Hemi- vs. reverse shoulder arthroplasty for acute proximal humeral fractures

Abstract

To date, there is no clear consensus on the superiority of shoulder hemiarthroplasty (HSA) or reverse shoulder arthroplasty (RSA) for the treatment of acute proximal humeral fractures (PHF). The aim of this study was to review the relevant literature for level I and II studies reporting clinical outcomes and revision rates for HSA or RSA in the treatment of acute PHF. Two electronic databases (PubMed, and Embase) were systematically searched for level I and II studies published after 1998 reporting clinical and/or radiographic outcomes of primary HSA or primary RSA as treatments for acute PHF. Of the 628 studies that were identified, nine were selected (four level I and five level II), with some heterogeneity in describing outcomes, complications, and revisions. The three studies that compared HSA versus RSA in patients with a mean age of >70 years found that RSA grants better clinical scores, less pain, higher forward elevation, and greater patient satisfaction. The remaining six studies compared outcomes of acute PHF treated by conventional HSA versus HSA + biceps tenodesis, trabecular metal HSA, intramedullary fibular allograft with locking compression plates, open reduction with internal fixation, or nonoperative treatment. Reverse shoulder arthroplasty is a reliable treatment for acute PHF in elderly patients, which grants better outcomes and is associated with fewer complications than HSA at short-term follow-up. Future research is needed to establish the best surgical treatment for acute PHF in young patients. Level II, systematic review of level I and II studies.