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Anazor FC, Relwani J, Dhinsa BS. Postoperative outcomes of third-generation shoulder hemiarthroplasties for three-and four-part proximal humeral fractures: A systematic review of published studies from 2012 to 2022. J Clin Orthop Trauma 2024; 53:102435. [PMID: 38983585 PMCID: PMC11228791 DOI: 10.1016/j.jcot.2024.102435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 05/19/2024] [Accepted: 06/05/2024] [Indexed: 07/11/2024] Open
Abstract
Background The aim of this study was to provide up-to-date evidence on the outcomes for hemiarthroplasties (HAs) that were performed using modern third-generation prostheses (post-2004) for isolated (excluding head-splits and fracture-dislocations) three-and four-part proximal humerus fractures (PHFs). Methods PubMed, Medline, Embase and the Cochrane register were searched from January 1, 2012, to November 15, 2022, conforming to the PRISMA guidelines. The outcome measures were the complication rates, revision rates, surgery-related postoperative mortality, post-operative clinical outcome scores and radiological outcomes. Results 432 hemiarthroplasties in 432 patients were performed across the 11 eligible studies (two prospective and 9 retrospective). Three studies compared HA versus reverse shoulder replacement (RSR); one study compared HA with locking plate fixation (LPF) and RSR; one study compared HA with LPF. 61.1 % and 19.4 % of hemiarthroplasties were performed using cemented and uncemented techniques respectively, while cementing data was ill-defined in 19.4 % of shoulders. The results for the outcome measures have been derived directly from the included studies and no statistical pooling was performed, due to heterogeneity in the different study designs and outcomes. Descriptive data synthesis from the included studies showed that third generation HAs have higher overall postoperative complication rates, with similar revision and mortality rates when compared to RSR and LPF for three-and four-part PHFs. RSR and LPF showed better statistically significant improvements than HA for the Constant-Murley score, Quick DASH, forward flexion and abduction. Mixed results were observed for the DASH score, ASES score and internal rotation ROM between RSR/LPF versus HA. Conclusion Low to moderate quality evidence from this review showed that even third-generation HA prostheses provided worse overall outcomes than RSR and LPF for three-and four-part PHFs.
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Affiliation(s)
- Fitzgerald Chukwuemeka Anazor
- Specialty Trainee Registrar (ST3), Trauma and Orthopaedic Surgery, East Midlands North (Nottingham) Orthopaedic Rotation, United Kingdom
| | - Jaikumar Relwani
- Consultant Orthopaedic and Trauma Surgeon, Department of Trauma and Orthopaedics, East Kent Hospitals University NHS Foundation Trust, TN 24 0LZ, United Kingdom
| | - Baljinder Singh Dhinsa
- Consultant Orthopaedic and Trauma Surgeon, Department of Trauma and Orthopaedics, East Kent Hospitals University NHS Foundation Trust, TN 24 0LZ, United Kingdom
- Professor of Regenerative Orthopaedics, Canterbury Christchurch University, United Kingdom
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Vandenbosch D, Van Tongel A, De Wilde L, Cools AM. Electromyographic analysis of selected shoulder muscles during shoulder rehabilitation exercises in patients after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2024:S1058-2746(24)00349-5. [PMID: 38754545 DOI: 10.1016/j.jse.2024.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/27/2024] [Accepted: 03/25/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) aims to restore function in patients with rotator cuff failure and joint arthropathy. After surgery, patients are routinely referred to a rehabilitation specialist to regain range of motion, strength, and function. A key element in these programs is active exercises. The exercises are often selected based on assumed muscle activity, investigated by electromyography (EMG). In particular, in this patient population, activation of the deltoid and the scapular muscles is the focus of exercise therapy. Currently, most studies investigating muscle activity levels during exercises are performed on healthy individuals. To our knowledge, no study exists analyzing EMG activity during exercises in a population of shoulder arthroplasty patients. Therefore, the study aimed to analyze activity in the shoulder girdle muscles during 6 commonly used rehabilitation exercises 12 weeks after reverse shoulder arthroplasty surgery. METHODS Forty-four patients (50 shoulders) participated in this cross-sectional study, 12 weeks postoperatively (mean 99.18 ± 12.8 days), aged 68.9 ± 7.75 years. Surface EMG activity was measured in 10 shoulder girdle muscles: the 3 trapezius parts, serratus anterior, the 3 deltoid parts, latissimus dorsi, and 2 pectoralis major parts during 6 exercises, 3 in a closed chain, and 3 open chain elevation exercises. RESULTS Gravity-minimized exercises (horizontal plane) show low activity for almost all muscles. Vertical closed kinetic chain exercises show an increased activity compared to horizontal plane exercises. Open kinetic chain exercises against gravity showed the greatest activity in deltoid and upper trapezius. For the other muscles, no consistency in progression was found. CONCLUSION This study offers a progression of exercises for patients after reverse shoulder arthroplasty based on increased muscle activity.
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Affiliation(s)
- Dominiek Vandenbosch
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Campus UZ Gent, Ghent, Belgium; Department of Physical Health and Rehabilitation, Ghent University Hospital, Ghent, Belgium.
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Ann M Cools
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Campus UZ Gent, Ghent, Belgium
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Labrum JT, Kuttner NP, Atwan Y, Sanchez-Sotelo J, Barlow JD. Fracture Dislocations of the Glenohumeral Joint. Curr Rev Musculoskelet Med 2023:10.1007/s12178-023-09846-y. [PMID: 37329400 PMCID: PMC10382466 DOI: 10.1007/s12178-023-09846-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE OF REVIEW Proximal humerus fracture dislocations typically result from high-energy mechanisms and carry specific risks, technical challenges, and management considerations. It is vital for treating surgeons to understand the various indications, procedures, and complications involved with their treatment. RECENT FINDINGS While these injuries are relatively rare in comparison with other categories of proximal humerus fractures, fracture dislocations of the proximal humerus require treating surgeons to consider patient age, activity level, injury pattern, and occasionally intra-operative findings to select the ideal treatment strategy for each injury. Proximal humerus fracture dislocations are complex injuries that require special considerations. This review summarizes recent literature regarding the evaluation and management of these injuries as well as the indications and surgical techniques for each treatment strategy. Thorough pre-operative patient evaluation and shared decision-making should be employed in all cases. While nonoperative management is uncommonly considered, open reduction and internal fixation (ORIF), hemiarthroplasty, and reverse total shoulder replacement are at the surgeon's disposal, each with their own indications and complication profile.
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Affiliation(s)
- Joseph T Labrum
- Department of Orthopaedic Surgery, Mayo Clinic, 200 1St St SW, Rochester, MN, 55902, USA
| | - Nicolas P Kuttner
- Department of Orthopaedic Surgery, Mayo Clinic, 200 1St St SW, Rochester, MN, 55902, USA
| | - Yousif Atwan
- Department of Orthopaedic Surgery, Mayo Clinic, 200 1St St SW, Rochester, MN, 55902, USA
| | - Joaquin Sanchez-Sotelo
- Department of Orthopaedic Surgery, Mayo Clinic, 200 1St St SW, Rochester, MN, 55902, USA
| | - Jonathan D Barlow
- Department of Orthopaedic Surgery, Mayo Clinic, 200 1St St SW, Rochester, MN, 55902, USA.
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Belayneh R, Lott A, Haglin J, Zuckerman J, Egol K. The role of patients' overall expectations of health on outcomes following proximal humerus fracture repair. Orthop Traumatol Surg Res 2021; 107:103043. [PMID: 34389496 DOI: 10.1016/j.otsr.2021.103043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 02/16/2021] [Accepted: 03/12/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The purpose of this study is to evaluate the relationship between patients' own health expectations and treatment outcomes following surgical repair of proximal humerus fractures. HYPOTHESIS Patients' health expectations will correlate with treatment outcomes following surgical repair of proximal humerus fractures. MATERIAL AND METHODS Over a 14-year period, 247 patients with a displaced proximal humerus fracture who underwent ORIF with locking compression plates were prospectively followed at one academic institution. Minimum follow-up period was 12 months. Patient-reported functional outcome data for the latest follow up visit (12 months and greater) was obtained from Disabilities of Arm, Shoulder, and Hand (DASH) questionnaires. Survey responses regarding health expectations were recorded at 3-month follow-up and converted to dichotomous variables. Two groups were identified: the high expectations and the low expectations groups. Statistical analysis comparing the two groups and their functional and clinical outcomes was performed using the independent t-test, using p<0.05 for significance. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated to further statistically characterize the relationship between health expectations at 3 months and long-term outcomes. RESULTS One hundred and eighty-five (75.0%) patients available for analysis with a mean follow-up length of 24.8 months. The cohort included 124 (67%) females and 61 (33%) males and the average age at time of injury was 59.5 years. Eighty-six (46.5%) patients had low expectations for their overall health and 99 (53.5%) patients had high expectations for their health. No significant differences were seen between groups in regards to age, gender, follow-up length, Charlson Comorbidity Index (CCI), smoking and tobacco use, fracture pattern (OTA and Neer classifications), early complications (p>0.05), fracture healing, and avascular necrosis. The mean DASH score at the latest follow up for patients with low expectations was 31.42±22.8 whereas the mean for those with high expectations was 16.76±20.2 (p<0.0005). The mean forward flexion of the shoulder for patients with low expectations was 137.8±31.5 degrees as compared to 148.5±26.3 degrees (p<0.05). The positive predictive value of good expectations correlating with good outcomes was 71.7%. DISCUSSION Patients with high expectations for their health early following injury had better outcomes in the long term. These high expectations also appeared to have an optimal influence on range of shoulder motion. This data suggests attitudinal and psychological factors that affect patient health expectations early on in the course of treatment may also influence patients' functional and clinical outcomes. LEVEL OF EVIDENCE II; Retrospective Study.
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Affiliation(s)
- Rebekah Belayneh
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17(th) Street, 10003 New York, NY, USA; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, 911 L.S. Kaufmann Bldg., 15213 Pittsburgh, PA, USA.
| | - Ariana Lott
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17(th) Street, 10003 New York, NY, USA
| | - Jack Haglin
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17(th) Street, 10003 New York, NY, USA
| | - Joseph Zuckerman
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17(th) Street, 10003 New York, NY, USA
| | - Kenneth Egol
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17(th) Street, 10003 New York, NY, USA
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Management of proximal humeral fractures: a review. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Xue Z, Pei Z, Zhang H, Tang C, Jia J, Zhang K, Zhang K, Wang L, Guan Z. Histological characteristics of bone in-growth of proximal humeral implants with different spatial structures. Aging (Albany NY) 2021; 13:4291-4298. [PMID: 33495410 PMCID: PMC7906205 DOI: 10.18632/aging.202391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022]
Abstract
This study compares the longitudinal histological characteristics of proximal humeral implants with different spatial structures in rabbits. Thirty skeletally-mature male rabbits were divided into a trabecular structure group and regular hexahedron structure group according to the different spatial structures of a biological titanium alloy screw inserted into the greater tuberosity of the proximal humerus. Samples were collected 3, 6, and 12 weeks after the implantation surgery. Histological results showed that the amount of bone in-growth in the porous cavity of the screw implant increased over time. Quantitative analysis showed there was significantly more bone in-growth in the trabecular structure group than the classic structure group 3 weeks (25.4% ± 6.9% vs 19.6% ± 3.7%, P < 0.05) and 6 weeks (31.2% ± 1.7% vs 26.9% ± 5.3, P < 0.05) after the implantation surgery. No significant difference was detected between the two groups 12 weeks after the surgery (41.7% ± 2.5% vs 39% ± 4.1%, P > 0.05). Our data found that bone in-growth significantly differed among the three time points (P < 0.05) in both groups, but not between the implants with different spatial structures 12 weeks after the surgery.
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Affiliation(s)
- Zhe Xue
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Zheng Pei
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Hui Zhang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Chong Tang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Junxiu Jia
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Kun Zhang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Keshi Zhang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Luning Wang
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Haidian 100083, Beijing, P.R. China
| | - Zhenpeng Guan
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
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Liu JN, Agarwalla A, Gowd AK, Romeo AA, Forsythe B, Verma NN, Nicholson GP. Reverse shoulder arthroplasty for proximal humerus fracture: a more complex episode of care than for cuff tear arthropathy. J Shoulder Elbow Surg 2019; 28:2139-2146. [PMID: 31300365 DOI: 10.1016/j.jse.2019.03.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The purpose of this investigation is to identify the in-hospital and 30-day postoperative complications for reverse total shoulder arthroplasty (RTSA) performed because of proximal humerus fracture (PHFx) vs. cuff tear arthropathy (CTA), and determine whether acute fracture is associated with differences in complications after RTSA. METHODS The National Surgical Quality Improvement Program database was queried for RTSA performed for PHFx and CTA. This database contains surgical outcomes within 30 days after the index procedure. Patients underwent a 1:1 propensity matched based on preoperative demographics and comorbidities. Outcomes included operative time, length of stay (LOS), complications, transfusion, readmission, and discharge destination. RESULTS A total of 1006 patients (503 per group) were included. With a PHFx, operative time was longer (129.5 ± 54.2 vs. 96.0 ± 40.0 minutes, P < .001), and the patients were more likely to have an adverse event (19.0% vs. 8.2%, P < .001), require transfusion (15.71% vs. 3.98%, P < .001), have longer LOS (3.8 ± 3.6 vs. 2.2 ± 1.7 days, P < .001), and were more likely to be discharged to an extended care facility (27.2% vs. 10.3%, P < .001). PHFx was an independent risk factor for an adverse event after an RTSA. CONCLUSIONS RTSA to treat PHFx is associated with longer LOS, increased complications, and discharge to an extended care facility compared with RTSA for CTA. Patients with PHFx require more health care resources than patients with CTA. It is imperative for surgeons, patients, families, governments, hospital systems, and insurance payers to recognize the differences in resource utilization for RTSA in treating PHFx compared with CTA.
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Affiliation(s)
- Joseph N Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University, Baptist Medical Center, Winston-Salem, NC, USA
| | - Anthony A Romeo
- Department of Orthopaedic Surgery, The Rothman Institute, New York, NY, USA
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
| | - Gregory P Nicholson
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
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Misra S, Vaishya R, Trikha V, Maheshwari J. Practice guidelines for proximal humeral fractures. J Clin Orthop Trauma 2019; 10:631-633. [PMID: 31061604 PMCID: PMC6494746 DOI: 10.1016/j.jcot.2019.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Shashank Misra
- Sir Gangaram & Surya Hospitals, New Delhi, India,Corresponding author. Delhi Shoulder & Knee Clinic, Sir Gangaram & Surya Hospitals, New Delhi, India.
| | - Raju Vaishya
- Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110025, India
| | - Vivek Trikha
- Orthopaedics, Lok Nayak Jai Prakash Truama Centre, AIIMS, Ring Road, New Delhi, India
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Abstract
OBJECTIVES To determine the effect of osteonecrosis (ON) on the clinical and functional outcome after open reduction and internal fixation of proximal humerus fractures. DESIGN Prospective cohort study. SETTING Academic medical center. PATIENTS Over a 12-year period, patients were screened and identified on presentation to the emergency department or in the clinical office for inclusion in an institutional review board-approved registry. One hundred sixty-five patients with 166 proximal humerus fractures met inclusion criteria. Eight patients developed radiographic evidence of ON (4.8%). INTERVENTION Surgical repair of proximal humerus fractures. MAIN OUTCOME MEASURE Patients were divided into 2 cohorts; 1 cohort being those diagnosed with ON and the other cohort being those who were not. All patients were prospectively followed and assessed for clinical and functional outcomes at the latest follow-up visit (mean = 22.9 months) using the Disabilities of Arm, Shoulder and Hand survey along with ranges of motion of the injured extremity. RESULTS Average postoperative forward elevation for patients with ON was worse than those without ON (P = 0.002). Additionally, there was a significant difference in Disabilities of Arm, Shoulder and Hand scores at the latest follow-up between the 2 groups (P = 0.026). There was no difference in external rotation or mean length of follow-up between the 2 groups (P > 0.05). CONCLUSIONS This study demonstrates the negative effects of ON after open reduction and internal fixation of proximal humerus fractures. Those who develop ON have poorer functional and clinical outcomes as compared with patients without ON. Consequently, the development of ON can be used as a predictor of poor outcomes. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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A New Stem Guide and a Tuberosity Anchoring "Lasso" System for Shoulder Hemiarthroplasty in the Treatment of Complex Proximal Humerus Fractures. Tech Hand Up Extrem Surg 2017; 21:131-136. [PMID: 28885384 DOI: 10.1097/bth.0000000000000172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hemiarthroplasty implantation for proximal humerus fracture is challenging. In case of young demanding patients with functional rotator cuff, humeral head replacement is an option if open reduction internal fixation is not a viable solution. The criteria for success in terms of clinical outcomes and longevity are anatomic healing of the tuberosities and stem positioning (restoring correct height, version, and axis). The purpose of this article is to describe a technique including a new stem guide and a tuberosity anchor "lasso" system for the implantation of hemiarthroplasty in complex proximal humerus fractures. A standard delto-pectoral approach is performed. After humeral head removal and tuberosity mobilization and debridement, a stem-positioning system guarantees correct height and version of the humeral stem, established after anatomic reduction of the greater tuberosity. A centering device is added on the humeral stem to prevent any varus or valgus. Fixation of the tuberosities is achieved with 6 nonabsorbable sutures fixed on a polyester "lasso" anchoring system circling the humerus, respecting the direction of rotator cuff tendons and adding double circumferential tightening. After reduction of the implant, stability, and passive range of motion are assessed intraoperatively and fluoroscopic control of the prosthesis is performed. The patient is maintained in a sling in neutral rotation and passive motion is started after 4 weeks; active motion is allowed after 2 months. We believe this surgical technique could help limit complications and prevent revision of the humeral stem in case of further conversion to reverse shoulder arthroplasty.
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Thorsness R, Shields E, Chen RE, Owens K, Gorczyca J, Voloshin I. Open Reduction and Internal Fixation Versus Hemiarthroplasty in the Management of Complex Articular Fractures and Fracture-dislocations of the Proximal Humerus. J Shoulder Elb Arthroplast 2017. [DOI: 10.1177/2471549217709364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Robert Thorsness
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York
| | - Edward Shields
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York
| | - Raymond E Chen
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York
| | - Kathy Owens
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York
| | - John Gorczyca
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York
| | - Ilya Voloshin
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York
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Shukla DR, McAnany S, Kim J, Overley S, Parsons BO. Hemiarthroplasty versus reverse shoulder arthroplasty for treatment of proximal humeral fractures: a meta-analysis. J Shoulder Elbow Surg 2016; 25:330-40. [PMID: 26644230 DOI: 10.1016/j.jse.2015.08.030] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND We performed a meta-analysis of studies with at least Level IV evidence to compare outcomes between hemiarthroplasty and reverse shoulder arthroplasty for the treatment of proximal humeral fractures. METHODS Three electronic databases (PubMed, Cochrane, and EMBASE) were searched. The quality of each study was investigated, and data on radiographic and functional outcomes were extracted and analyzed. RESULTS The analysis included 1 Level I study, 1 Level II study, 3 Level III studies, and 2 Level IV studies. Reverse shoulder arthroplasty was more favorable than hemiarthroplasty in forward elevation (P < .001), abduction (P < .001), tuberosity healing (P = .002), Constant score (P < .001), American Shoulder and Elbow Surgeons score (P < .001), and Disabilities of the Arm, Shoulder and Hand score (P = .001). Only external rotation (P = .85) was not in favor of reverse shoulder arthroplasty. CONCLUSIONS The available literature suggests that reverse shoulder arthroplasty performed to address complex proximal humeral fractures might result in more favorable clinical outcomes than hemiarthroplasty performed for the same indication.
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Affiliation(s)
- Dave R Shukla
- Leni & Peter May Department of Orthopaedics, Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Steven McAnany
- Leni & Peter May Department of Orthopaedics, Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun Kim
- Leni & Peter May Department of Orthopaedics, Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sam Overley
- Leni & Peter May Department of Orthopaedics, Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Leni & Peter May Department of Orthopaedics, Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Reverse shoulder arthroplasty versus hemiarthroplasty for treatment of proximal humerus fractures. J Shoulder Elbow Surg 2015; 24:1560-6. [PMID: 25958208 DOI: 10.1016/j.jse.2015.03.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 03/13/2015] [Accepted: 03/18/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Whereas most proximal humerus fractures are treated nonoperatively, complex 3- and 4-part fractures may require shoulder arthroplasty. Hemi-shoulder arthroplasty (HSA) has been the standard treatment, but recently there has been discussion and utilization of reverse total shoulder arthroplasty (RTSA) as a viable treatment option. This study evaluated the national utilization of RTSA and HSA for proximal humerus fractures and compared patient and hospital characteristics associated with each procedure. METHODS This study used the Nationwide Inpatient Sample database for 2011, which allows national estimates of inpatient hospital discharges. Patients were selected by diagnosis and procedure codes to identify those who underwent RTSA or HSA for treatment of proximal humerus fractures. Patient and hospital characteristics associated with each procedure as well as in-hospital complication rates were identified. RESULTS An estimated 7714 patients with proximal humerus fractures were selected, 27.4% of whom were treated with RTSA. Except for increased age, patient characteristics were similar between groups, as were complication rates. RTSA was more likely to be performed over HSA in small, rural, nonteaching hospitals and also in those that had already adopted and performed a high volume of RTSA procedures for other diagnoses. CONCLUSIONS Although HSA remains the most common arthroplasty choice for proximal humerus fractures, RTSA is becoming widely used. Patient characteristics and complications were similar between the 2 procedures, and as clinical evidence appears to show improved outcomes with RTSA, it is likely that acceptance of RTSA will continue to grow.
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Nikola C, Hrvoje K, Nenad M. Reverse shoulder arthroplasty in acute fractures provides better results than in revision procedures for fracture sequelae. INTERNATIONAL ORTHOPAEDICS 2014; 39:343-8. [DOI: 10.1007/s00264-014-2649-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 12/02/2014] [Indexed: 11/29/2022]
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Hospital readmissions after surgical treatment of proximal humerus fractures: is arthroplasty safer than open reduction internal fixation? Clin Orthop Relat Res 2014; 472:2317-24. [PMID: 24733446 PMCID: PMC4079887 DOI: 10.1007/s11999-014-3613-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 03/27/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND With technologic advances such as locked periarticular plating, hemiarthroplasty of the humeral head, and more recently reverse total shoulder replacement, surgical treatment of proximal humerus fractures has become more commonplace. However, there is insufficient information regarding patient outcomes after surgery, such as the frequency of unplanned hospital readmissions and factors contributing to readmission. QUESTIONS/PURPOSES We measured (1) the frequency of unplanned hospital readmissions after surgical treatment of proximal humerus fractures, (2) the medical and surgical causes of readmission, and (3) the risk factors associated with unplanned readmissions. METHODS The State Inpatient Database from seven different states was used to identify patients who underwent treatment for a proximal humerus fracture with open reduction and internal fixation (ORIF), hemiarthroplasty of the humeral head, or reverse total shoulder arthroplasty from 2005 through 2010. The database was used to measure the 30-day and 90-day readmission rates and identify causes and risk factors for readmission. Multivariate modeling and a Cox proportional hazards model were used for statistical analysis. RESULTS A total of 27,017 patients were included with an overall 90-day readmission rate of 14% (15% for treatment with ORIF, 15% for reverse total shoulder arthroplasty, and 13% for hemiarthroplasty). The majority of readmissions were associated with medical diagnoses (75%), but treatment with ORIF was associated with the most readmissions from surgical complications, (29%) followed by reverse total shoulder arthroplasty (20%) and hemiarthroplasty (16%) (p < 0.001). Risk of readmission was greater for patients who were female, African American, discharged to a nursing facility, or had Medicaid insurance. CONCLUSIONS As the majority of unplanned hospital readmissions were associated with medical diagnoses, it is important to consider patient medical comorbidities before surgical treatment of proximal humerus fractures and during the postoperative care phase. LEVEL OF EVIDENCE Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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