Does age affect patient outcomes after humeral head replacement in the treatment of acute proximal humeral fractures? A comparative cohort study with a minimum 10 years long-term follow-up

Abstract

Humeral head replacement (HHR) is now rarely recommended for complex proximal humeral fractures (PHFs) in older patients. However, in relatively young and active patients with unreconstructable complex PHFs, controversy still exists regarding the treatment options of reverse shoulder arthroplasty (RSA) and HHR. The goal of this study was to compare the survival, functional and radiographic outcomes of HHR in patients aged <70 years and those aged ≥70 years after a minimum 10 years follow-up. Eighty-seven out of 135 patients undergoing primary HHR were enrolled and then divided into 2 groups based on age: <70 years and ≥70 years. Clinical and radiographic evaluations were performed with a minimum follow-up of 10 years. There were 64 patients (54.9 years old) in the younger group and 23 patients (73.5 years old) in the older group. The younger and older groups had comparable ten-year implant survivorship (98.4% vs. 91.3%). Patients aged ≥70 years had worse American Shoulder and Elbow Surgeons (ASES) scores (74.2 vs. 81.0, P=.042) and lower satisfaction rates (12% vs. 64%, P<.001) than younger patients. At the final follow-up, older patients had worse forward flexion (117° vs. 129°, P =.047) and internal rotation (17 vs. 15, P=.036). More greater tuberosity (GT) complications (39% vs. 16%, P=.019), glenoid erosion (100% vs. 59%, P=.077) and humeral head superior migration (80% vs. 31%, P=.037) were also identified in patients aged ≥70 years. Unlike the increased risk for revision and functional deterioration over time after RSA for PHFs in younger patients, a high implant survival rate with lasting pain relief and stable functional outcomes could be observed in younger patients after HHR during long-term follow-up. Patients aged ≥70 years had worse clinical outcomes, lower patient satisfaction, more GT complications, and more glenoid erosion and humeral head superior migration than those aged <70 years. HHR should not be recommended for the treatment of unreconstructable complex acute PHFs in older patient populations.