title: Revision after shoulder replacement for acute fracture of the proximal humerus.
abstract: Background and purpose - For more than half a century, stemmed hemiarthroplasty (SHA) has been used in the treatment of comminuted and displaced fractures of the proximal humerus. Reverse shoulder arthroplasty (RSA) has been increasingly popular in cases where it is difficult to obtain satisfactory fixation of the tuberosities. We report revision rates and reasons for revision after shoulder arthroplasty for acute fractures of the proximal humerus. Patients and methods - This study was based on a common dataset from the Nordic Arthroplasty Register Association (NARA), which includes data reported to the national shoulder arthroplasty registries in Denmark, Sweden, and Norway. We included 6,756 shoulder arthroplasties performed for acute fractures between 2004 and 2013. Results - There were 6,112 SHAs (90%) and 565 RSAs (8.4%). The cumulative arthroplasty survival rate after 5 years was 0.96 for both SHA and RSA. The relative risk of revision of RSA was 1.4 (95% CI: 0.9-2.2) with SHA as reference. For both types of arthroplasty, the most common reason for revision was infection (SHA 0.8%, RSA 2.1%). The relative risk of revision due to infection was 3.1 (95% CI: 1.6-5.9) for RSA with SHA as reference. The relative risk of revision for patients who were less than 75 years of age was 2.8 (95% CI: 2.0-3.8) compared to older patients. Interpretation - Revision after shoulder arthroplasty for acute fractures was rare. Survival rates were similar between SHA and RSA, but RSA had a statistically significant and clinically relevant higher risk of revision because of infection.
authors.affiliation: a Department of Orthopedic Surgery , Herlev Hospital, University of Copenhagen , Denmark.
authors.forename: Stig
authors.initials: S
authors.lastname: Brorson
authors.affiliation: b Department of Orthopedics , Karolinska Institutet Danderyds Sjukhus AB , Stockholm , Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Salomonsson
authors.affiliation: c Department of Orthopedic Surgery , Aalborg University Hospital , Aalborg , Denmark.
authors.forename: Steen L
authors.initials: SL
authors.lastname: Jensen
authors.affiliation: d Norwegian Arthroplasty Register, Department of Orthopedic Surgery , Haukeland University Hospital , Norway.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Fenstad
authors.affiliation: b Department of Orthopedics , Karolinska Institutet Danderyds Sjukhus AB , Stockholm , Sweden.
authors.forename: Yilmaz
authors.initials: Y
authors.lastname: Demir
authors.affiliation: a Department of Orthopedic Surgery , Herlev Hospital, University of Copenhagen , Denmark.
authors.forename: Jeppe V
authors.initials: JV
authors.lastname: Rasmussen
mesh_terms: D000367:Age Factors; D000368:Aged; D000072228:Arthroplasty, Replacement, Shoulder / Q000009:adverse effects*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009664:Norway / Q000453:epidemiology; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000601:surgery; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data*; D012307:Risk Factors; D012784:Shoulder Fractures / Q000601:surgery*; D013548:Sweden / Q000453:epidemiology