Cuff, J Bone Joint Surg Am 2013 - Comparison of Hemiarthroplasty and Reverse Shoulder Arthroplasty for the Treatment of Proximal Humeral Fractures in Elderly Patients
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Comparison of Hemiarthroplasty and Reverse Shoulder Arthroplasty for the Treatment of Proximal Humeral Fractures in Elderly Patients
Cuff, Pupello·J Bone Joint Surg Am·2013·327 citations
Cuff and Pupello compared hemiarthroplasty with reverse shoulder arthroplasty for comminuted proximal humeral fractures in patients 70 or older.
Prospective single‑surgeon series of 53 consecutive patients (mean age 74.4), the first 26 treated with hemiarthroplasty and the next 27 with reverse arthroplasty, 2007 to 2010. Not randomized.
Reverse arthroplasty would give more consistent and better function than hemiarthroplasty.
Key Findings
Reverse arthroplasty gave better mean ASES (77 vs 62, p = 0.0001) and SST scores (7.4 vs 5.8, p = 0.0062), and more patients were satisfied (91% vs 61%, p = 0.038).
Forward elevation was 139° after reverse arthroplasty vs 100° after hemiarthroplasty (p = 0.0002). Internal and external rotation did not differ.
Tuberosities healed in 61% after hemiarthroplasty and 83% after reverse arthroplasty, a difference that was not significant (p = 0.17).
After hemiarthroplasty, results depended on tuberosity healing: healed shoulders averaged ASES 71 and 131° elevation, resorbed ones 38 and 52° (p < 0.0001).
After reverse arthroplasty, ASES, SST and elevation did not differ by tuberosity healing, but healed tuberosities gave more external rotation (28° vs 12°, p = 0.02).
Complications were 2 per group, and 3 hemiarthroplasty patients with resorbed tuberosities chose revision to reverse arthroplasty. Hemiarthroplasty follow‑up averaged 10 months longer, and preinjury scores were unavailable.
Board pearl
Overhead elevation after fracture hemiarthroplasty depended on tuberosity healing, appearing all or nothing. After reverse arthroplasty, scores did not differ significantly by healing, though only 4 shoulders had resorption. Both authors consult for the reverse implant's maker.
Authors' conclusion
In this series, reverse shoulder arthroplasty resulted in better clinical outcomes and a similar complication rate compared with hemiarthroplasty for the treatment of comminuted proximal humeral fractures in the elderly.
Cuff and Pupello compared hemiarthroplasty with reverse shoulder arthroplasty for comminuted proximal humeral fractures in patients 70 or older.
Prospective single‑surgeon series of 53 consecutive patients (mean age 74.4), the first 26 treated with hemiarthroplasty and the next 27 with reverse arthroplasty, 2007 to 2010. Not randomized.
Reverse arthroplasty would give more consistent and better function than hemiarthroplasty.
Key Findings
Reverse arthroplasty gave better mean ASES (77 vs 62, p = 0.0001) and SST scores (7.4 vs 5.8, p = 0.0062), and more patients were satisfied (91% vs 61%, p = 0.038).
Forward elevation was 139° after reverse arthroplasty vs 100° after hemiarthroplasty (p = 0.0002). Internal and external rotation did not differ.
Tuberosities healed in 61% after hemiarthroplasty and 83% after reverse arthroplasty, a difference that was not significant (p = 0.17).
After hemiarthroplasty, results depended on tuberosity healing: healed shoulders averaged ASES 71 and 131° elevation, resorbed ones 38 and 52° (p < 0.0001).
After reverse arthroplasty, ASES, SST and elevation did not differ by tuberosity healing, but healed tuberosities gave more external rotation (28° vs 12°, p = 0.02).
Complications were 2 per group, and 3 hemiarthroplasty patients with resorbed tuberosities chose revision to reverse arthroplasty. Hemiarthroplasty follow‑up averaged 10 months longer, and preinjury scores were unavailable.
Board pearl
Overhead elevation after fracture hemiarthroplasty depended on tuberosity healing, appearing all or nothing. After reverse arthroplasty, scores did not differ significantly by healing, though only 4 shoulders had resorption. Both authors consult for the reverse implant's maker.
Authors' conclusion
In this series, reverse shoulder arthroplasty resulted in better clinical outcomes and a similar complication rate compared with hemiarthroplasty for the treatment of comminuted proximal humeral fractures in the elderly.