Shoulder
Functional outcomes of reverse shoulder arthroplasty compared with hemiarthroplasty for acute proximal humeral fractures

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Background

Complex acute proximal humeral fractures may require prosthetic replacement of the proximal humerus. Reverse shoulder arthroplasty (RSA) has been suggested as an alternative to hemiarthroplasty in the management of such fractures. This study compared the functional outcomes of RSA with hemiarthroplasty in patients with acute proximal humeral fractures.

Materials and methods

All patients who underwent RSA or shoulder hemiarthroplasty for acute proximal humeral fractures between January 1, 1999, and December 31, 2010 were identified from The New Zealand Joint Registry. Baseline information, operative characteristics, and postoperative outcomes (Oxford Shoulder Score [OSS] at 6 months and 5 years, revision rate, and mortality rate) were examined and compared between the study groups.

Results

During the study period, 55 patients underwent RSA and 313 underwent shoulder hemiarthroplasty for acute proximal humeral fractures. Compared with hemiarthroplasty patients, RSA patients were significantly older (mean age, 79.6 vs 71.9 years; P < .001) and more often women (93% vs 78%, P = .013). The 6-month OSS was 28.1 for RSA and 27.9 for hemiarthroplasty, which was not significantly different (P = .923); however, the RSA group had a significantly better 5-year OSS than the hemiarthroplasty group (41.5 vs 32.3; P = .022). There was no significant difference between the RSA and hemiarthroplasty groups in revision rate per 100 component-years (1.7 vs 1.1; P = .747) or in 1-year mortality (3.5% vs 3.6%; P > .99).

Conclusions

Patients with acute proximal humeral fractures who undergo RSA appear to achieve superior 5-year functional outcomes compared with patients who undergo hemiarthroplasty.

Section snippets

Materials and methods

Data covering the period of January 1, 1999, to December 31, 2010, were obtained from The New Zealand Joint Registry. Registry records of all patients who underwent primary RSA and those who underwent primary shoulder hemiarthroplasty during this time with the principle diagnosis of acute proximal humeral fracture were analyzed.

Patients undergoing RSA were compared with patients undergoing shoulder hemiarthroplasty with respect to baseline information (age, sex, surgeon case volume), operative

Results

During the study period, 55 patients who underwent primary RSA and 313 patients who underwent primary shoulder hemiarthroplasty with the principle diagnosis of acute proximal humeral fracture were identified from New Zealand Joint Registry records.

Discussion

The comparable 6-month functional results seen in our study support the findings of previous studies, which did not identify substantial early functional benefit of RSA over hemiarthroplasty in the management of acute proximal humeral fractures.13, 29 We have identified an important midterm difference between the 2 patient groups, however, with RSA patients achieving 5-year functional results superior to hemiarthroplasty patients. In addition to patient functional benefits, this superior OSS is

Conclusion

In this nationwide registry-based cohort study comparing 55 patients undergoing primary RSA with 313 patients undergoing primary hemiarthroplasty for acute proximal humeral fractures, RSA appeared to produce functionally superior results to hemiarthroplasty at 5 years postoperatively. To our knowledge, this study reports the largest series with functional postoperative outcome data comparing RSA with hemiarthroplasty in the management of acute proximal humeral fractures. Our results support RSA

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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    This study was approved by the Multi Region Ethics Committee, New Zealand (study reference number: MEC/11/EXP/088).

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