Cementoplasty as an effective surgical strategy for reverse shoulder arthroplasty with contained tuberosity bone loss: clinical midterm outcomes.

Background: 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. Methods: 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 Results: 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%. Conclusion: 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.