Primary stemmed shoulder hemiarthroplasty for proximal humerus fractures in active patients aged ≤40 years: average 20 years of follow-up

Abstract

BackgroundAlthough open reduction and internal fixation is a standard treatment for the management of severe proximal humeral fractures, it is associated with high risk for humeral head necrosis. Therefore, stemmed hemiarthroplasty (SHA) may be successfully used for older patients, but the expected long-term outcomes for young, active patients remain unclear. Therefore, in this study, we report the long-term clinical outcomes of SHA of the shoulder in young, active patients aged <40 years. MethodsBetween 1986 and 2003, we investigated 11 shoulders of 11 patients (all male) for primary SHA of the shoulder. Five patients received cemented hemiarthroplasty. The average age was 28.6 years (range, 17–40 years), and the average follow-up was 20.5 years (range, 18–26 years). Fractures were 2-part (dislocation of anatomical neck fracture) in 3 patients, 3-part in 2 patients, and 4-part in 6 patients. Clinical function was assessed using the Japanese Orthopaedic Association score and Constant score. Acromiohumeral interval, prosthetic loosening, superior migration, and glenoid erosion were compared between the immediate postoperative and 5-year, 10-year, and most recent (final) follow-up radiographs. ResultsThe mean Japanese Orthopaedic Association and Constant scores at final follow-up were 87.5 ± 10.6 points (range, 58–100) and 82.8 ± 12.7 points (range, 48–95), respectively. There was no change in clinical score at the final follow-up compared with scores at 5 or 10 years after surgery. Clinical outcome was poor in 1 patient (absorption of greater tuberosity) regarding range of motion. No patient had prosthetic loosening or periprosthetic fracture. Three patients had mild or moderate glenoid erosion. The acromiohumeral interval gradually decreased with time. ConclusionThere was good long-term survival of primary SHA (average, 20.2 years). No long-term concerns were identified in terms of implant loosening or severe osteoarthritis of the glenoid, despite the young age of the patients at implant (<40 years). However, poor clinical results were found in older patients with regard to absorption and malunion of the greater tuberosity. In addition, there remain substantial concerns regarding progressive glenoid erosion and the outcomes of revision to a more standard arthroplasty.