Shoulder hemiarthroplasty for proximal humeral fractures: analysis of clinical and radiographic outcomes at midterm follow-up: a series of 51 patients

Abstract

Shoulder hemiarthroplasty has historically been the gold standard treatment for proximal humeral fractures not suitable to open reduction and internal fixation. In the last decades, reverse shoulder arthroplasty has gained more and more importance. Aim of this study is to retrospectively analyze subjective and objective outcomes of a group of consecutive patients. Fifty-one patients were evaluated with a mean follow-up of 18 months (range 12-60). For all the cases, the same surgical technique was performed in all cases. Range of motion, Constant-Murley score, ponderate Constant-Murley score, visual analog score and a patients' self-assessment scale were calculated. Anatomic tuberosities healing, stem positioning or mobilization were evaluated on postoperative X-rays and follow-up CT-scans. Statistical analysis was performed to calculate a correlation between subjective and objective results. Thirty-five patients (75%) declared to be satisfied of the operated shoulder. The mean CMS was 50 (17-91), the mean pCMS 72 (16-111). The mean forward flexion measured was 98° (40°-170°), the mean external rotation with adducted arm 22° (0°-60°), the mean internal rotation at sacrum (gluteus-T12). Four implants needed revision. Forty-seven stems were correctly positioned; 84.3% of tuberosities was anatomic or low positioned and consolidated in 74.5% of cases. Statistical analysis revealed significant correlation between CMS, pCMS, VAS and subjective satisfaction and between anatomic tuberosities healing and 3-part fractures. HA implant is a valid and reliable technique for the treatment of proximal humeral fracture. From our data, patients' satisfaction depends upon pain relief more than upon restore of function.

Low revision rate despite poor functional outcome after stemmed hemiarthroplasty for acute proximal humeral fractures: 2,750 cases reported to the Danish Shoulder Arthroplasty Registry

“…The patient satisfaction self-assessment scale was used in a study of 51 patients, with a mean age of 71 years and of whom 39 were female, who were treated with SHA for 3- or 4-part proximal humeral fractures (Valenti et al. 2017). This study found that 13 of 51 patients reported poor satisfaction after 18 months.…”

The Augment of the Stability in Locking Compression Plate with Intramedullary Fibular Allograft for Proximal Humerus Fractures in Elderly People

“…Xavier et al thought that cavity defects in proximal humerus were an indication to abandon internal fixation and to choose the method of prosthetic replacement [ 54 ]. So recently, hemiarthroplasty has been recommended as a good option for the treatment displaced PHF, especially with elderly patients [ 55 – 57 ]. However, high complication rates and poor functional results have been reported by the method because of tuberosity malreduction or migration, postoperative pain and instability [ 58 , 59 ].…”

Quality, cost and outcomes measures in orthopaedic healthcare

“…By studying a process, improvements can be applied to the most appropriate aspect of the process and outcomes can be evaluated and measured. For example, the outcomes of the patients with calcaneal fractures can be ensured [10], the risk of bleeding of hip fracture patients taking clopidrogel can be estimated [11], the use of antiosteoporotic medication in elderly patients with fragility pelvic fractures can be classified [12], and traditional treatments in trauma can be revisited [13][14][15][16][17][18].…”