Raiss et al. studied the use of the reverse shoulder prosthesis for the treatment of proximal humeral nonunions. Their reasonably large multicenter retrospective study attempts to provide answers regarding a condition that has historically been very challenging to treat. The authors did find improved functional results, with better forward elevation, external rotation, and Constant scores, in the patients in their study. They noted improved strength and shoulder range of motion when the tuberosities were preserved and the subscapularis was repaired. Moreover, they reported a fairly high rate of satisfaction: 75% of the patients were satisfied or very satisfied. However, the authors also found a high rate of complications (41%). The most common of these was dislocation, which occurred in eleven (34%) of the thirty-two patients. Seven of these eleven patients underwent revision surgery. Three others with a dislocation chose not to undergo further surgery, which led to poor functional results. In one patient, the shoulder remained stable after closed reduction. In addition, infection occurred in four (13%) of the thirty-two patients.

In several studies, authors have reported on the use of standard arthroplasty for the treatment of proximal humeral nonunions, with mixed results. Also, one smaller study of reverse prostheses for the treatment of nonunions (n = 18) has been published. In a separate article, Boileau et al. described a 32% complication rate and low satisfaction with arthroplasty for the treatment of proximal humeral nonunions (type-3 sequelae). In contrast, Duquin et al. reported improved flexion and external rotation, similar to the results in the current study, with the use of standard arthroplasties. The prosthesis survived for at least twenty years in 93% of patients. However, <50% of the patients were satisfied. Reoperation occurred in 18%, and 21% had complications. They reported that patients with healed tuberosities had the best results. Lin et al. noted a high level of satisfaction and improved functional results in nine of twelve patients who underwent hemiarthroplasty for the treatment of nonunions. In their study, the greater tuberosity was not osteotomized and a medial calcar graft was used in a technique similar to the one used later in the current study (in which the tuberosities are incorporated into the repair). Martinez et al. reported on the use of reverse prostheses for the treatment of nonunions of the proximal part of the humerus (n = 18); they noted a complication rate of 27%, with 22% requiring additional surgery (for two dislocations and two infections).