First randomized controlled trial comparing reverse shoulder arthroplasty (RSA) versus hemiarthroplasty (HA) for acute complex proximal humeral fractures. 62 patients older than 70 with displaced 4-part or head-splitting fractures were randomized and followed a mean of 28.5 months. The question: which arthroplasty gives better pain, function, and durability in the elderly?
For a displaced 4-part proximal humeral fracture in a patient over 70 that cannot be reconstructed, this trial supports RSA over hemiarthroplasty as the default. The mental model is simple: HA relies on the tuberosities healing so the cuff can drive the shoulder. In elderly comminuted, osteoporotic bone, tuberosities often resorb or fail, and HA function collapses to a Constant near 21.
RSA sidesteps this entirely by making the deltoid the prime mover, so function is independent of tuberosity healing. That is why RSA outperformed HA in Constant, UCLA, elevation, abduction, and revision rate. A key management pearl: do not plan on rescuing a failed HA with later conversion to RSA. Salvage revision here averaged a Constant of only 22, far worse than primary RSA.
Limitations to weigh: follow-up was only ~28 months, and results apply to this specific chamfered implant design, not all RSA models.
First randomized controlled trial comparing reverse shoulder arthroplasty (RSA) versus hemiarthroplasty (HA) for acute complex proximal humeral fractures. 62 patients older than 70 with displaced 4-part or head-splitting fractures were randomized and followed a mean of 28.5 months. The question: which arthroplasty gives better pain, function, and durability in the elderly?
For a displaced 4-part proximal humeral fracture in a patient over 70 that cannot be reconstructed, this trial supports RSA over hemiarthroplasty as the default. The mental model is simple: HA relies on the tuberosities healing so the cuff can drive the shoulder. In elderly comminuted, osteoporotic bone, tuberosities often resorb or fail, and HA function collapses to a Constant near 21.
RSA sidesteps this entirely by making the deltoid the prime mover, so function is independent of tuberosity healing. That is why RSA outperformed HA in Constant, UCLA, elevation, abduction, and revision rate. A key management pearl: do not plan on rescuing a failed HA with later conversion to RSA. Salvage revision here averaged a Constant of only 22, far worse than primary RSA.
Limitations to weigh: follow-up was only ~28 months, and results apply to this specific chamfered implant design, not all RSA models.