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Fleischhacker, Evi; Sprecher, Christoph; Milz, Stefan; Gleich, Johannes; Siebenbürger, Georg; Helfen, Tobias; Böcker, Wolfgang; Ockert, Ben (2022): Functional outcomes before and after implant removal in patients with posttraumatic shoulder stiffness and healed proximal humerus fractures: does implant material (PEEK vs. titanium) have an impact? – a pilot study. BMC Musculosceletal Disorders (23): 95. ISSN 1471-2474

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Background: Posttraumatic shoulder stifness remains a problem after proximal humerus fracture (PHF) despite
good healing rates. The aim of this pilot study was to determine whether the implant material and overlying soft tissue have an efect on shoulder range of motion (ROM) before and after implant removal (IR).

Methods: 16 patients (mean age 55.2±15.3 (SD) years; 62.5% female) were included who underwent operative
treatment with locking plates of either carbon fber reinforced Polyetheretherketone (PEEK) (PEEKPower® humeral
fracture plate, Arthrex, Naples, Florida, USA, n=8) or titanium alloy (Ti) (Philos®, DePuy Synthes, Johnson & Johnson
Medical, Raynham, Massachusetts, USA, n=8) for PHF. All patients presented with a limited ROM and persistent pain
in everyday life after the fracture had healed, whereupon IR was indicated. ROM before and after IR were compared as
well as the Constant Score (CS) and the CS compared to the contralateral shoulder (%CS) 1 year after IR.

Results: In group PEEK, elevation was 116.3°±19.2° pre- and 129.4°±23.7° post-IR (p=0.027). External rotation was 35.0°±7.6° pre- and 50.6°±21.8° post-IR (p=0.041). External rotation with the humerus abducted
90° was 38.8°±18.1° pre- and 52.5°±25.5° post-IR (p=0.024). In group Ti, elevation was 110.0°±34.6° pre- and
133.8°±31.1° post-IR (p=0.011). External rotation with the humerus at rest was 33.8°±23.1° pre- and 48.8°±18.7°
post-IR (p=0.048). External rotation with the humerus abducted 90° was 40.0°±31.6° pre- and 52.5°±22.5° post-IR
(p=0.011). Comparison of the two implant materials showed no signifcant diference. The overall CS was 90.3±8.8,
the %CS was 91.8%±14.7%.

Conclusion: There was no signifcant diference in ROM, CS and %CS with respect to plate materials, although lower
cell adhesion is reported for the hydrophobic PEEK. However, all patients showed improved functional outcomes after
IR in this pilot study. In patients with shoulder stifness following locked plating for PHF, implants should be removed
and open arthrolysis should be performed, independently from the hardware material.

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