P35: A Systematic review on the outcomes of the reverse shoulder arthroplasty versus hemiarthroplasty for the 3- and 4- part proximal humeral fractures in the elderly population

Abstract

Abstract Background The hemiarthroplasty (HA) and reverse total shoulder arthroplasty (RTSA) are common surgical methods in of the proximal humerus management, where the surgical fixation is not feasible. Our aim is to analyse the most recent data to inform choices on best management for managing 3- and 4 -part fracture dislocations of the proximal humeral fractures in the elderly population. Methods The Medline, PubMed and Scopus databases were searched in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify the relevant literature to include for analysis. The inclusion criteria involved English language, functional outcomes, revision rates, hemiarthroplasty, and reverse total shoulder arthroplasty. The exclusion criteria were publications before 2018, systematic reviews and meta-analysis, other management options such as conservative management, surgical fixation, and total anatomical shoulder replacement. Results The data collected included study design and level of evidence, number of patients and patients’ characteristics, follow-up time post-surgery, functional outcomes, range of movement, Constant score, subjective scores including Disability of Arm and Shoulder (QuickDASH) and American Shoulder and Elbow Score (ASES), and revision rates. Conclusions The evidence suggests that RTSA is the new gold standard management for 3- and 4-part fracture dislocations of the proximal humerus in a selected group of patients over 65 years old with irreparable rotator cuff. The available literature is medium quality, requiring more robust evidence including prospective large cohort studies utilising unified objective and subjective functional outcome scores.