Functional outcomes of reverse shoulder arthroplasty compared with hemiarthroplasty for acute proximal humeral fractures

Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] (Impact Factor: 2.29). 05/2012; 22(1). DOI: 10.1016/j.jse.2012.03.006
Source: PubMed


BACKGROUND: Complex acute proximal humeral fractures may require prosthetic replacement of the proximal humerus. Reverse shoulder arthroplasty (RSA) has been suggested as an alternative to hemiarthroplasty in the management of such fractures. This study compared the functional outcomes of RSA with hemiarthroplasty in patients with acute proximal humeral fractures. MATERIALS AND METHODS: All patients who underwent RSA or shoulder hemiarthroplasty for acute proximal humeral fractures between January 1, 1999, and December 31, 2010 were identified from The New Zealand Joint Registry. Baseline information, operative characteristics, and postoperative outcomes (Oxford Shoulder Score [OSS] at 6 months and 5 years, revision rate, and mortality rate) were examined and compared between the study groups. RESULTS: During the study period, 55 patients underwent RSA and 313 underwent shoulder hemiarthroplasty for acute proximal humeral fractures. Compared with hemiarthroplasty patients, RSA patients were significantly older (mean age, 79.6 vs 71.9 years; P < .001) and more often women (93% vs 78%, P = .013). The 6-month OSS was 28.1 for RSA and 27.9 for hemiarthroplasty, which was not significantly different (P = .923); however, the RSA group had a significantly better 5-year OSS than the hemiarthroplasty group (41.5 vs 32.3; P = .022). There was no significant difference between the RSA and hemiarthroplasty groups in revision rate per 100 component-years (1.7 vs 1.1; P = .747) or in 1-year mortality (3.5% vs 3.6%; P > .99). CONCLUSIONS: Patients with acute proximal humeral fractures who undergo RSA appear to achieve superior 5-year functional outcomes compared with patients who undergo hemiarthroplasty.

Download full-text


Available from: Craig M Ball, Aug 05, 2014
44 Reads
  • Source
    • "Figure 3 – True AP and scapular Y radiographs at 3 months post-operative with healing of the greater tuberosity fragment. be associated with better outcome scores [21]. Pre-operative patient demographic factors and intra-operative variables were also not found to have an association with OSS results. "
    [Show abstract] [Hide abstract]
    ABSTRACT: A reverse shoulder arthroplasty is a consideration for the treatment of comminuted four-part proximal humerus fractures in elderly patients. While a reverse TSA should not replace other treatment modalities, it is indicated in elderly patients with fractures that are not amenable to fixation. Immediate stability and relative independence from tuberosity healing are clear advantages, but the complication rate is substantially higher. Larger studies are necessary to clarify appropriate indications.
    Seminars in Arthroplasty 03/2014; 25(1). DOI:10.1053/j.sart.2014.02.004
  • Source
    • "Because the functional outcomes of rTSA in patients with proximal humerus fractures (Fig. 2) appear to depend less on tuberosity healing and rotator cuff integrity, patients with rTSA have been observed to recover more quickly after surgery than do patients with a hemiarthroplasty.2) Several studies about the outcomes after rTSA for proximal humeral fracture have reported favorable results (Table 1).28,30-36) Bufquin et al.31) found that the clinical results for rTSA used for proximal humerus fractures were not influenced by the healing of the tuberosities, even though they had 19 patients with displacement of the tuberosities after surgery. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Total shoulder arthroplasty and shoulder hemiarthroplasty have been the traditional method for treating a variety of shoulder conditions, including arthritis, cuff tear arthropathy, and some fracture types. However, these procedures did not provide consistently good results for patients with torn rotator cuffs. The development of the reverse prosthesis by Grammont in the late 20th century revolutionized the treatment of the rotator-cuff-deficient shoulder with arthritis. The main indication for the reverse prosthesis remains the patient with cuff tear arthropathy who has pain and loss of motion. Because the reverse total shoulder arthroplasty produced such good results in these patients, the indications for the reverse prosthesis have expanded to include other shoulder conditions that have previously been difficult to treat successfully and predictably. This review discusses and critically reviews these newer indications for the reverse total shoulder arthroplasty.
    Clinics in orthopedic surgery 12/2013; 5(4):243-255. DOI:10.4055/cios.2013.5.4.243
  • Source
    • "There is a growing tendency for complex PHF in osteoporotic patients to be treated with RSA. It has been proved that patients treated with RSA are easier to mobilize, require less time in hospital and have a better functional outcome after 6 months compared with patients who have undergone other forms of treatment [8]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: There is a growing tendency for complex proximal humerus fractures (PHF) in osteoporotic patients to be treated with reverse shoulder arthroplasty (RSA). It has been proposed that RSA has more benefits than other treatment options. The aim of our study was to investigate preoperative characteristics as well as clinical and radiological outcomes in patients with complex 3- or 4-part PHF who had undergone primary RSA. Patients with a minimum follow-up of 6 months who had undergone a primary RSA after 3- or 4-part PHF in the period between 2008 and 2011 were eligible for the study. Clinical records, X-rays and CT-scans were investigated and a clinical examination was performed. Disabilities of the Arm, Shoulder and Hand (DASH) score and Constant-Murley score (CMS) were calculated. Sixteen patients were examined as part of the study. The mean follow-up was 20 months (range 6-42 months). According to Codman-Hertel classification we encountered 15 Hertel "12" and 1 Hertel "8" type fractures. Thirty-two patients (27 female -- 84.4%) with a mean age of 72 years underwent operations to treat complex 3- and 4-part fractures of the proximal humerus. Sixteen patients were reexamined. In 14 cases the dominant upper extremity was on the right, in 2 cases it was on the left, in 6 cases the right side was affected and in 10 cases the left side was affected. The mean CMS was 54.8 (range 18-95)and the mean DASH was 37.5 (range 2.9-81). A trend was established between the CMS and dominance of the affected shoulder. The CMS was better if the affected shoulder was on the non-dominant side (p-value 0.051). No statistical difference was noted between age and clinical outcome. Our mid-term follow-up shows satisfying results in terms of the treatment of severe displaced fractures in elderly patients with RSA. RSA can provide immediate relief and good shoulder function in elderly patients. Nevertheless, the question of longevity of these implants remains to be observed.
    BMC Musculoskeletal Disorders 08/2013; 14(1):231. DOI:10.1186/1471-2474-14-231 · 1.72 Impact Factor
Show more