title: Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study.
abstract: BACKGROUND
  There is no consensus on what type of arthroplasty is best for the treatment of complex proximal humeral fractures in elderly patients. The purpose of this prospective study was to compare the outcomes of reverse shoulder arthroplasty (RSA) and hemiarthroplasty (HA).
  
  
  METHODS
  Sixty-two patients older than 70 years were randomized to RSA (31 patients) and HA (31 patients). One HA patient died at 1 year, and she was excluded. The mean follow-up was 28.5 months (range, 24-49 months).
  
  
  RESULTS
  Compared with HA patients, RSA patients had significantly higher (P = .001) mean University of California-Los Angeles (29.1 vs 21.1) and Constant (56.1 vs 40.0) scores, forward elevation (120.3° vs 79.8°), and abduction (112.9° vs 78.7°) but no difference in internal rotation (2.7° vs 2.6°; P = .91). The Disabilities of the Arm, Shoulder, and Hand score was higher in the HA patients (17 vs 29; P = .001). In the HA group, 56.6% of tuberosities healed and 30% resorbed. Patients with failure of tuberosities had significantly worse functional outcomes. There were 2 complications (intraoperative humeral fracture and superficial infection). One patient was manipulated under general anesthesia because of postoperative stiffness. Six patients with HA had proximal migration that required revision to RSA. In the RSA group, 64.5% of tuberosities healed and 13.2% resorbed. Functional outcome was irrespective of healing of the tuberosities. Notching was observed in only 1 RSA patient. One patient developed a hematoma and another a deep infection requiring a 2-stage revision to another RSA.
  
  
  CONCLUSIONS
  RSA resulted in better pain and function and lower revision rate. Revision from HA to RSA does not appear to improve outcomes.
authors.affiliation: Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Sebastiá-Forcada
authors.affiliation: Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain.
authors.forename: Román
authors.initials: R
authors.lastname: Cebrián-Gómez
authors.affiliation: Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain. Electronic address: lizaur1@telefonica.net.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Lizaur-Utrilla
authors.affiliation: Unit of Clinical Investigation, Elda University Hospital, Alicante, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Gil-Guillén
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement; D005260:Female; D062785:Hemiarthroplasty; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012784:Shoulder Fractures / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery; D016896:Treatment Outcome
keywords: Proximal humeral fracture; hemiarthroplasty; reverse shoulder arthroplasty