ArticleJSES international2026
Does excessive lateralization influence tuberosity healing in reverse total shoulder arthroplasty for proximal humeral fractures?
Article in JSES international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: This study evaluated the influence of stem global lateralization on tuberosity consolidation and functional outcomes in patients undergoing reverse total shoulder arthroplasty (rTSA) for proximal humeral fractures (PHFs). Methods: A retrospective, two-institution study included patients who underwent rTSA for acute PHFs implanted with one of 3 stems: the Arrow (global lateralization 21.4 mm), the Humelock II (11.2 mm), or the Unique (14.7 mm). Stems were classified as very highly lateralized (VHL; >20 mm, Arrow) or lateralized (L; 10-15 mm, Unique and Humelock II). Tuberosity consolidation was assessed radiographically at a minimum 12-month follow-up. Functional outcomes included forward flexion, external rotation, visual analog scale pain, and Constant Murley score (CS). The lateralization shoulder angle (LSA) and distalization shoulder angle were measured and compared across groups. Complication and reoperation rates were recorded. Results: A total of 113 patients were included: Arrow (N = 53), Humelock II (N = 40), and Unique (N = 20), comprising 53 in the VHL group and 60 in the L group. The overall consolidation rate was 82.1%. Nonunion rates differed significantly across stems ( Conclusion: A significant dose-response relationship between increasing stem lateralization and tuberosity nonunion rate was observed, with functional consequences extending beyond nonunion alone. Post-operative LSA does not reliably reflect the local mechanical environment at the tuberosity-implant interface. These findings identify proximal stem lateralization as a potentially important modifiable determinant of outcomes after fracture rTSA and underscore the need for prospective studies to define the threshold of lateralization compatible with reliable tuberosity healing.
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