Beyond scores: Predictable early recovery and independence after reverse shoulder arthroplasty for complex proximal humerus fractures

Background Reverse shoulder arthroplasty (RSA) is increasingly used for complex proximal humeral fractures in older adults, yet early functional recovery and return to independence remain underreported. This study evaluated the timing and predictability of functional recovery following RSA in patients aged ≥60 years. Methods A prospective single-centre cohort study was conducted on patients aged ≥60 years who underwent RSA for acute three- or four-part fractures or fracture-dislocations between 2014 and 2024. A standardized surgical technique and rehabilitation protocol were outcomes included the Oxford Shoulder Score (OSS), range of motion, SF-12, patient satisfaction, and time to independent washing/dressing, household activities, and driving. Results Fifty-five patients (mean age 72.9 ± 7.0 years) met inclusion criteria. At final follow-up (≥12 months), mean OSS was 43.4 ± 4.9 and mean forward flexion was 135°. All patients regained independence in washing/dressing (median <6 weeks), 100% resumed household activities, and all pre-injury drivers returned to driving (median 8–12 weeks). Satisfaction averaged 4.7/5 (94.5% ≥ 4/5). The complication rate was 5.5%, with one revision. Tuberosity union occurred in 85% and did not significantly influence OSS. Conclusion RSA provides reliable and predictable functional recovery with early return to independence in elderly patients with complex proximal humeral fractures.