Hemiarthroplasty versus reverse shoulder arthroplasty in 4-part displaced fractures of the proximal humerus: Multicenter retrospective study.
Complex 4-part fractures of the proximal humerus are one of the most difficult fractures to manage. For several years, reverse total arthroplasty (RSA) has been proposed as an alternative to hemiarthroplasty (HA) when internal fixation is insufficient. The goal of this study was to compare the short and intermediate term results of these 2 different types of arthroplasty.



In a retrospective, multicenter study, 57 HA and 41 RSA were reviewed after a follow-up of at least 2 years. The clinical evaluation was based on the absolute and adjusted Constant scores, Simple shoulder value (SSV) and the quick-DASH scores. The radiological assessment included standard radiological tests.



After a mean follow-up of 39 months, the RSA group had a significantly higher adjusted Constant score than the HA group (83% vs 73%, respectively P=0.02). However, there was no significant difference in the absolute Constant score, the quick-DASH or the SSV scores. Active anterior elevation was better in the RSA group, while internal rotation was better in the HA group (130° vs 112°, P=0.01; sacrum vs L3, P=0.03). There was no significant difference in external rotation (28° vs 23°, P=0.31). The rate of complications was higher in the HA group than in the RSA group (24% vs 10%, P=0.01). The radiological rate of union of the greater tuberosity was similar in both groups (70%) and scapular notching was found in 23% of the RSA group.



The short and intermediate term clinical outcomes are better with RSA than with HA. The complication rate is higher with HA. Nevertheless, scapular notching occurred in more than 20% of patients with RSA, suggesting that care should be taken when using this prosthesis in young, active patients.
Département de chirurgie orthopédique, hôpital Riquet, CHU de Toulouse, place Baylac, 31059 Toulouse cedex, France. Electronic address: nicolasbonnevialle@yahoo.fr.
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Bonnevialle
Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France.
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Tournier
Service de chirurgie du membre supérieur, hôpitaux universitaires-CCOM, 10, avenue Baumann, 67400 Illkirch, France.
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Clavert
Service d'orthopédie traumatologie, hôpital Maison-Blanche, CHU de Reims, rue Cognacq-Jay, 51100 Reims, France.
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Ohl
Service d'orthopédie-traumatologie, centre chirurgical E.-Galle, 49, rue Hermite, 54000 Nancy, France.
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Sirveaux
Service d'orthopédie-traumatologie, CHRU de Grenoble, 38000 Grenoble, France.
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Saragaglia
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D062785:Hemiarthroplasty; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000601:surgery*; D016896:Treatment Outcome
4-part fracture; Cephalotuberosity fracture; Fracture; Hemiarthroplasty; Reverse shoulder arthroplasty