Periprosthetic Humeral Fractures After Short-Stem Reverse Shoulder Arthroplasty - Treatment Patterns, Classification, and Clinical Outcomes

Sep 30, 2026

Periprosthetic humeral fractures (PF) after reverse total shoulder arthroplasty (RSA), especially with short stems, are expected to rise. This retrospective multicenter case series assessed PF occurrence and outcomes after short-stem RSA from 2014–2023, using fracture location and stem loosening for classification. Among 165 patients, PF occurred in 3.0%, with all cases revised using long-stem conversion; four achieved bone union, one had infection without union. Functional scores worsened mildly without statistical significance.

LanguageEnglish

CategoryHealthcare

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Abstract

Introduction

Materials and Methods

Article Periprosthetic Humeral Fractures After Short-Stem Reverse Shoulder Arthroplasty: Treatment Patterns, Classification, and Clinical Outcomes Naoya Kubota 1, Katsumasa Nakazawa 2, *, Tomoya Manaka 2, Yoichi Ito 3, Yoshihiro Hirakawa 4, Ayako Ogura 3 and Hidetomi Terai 2 Academic Editors: Nicholas David Clement and Christian von Rüden Received: 21 October 2025 Revised: 27 November 2025 Accepted: 29 December 2025 Published: 30 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Saiseikai Senri Hospital, 1-1-6 Tsukumodai Suita-shi, Osaka 565-0862, Japan 2 Department of Orthopedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan 3 Ito Clinic, Osaka Shoulder Center, 1-10-12 Ueda Matsubara, Osaka 580-0016, Japan 4 Ishikiriseiki Hospital, 18-28 Yayoicho Higashiosaka, Osaka 579-8026, Japan * [Correspondence: v0vpeace@yahoo.co.jp](Correspondence: v0vpeace@yahoo.co.jp) Abstract Background/Objectives: Periprosthetic humeral fractures (PF) after reverse total shoulder arthroplasty (RSA) are expected to increase. This study investigated PF after RSA with short stems and reported outcomes. Methods: A total of 165 patients underwent short-stem RSAs between 2014 and 2023 . Among them, patients who developed postoperative PFs were identified and classified by fracture location and stem loosening. Operative data, complications, and bone union time were analyzed. Clinical outcomes before injury and at final follow-up were evaluated. Results: PF occurred in 5/165 patients (3.0%) . Based on our classification, four had type B1 fractures and one had a type B3 fracture. All underwent revision RSA (Re-RSA) with conversion to long-stem implants. Bone union was achieved in four patients, while one patient experienced infection without union. Among the four patients without complications, mean shoulder flexion declined from 138◦ pre-injury to 103◦, abduction from 118◦ to 95◦, external rotation from 37◦ to 31◦, the American Shoulder and Elbow Surgeons (ASES) score from 82.0 to 68.7, Constant Score from 67 to 43, while the Visual Analog Scale (VAS) pain score increased from 1.7 to 2.6 . Conclusions: All five cases of PF following short-stem RSA were stem-level (type B) fractures. All patients underwent Re-RSA using long-stem conversion. Four patients had bone union. Clinical outcomes atone year postoperatively had deteriorated mildly compared to pre-fracture. However, this change was not statistically significant. One patient had a postoperative infection, and bone union was not observed. This study indicates the need for caution regarding postoperative infections after RSA. Keywords: reverse total shoulder arthroplasty; periprosthetic humeral fracture; periprosthetic fractures; postoperative complications; short stem 1. Introduction Reverse total shoulder arthroplasty (RSA) was first reported by Paul Grammontet al. [1] in 1987 . RSA is considered to be a good indication for cuff tear arthropathy, massive rotator cuff tears, and proximal humeral fractures. However, a high complication rate of approximately 40% has been reported worldwide, including infections, postoperative fractures, loosening, and instability [2–4] . Postoperative periprosthetic humeral fractures (PFs) have so far been considered a relatively rare complication, but they are becoming more common with the recent increase in incidence of RSAs being performed. Incidence of PFs range from 0.9 to 2.0% of postoperative complications after RSA, and are more common in elderly women, suggesting an association with osteoporosis [5–8] . Therefore, PF is an issue of particular concern associated with RSA [9] . There are several classifications of PF, but the Wright and Cofield system, reported in 1995, is the most commo

FAQs

How common were periprosthetic humeral fractures after short-stem reverse shoulder arthroplasty in this study?

PF occurred in 5 of 165 patients, representing 3.0% of cases.

How were the fractures classified and what types were found?

Fractures were classified by location and stem loosening; four cases were type B1 and one case was type B3 in the study’s system.

What treatments were used and what were the outcomes?

All five patients underwent revision RSA using long-stem conversion. Four achieved bone union, while one developed postoperative infection without union.

Sep 30, 2026

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