Hemiarthroplasty Versus Reverse Total Shoulder Arthroplasty for Acute Proximal Humerus Fractures in Elderly Patients

Abstract

Proximal humerus fractures are the third most common fracture in elderly patients. Hemiarthroplasty has been the treatment of choice in patients with bone quality and fracture patterns not amenable to open reduction and internal fixation. Reverse total shoulder arthroplasty is a newer option that appears to be less dependent on tuberosity healing than hemiarthroplasty. The authors hypothesized that reverse total shoulder arthroplasty provides improved functional outcomes compared with hemiarthroplasty for fractures in elderly patients.A retrospective review was performed of all patients treated with arthroplasty for acute proximal humerus fractures in an orthopedic practice using a Current Procedural Terminology code search, patient charts, and radiographs. Validated outcome scores were used to assess satisfaction, function, and general well-being. Twenty-three patients were treated for acute proximal humerus fractures (11 reverse total shoulder arthroplasties and 12 hemiarthroplasties). Three patients were lost to follow-up, and 6 patients were deceased. Mean follow-up was 3.6 years (range, 1.3-8 years). Reverse total shoulder arthroplasty outperformed hemiarthroplasty with regard to forward flexion, American Shoulder and Elbow Society score, University of Pennsylvania shoulder score, and Single Assessment Numerical Evaluation score.Reverse total shoulder arthroplasty is a reliable option for acute, proximal humerus fractures that are not amenable to closed treatment or reconstruction in elderly patients. Improved functional outcomes when compared with hemiarthroplasty must be balanced against the increased cost and limited life expectancy of patients with this injury.

Comparison of Reverse Total Shoulder Arthroplasty vs Hemiarthroplasty for Acute Fractures of the Proximal Humerus: Systematic Review

“…A deltopectoral approach was used in six studies, 14,[17][18][19][20]22 and either a superolateral or deltopectoral approach was used in two studies. 13,21 The greater and lesser tuberosities were excised in one study. 13 The tuberosities were reattached in six studies.…”

“…13 The tuberosities were reattached in six studies. 13,14,17,[20][21][22] In two 14,21 of those studies, a technique described by Boileau et al 10 was used for tuberosity reconstruction. In this technique, heavy (no.…”

“…The ASES score was used in five studies, 17,[19][20][21][22] the DASH in three studies, 13,14,18 the absolute Constant-Murley score in three studies, 13,14,18 the modified Constant-Murley score in two studies, 14,18 and the SST in two studies. 19,20 Reverse total shoulder arthroplasty was more effective than HA in alleviating pain ( Table 2).…”

“…Of these, eight compared RTSA with HA for the treatment of acute proximal humerus fractures. 13,14,[17][18][19][20][21][22] These eight studies reported 180 patients treated with RTSA and 439 patients treated with HA. One study was a prospective, blinded, randomized controlled trial (level I), 14 and one was a prospective, nonrandomized study (level II).…”

Evolving trends in surgically managed patients with proximal humerus fracture: are we different after ten years?

“…Moreover, the results of these surgeries are variable, thus highlighting the need for future studies reviewing patients' functional outcomes following the various surgical treatment modalities.The trend toward primary reverse shoulder arthroplasty for elderly patients, especially those with concomitant cuff tears, has also been suggested in the literature. (24)(25)(26) However, this is beyond the scope of the present study.…”