Comparison of functional outcomes of reverse shoulder arthroplasty versus hemiarthroplasty in the primary treatment of acute proximal humerus fracture.
BACKGROUND
Treatment of complex proximal humeral fractures remains controversial. In cases where adequate open reduction and internal fixation cannot be achieved, hemiarthroplasty has been the traditional treatment; however, clinical results have been mixed. Reverse shoulder arthroplasty (RSA) has been suggested as an alternative, and this study aimed to compare the functional results of RSA versus hemiarthroplasty in patients with acute proximal humeral fracture.


METHODS
Ten patients with acute proximal humerus fractures unsuitable for internal fixation (mean age 77) who underwent RSA for acute proximal humerus fracture unsuitable for internal fixation against the outcomes of 10 patients (mean age 75) who had previously undergone hemiarthroplasty for the same indication. Functional scores and radiographic outcomes were assessed at 22-44 months follow up.


RESULTS
At follow up the mean American Shoulder and Elbow Scorev score was 65 (range 40-88) in the RSA group and 67 (26-100) in the hemiarthroplasty group. Mean Oxford Shoulder scores were 29 (15-56) and 22 (12-34), respectively. Mean forward elevation was 115 degrees (range 45-140 degrees) and active external rotation was 49 degrees (5-105 degrees) in the RSA group, versus 108 degrees (50-180 degrees) and 48 degrees (10-90 degrees) in the hemiarthroplasty group. No statistically significant differences in outcome scores or range of motion were seen.


CONCLUSIONS
In these early results, the anticipated functional gains of RSA over hemiarthroplasty were not realized, suggesting the use of RSA for treatment of proximal humeral fractures should remain guarded. Larger prospective trials are necessary to identify the optimal management of patients in this situation.
Department of Orthopaedic Surgery, North Shore Hospital, Takapuna Auckland, New Zealand. simonwyoung@gmail.com
Simon W
SW
Young
Barak S
BS
Segal
Perry C
PC
Turner
Peter C
PC
Poon
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000009:adverse effects / Q000379:methods; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome