Background and purpose — When nonoperative treatment of proximal humerus fracture (PHF) fails, shoulder arthroplasty may be indicated. We investigated risk factors for revision and evaluated patient-reported outcome 1 year after treatment with either stemmed hemiarthroplasty (SHA) or reverse total shoulder arthroplasty (RTSA) after previous nonoperative treatment of PHF sequelae. Patients and methods — Data were derived from the Danish Shoulder Arthroplasty Registry and included 837 shoulder arthroplasties performed for PHF sequelae between 2006 and 2015. Type of arthroplasty, sex, age, and surgery period were investigated as risk factors. The Western Ontario Osteoarthritis of the Shoulder index (WOOS) was used to evaluate patient-reported outcome (0–100, 0 indicates worst outcome). Cox regression and linear regression models were used in the statistical analyses. Results — 644 patients undergoing SHA and 127 patients undergoing RTSA were included. During a mean follow-up of 3.7 years, 48 (7%) SHA and 14 (11%) RTSA were revised. Men undergoing RTSA had a higher revision rate than men undergoing SHA (hazard ratio [HR] 6, 95% confidence interval [CI] 2–19). 454 (62%) patients returned a complete WOOS questionnaire. The mean WOOS score was 53 for SHA and 53 for RTSA. Patients who were 65 years or older had a better WOOS score than younger patients (mean difference 7, CI 1–12). Half of patients had WOOS scores below 50. Interpretation — Shoulder arthroplasty for PHF sequelae was associated with a high risk of revision and a poor patient-reported outcome. Men treated with RTSA had a high risk of revision.

Background and purpose Proximal humerus fractures (PHF) may result in sequelae indicating arthroplasty. We report cumulative survival rates and reasons for revision after arthroplasty for proximal humerus fracture sequelae (PHFS). Patients and methods Data were derived from the Nordic Arthroplasty Register Association. The Kaplan– Meier method was used to illustrate survival rates. A scaled Schoenfeld residual plot was used to report the risk of revision for men relative to women in patients who were treated with reverse shoulder arthroplasty (RSA). Revision was defined as removal or exchange of any component or the addition of a glenoid component. Results 30,190 primary arthroplasties were reported from 2004 to 2016, of which 3,245 were for PHFS. The estimated 1-, 5-, and 10-year cumulative survival rates (95% CI) were 96% (95–97), 90% (89–92), and 86% (83–88) for stemmed hemiarthroplasty and 94% (92–95), 89% (87–91), and 86% (82–90) for RSA with a median time to revision of 18 months (IQR 9–44) and 3 months (IQR 0–17). The risk of revision for men relative to women in patients who were treated with RSA was 3.2 (1.9–5.1) 0–1 year after surgery and 1.9 (0.9–4.1) 1–8 years after surgery. The estimated 1-, 5-, and 10-year cumulative survival rates (95% CI) were 94% (92–96), 88% (85–90), and 80% (75–86) for men and 95% (94–96), 86% (84–89), and 81% (77–84) for young patients. Interpretation Shoulder arthroplasty for PHFS was associated with lower survival rates, compared with previously published results of shoulder arthroplasty for acute PHF. The low arthroplasty survival rates for men and young patients especially are worrying.

were implanted on a Sawbone® according to the manufacturer guidelines. All six implant systems were evaluated using a smaller and a larger glenosphere. The lowering and medialisation of the humerus with respect to the scapula after implantation of the implant was determined in neutral position (0 elevation and 0 internal rotation in scapular plane).The ROM was determined by the minimal and maximal elevation in the scapular and in 90 humeral plane, as by the maximal internal and external rotation at 30 and 60 elevation (glenoid plane) until bony contact.Results: With all implant systems the humerus was significantly lowered with respect to the scapula (p<0.05, mean: 38.8mm, SD: 4.4, range: 30.9; 43.6mm). With larger glenospheres, this lowering was significantly higher compared to smaller glenospheres (r¼ 0.94, p<0.05, mean: 2.1mm, SD:1.6).The humerus shifted medial (p<0.05, mean: 7.1mm, SD: 6.2) with a range of -1.5mm to 17.2 mm. The medialisation is positively correlated with the size of the glenosphere (r¼0.98, p<0.05, mean: 1.2mm, SD: 1.3). The total range of elevation depends on the orientation of the humerus in the vertical plane. The total range of elevation in the scapular plane ranges between 59.2 and 100.4 , whereas it ranges between 18.3 and 54.8 in the 90 humeral plane. The starting point, defined as the minimal elevation varies between 4.9 and 35 in the scapular plane, whereas it varies between 21.4 and 35.6 in the 90 humeral plane. The implantation of a large glenosphere resulted in a significant (p<0.05) enhancement of the total range of elevation and a reduction of the minimal elevation in both scapular an 90 humeral plane.Conclusions: There exists a wide variation in the measured parameters (position humerus, ROM) between the six most frequent implanted prosthesis. A larger glenosphere results in a better ROM in all different brands. These significant differences in ROM can be clinically important as it can result in impingement and restricted functionality of the humeroscapular joint.

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