening, or migration was observed. Mild nonprogressive radiolucent lines occurred in 10.5% of patients. Three complications (7.9%) were recorded. Implant survivorship was 94.7%. Personalized cementoplasty effectively restores proximal humeral anatomy and provides stable midterm fixation with favorable outcomes and low complication rates. It represents a practical alternative to allografts, metallic augments, or custom implants. Longer-term evaluation is warranted.

Background: Reverse shoulder arthroplasty (RSA) is increasingly employed for managing complex three- and four-part proximal humeral fractures (PHFs) in elderly patients. Tuberosity healing and implant stability remain critical challenges, particularly in uncemented RSA. We describe a novel surgical technique—the “Hug Technique” for uncemented RSA in acute three- and four-part PHFs, designed to preserve metaphyseal bone stock, avoid tuberosity osteotomy, and optimize tuberosity healing. Additionally, we evaluated the functional outcomes of our novel surgical technique. Methods: A single-center retrospective cohort study was conducted on patients treated with the “Hug Technique” between January 2023 and January 2025. Inclusion criteria were acute displaced three- or four-part PHFs, age > 65 years, intact deltoid function, and ≥12 months of follow-up. All procedures were performed by a single surgeon using a standardized reverse shoulder implant. Clinical outcomes, functional scores, radiographic findings, complications, and implant survivorship were assessed. Results: A total of 14 patients were included, with a mean age of 74.8 years and a mean follow-up of 14.2 months. At final follow-up, the mean postoperative Constant score was 68.4, and the mean ASES score was 81.6. Mean active forward flexion reached 132°, external rotation 28°, and internal rotation reached the L3 vertebral level in most patients. Anatomical or consolidated tuberosity healing was observed in 78.5% of cases. No cases of stem loosening were observed. Complications occurred in 2 patients, including one case of deep periprosthetic infection and one case of anterior dislocation. Conclusions: The “Hug Technique” represents a feasible surgical strategy for cementless RSA in complex PHFs. Preliminary clinical and radiographic results appear promising. Further prospective comparative studies are required.