Outcomes, and factors affecting outcomes, following shoulder hemiarthroplasty for proximal humeral fracture repair.
ABSTRACT Hemiarthroplasty has been applied to treat proximal humeral fracture with variable outcomes. The purpose of this retrospective study was to assess factors affecting outcome in patients following hemiarthroplasty for proximal humeral fracture (PHF) repair.
Patients with proximal humeral fractures treated over a 6-year period were included. Indications for hemiarthroplasty were severe three-part fractures associated with osteoporosis; four-part fractures with or without dislocation; splitting of the humeral head, or >45% collapse of the humeral head. Surgery outcome and postoperative complications were main outcome measures in this study.
Thirty-three of 47 patients were included in the final analysis (mean age 64.3 years, range 43-82). Mean postoperative follow-up was 44.4 (range 36-57) months. Postoperative complications (shoulder dislocation, mild shoulder subluxation, heterotopic ossification) occurred in seven patients. Healing of the greater and lesser tubercles was abnormal or poor in 18 patients. These patients had significantly higher pain scores (4.0 ± 1.1 vs. 2.2 ± 1.1) and significantly lower capacities for active lifting (79.3 ± 9.6 vs. 121.7 ± 24.3), external rotation (20.7 ± 3.7 vs. 39.2 ± 10.3), and Neer scores (79.2 ± 5.7 vs. 90.6 ± 3.6) versus patients who exhibited complete healing (all P < 0.001). Patient age, type of surgical approach, and fracture type were not major influencers of outcome.
In conclusion, the healing of the greater and lesser tubercles is the major determinant of outcome following hemiarthroplasty for PHF repair.
- SourceAvailable from: Andreas Panagopoulos[Show abstract] [Hide abstract]
ABSTRACT: Background. The purpose of this study was to report our experience with shoulder hemiarthroplasty in the context of old trauma. Methods. 33 patients with failed treatment for a complex proximal humeral fracture underwent prosthetic hemiarthroplasty. There were 15 men and 18 women with a mean age of 58.1 years. The average period from initial treatment was 14.9 months. Sequelae included 11 malunions, 4 nonunions, 15 cases with avascular necrosis (AVN) and 3 neglected posterior locked dislocations. Follow up investigation included radiological assessment and clinical evaluation using the Constant score and a visual analogue pain scale. Results. After a mean follow up of 82.5 months the median Constant score was 75.7 points, improved by 60% in comparison to preoperative values. Greater tuberosity displacement, large cuff tears and severe malunion were the factors most affected outcome. No cases of stem loosening or severe migration were noted. 60% of the patients were able to do activities up to shoulder level compared with 24% before reconstruction. Conclusions. Late shoulder hemiarthroplasty is technically difficult and the results are inferior to those reported for acute humeral head replacement, nonetheless remains a satisfactory reconstructive option when primary treatment fails.Advances in orthopedics. 01/2013; 2013:403580.
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ABSTRACT: Shoulder hemiarthroplasty is considered a standard treatment in case of complex proximal humeral fractures. However, great variability affects the clinical outcomes. In this work, we examined the clinical and radiographic outcomes in a series of patients treated with hemiarthroplasty for 3- and 4-part humeral fractures and focused on factors affecting the final result. In this study, we included 27 patients who had received a shoulder hemiarthroplasty between 2001 and 2005 at our institution. These patients were evaluated at an average of 7.2 years after surgery. All patients were managed within 10 days from trauma by the same surgeon and underwent the same time-scheduled rehabilitation program. Average age at surgery was 71.9 years. Implant survival was 88.9 %. At the latest follow-up, mean DASH and SST-12 scores were 26.8 and 6.5, respectively. Mean Constant-Murley score was 52.4. Tuberosities complications and reduction in the acromion-humeral distance were negatively related to clinical outcome. Age at surgery displayed a negative correlation with clinical outcome, despite not reaching the statistical significance. This is mainly due to great variability in the elder group of patients. Shoulder hemiarthroplasty is a useful and effective solution for complex humeral fractures, with good results in the majority of patients. However, outcomes display a great variability in relation to X-ray alterations and age at surgery. A careful attention in patient selection is needed in order to standardize the clinical results associated with this kind of prosthetic implant.MUSCULOSKELETAL SURGERY 03/2014;
- Minerva Ortopedica e Traumatologica 01/2013; 64:377-94.