Healing of the Greater Tuberosity in Acute Shoulder Hemiarthroplasty Using an Accelerated Rehabilitation Regime

Abstract

BackgroundDisplaced three- and four-part proximal humerus fractures are common and are frequently treated by shoulder hemiarthroplasty. The present study sought to evaluate an accelerated rehabilitaton regime following hemiarthoplasty and assess its affect on healing of the greater tuberosities.MethodsTwenty patients over a 2-year period treated with acute hemiarthroplasty were rehabilitated with an accelerated regime of passive movements on day 1, active movements from the second week, and strengthening from the fourth postoperative week. Clinical and radiological follow-up was at 12 months.ResultsAt 6 months, the mean Constant functional shoulder score was 55.52 (range 14 to 78). The average maximum forward elevation was 98.47° (range 30° to 160°). The mean pain score at 6 months was 11.42 (range 0 to 15). Twenty-two of 23 patients went on to heal radiologically by 3 months, with one case undergoing resorption of the tuberosities as a result of falls and a cerebrovascular event affecting the limb. At 3 months, 20/23 patients had undergone tuberosity healing with less than 0.5 cm displacement (86.9% of patients).DiscussionAn accelerated rehabilitation regime does not adversely affect the rate of healing of the tuberosities following shoulder hemiarthroplasty for proximal humerus fractures. The use of an early mobilization regime is likely to allow an earlier return to normal activities of daily living.