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: 2.37). 05/2012; 22(1). DOI: 10.1016/j.jse.2012.03.006
Source: PubMed

ABSTRACT 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
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to evaluate clinical and radiological outcomes of hemiarthroplasty for proximal humerus fractures. Thirty-five patients (33 women and two men), average age at the time of surgery of 75.1 (range, 64-92) years, who underwent hemiarthroplasty for proximal humerus fracture or fracture-dislocation of the shoulder were enrolled in this study. The Constant score was used for clinical evaluation of outcomes, and X-rays were performed after a minimum follow-up period of 12 months postoperatively. Parameters for radiological evaluation were as follows: value of acromiohumeral interval (AHI), humeral offset, medial and lateral projection, and the existence of subacromial spur, a radiolucent zone around humeral stem and an osteolytic change of the greater tuberosity. The average follow-up after surgery was 45.8 (range, 13-114) months. The average postoperative Constant score was 76.2 (range, 53-96) points. The mean values of AHI and humeral offset were 8.4 and 28.3 mm, respectively. A subacromial spur was observed in ten patients, and an osteolytic change of the greater tuberosity in seven patients. There was a significant correlation between Constant score and values of AHI or humeral offset. The Constant score in patients with a subacromial spur or radiolucent zone around humeral stem was markedly lower than that in patients without them. The clinical outcome of hemiarthroplasty was influenced by factors reflecting function and conditions of the rotator cuff. Anatomical reconstruction and bone union of the tuberosities need to ensure clinical success in hemiarthroplasty.
    International Orthopaedics 04/2015; DOI:10.1007/s00264-015-2758-y · 2.02 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background This study compared the use of reverse and hemishoulder arthroplasty for the treatment of proximal humeral fractures among orthopedic surgeons taking part II of the American Board of Orthopaedic Surgery board examination. We hypothesized that the use of reverse shoulder arthroplasty for fractures in the elderly is increasing amongst newly trained orthopedic surgeons. Materials and methods We queried the American Board of Orthopaedic Surgery database for the cases of proximal humeral fractures treated with arthroplasty submitted between 2005 and 2012. We evaluated the prosthesis used, patient-specific factors, complications, and the difference in use by shoulder fellowship-trained surgeons. Results From 2005 to 2012, 5395 board-eligible orthopedic surgeons submitted cases to the database. Of these, 435 (mean, 54 per year) were proximal humeral fractures treated with arthroplasty. The overall incidence of reverse shoulder arthroplasty for fracture increased from 2% to 4% during 2005 to 2007 to 38% in 2012. Shoulder surgeons treated 5 times more proximal humeral fractures with shoulder arthroplasty and were also more than 20 times more likely to use a reverse implant (P < .0001). The difference in complication rates between reverse and hemishoulder arthroplasty was not significant (P = .49). Patients who received a hemiarthroplasty tended to be younger (mean age, 70.8 vs 75.7 years; P = .0015). Conclusions Overall, the use of a hemiarthroplasty for fracture is still more common (62% in 2012), although the relative proportion of reverse implants is rising. Among shoulder surgeons, more than 50% of the arthroplasties performed for fractures during the past 3 years (2010-2012) have been reverse arthroplasties.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Trotz ihrer Häufigkeit wurden bislang keine eindeutigen Algorithmen zur Behandlung der Fraktur des proximalen Humerus veröffentlicht. Aufgrund der vorliegenden Daten empfehlen wir bei jungen Patienten mit hohem funktionellem Anspruch und gutem Rehabilitationspotenzial eher die osteosynthetische Versorgung der proximalen Humeruskopffraktur. Bei Auftreten einer symptomatischen Humeruskopfnekrose kann dann sekundär eine anatomische Endoprothese implantiert werden. Bei Patienten mit einem biologischen Alter > 70 Jahre und bestehendem Rotatorenmanschettendefekt bei proximaler Humerusfraktur stellen wir aufgrund guter klinischer Ergebnisse zunehmend die Indikation zur Implantation einer inversen Schulterendoprothese. Diese sollte aufgrund des technischen Anspruchs und der hohen Komplikationsrate dem Operateur mit schulterendoprothetischer Expertise vorbehalten sein. Zusammenfassend sollte der Unfallchirurg nach Analyse fraktur- und patientenspezifischer Risikofaktoren sowie der Leistungsansprüche zusammen mit dem Patienten die individuell beste Therapie wählen.
    Der Unfallchirurg 11/2013; 116(11). DOI:10.1007/s00113-013-2423-0 · 0.61 Impact Factor