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UNBEHAUN D, RASMUSSEN S, HOLE R, FENSTAD AM, SALOMONSSON B, DEMIR Y, JENSEN SL, BRORSON S, ÄÄRIMAA V, MECHLENBURG I, RASMUSSEN JV. Low arthroplasty survival after treatment for proximal humerus fracture sequelae: 3,245 shoulder replacements from the Nordic Arthroplasty Register Association. Acta Orthop 2020; 91:776-781. [PMID: 32677862 PMCID: PMC9897622 DOI: 10.1080/17453674.2020.1793548] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Proximal humerus fractures (PHF) may result in sequelae indicating arthroplasty. We report cumulative survival rates and reasons for revision after arthroplasty for proximal humerus fracture sequelae (PHFS).Patients and methods - Data were derived from the Nordic Arthroplasty Register Association. The Kaplan-Meier method was used to illustrate survival rates. A scaled Schoenfeld residual plot was used to report the risk of revision for men relative to women in patients who were treated with reverse shoulder arthroplasty (RSA). Revision was defined as removal or exchange of any component or the addition of a glenoid component.Results - 30,190 primary arthroplasties were reported from 2004 to 2016, of which 3,245 were for PHFS. The estimated 1-, 5-, and 10-year cumulative survival rates (95% CI) were 96% (95-97), 90% (89-92), and 86% (83-88) for stemmed hemiarthroplasty and 94% (92-95), 89% (87-91), and 86% (82-90) for RSA with a median time to revision of 18 months (IQR 9-44) and 3 months (IQR 0-17). The risk of revision for men relative to women in patients who were treated with RSA was 3.2 (1.9-5.1) 0-1 year after surgery and 1.9 (0.9-4.1) 1-8 years after surgery. The estimated 1-, 5-, and 10-year cumulative survival rates (95% CI) were 94% (92-96), 88% (85-90), and 80% (75-86) for men and 95% (94-96), 86% (84-89), and 81% (77-84) for young patients.Interpretation - Shoulder arthroplasty for PHFS was associated with lower survival rates, compared with previously published results of shoulder arthroplasty for acute PHF. The low arthroplasty survival rates for men and young patients especially are worrying.
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Affiliation(s)
| | | | - Randi HOLE
- Norwegian Arthroplasty Register, Department of
Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Anne Marie FENSTAD
- Norwegian Arthroplasty Register, Department of
Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Björn SALOMONSSON
- Department of Clinical Sciences, Danderyd Hospital,
Division of Orthopedics, Karolinska Institutet, Stockholm, Sweden
| | - Yilmaz DEMIR
- Department of Clinical Sciences, Danderyd Hospital,
Division of Orthopedics, Karolinska Institutet, Stockholm, Sweden
| | - Steen Lund JENSEN
- Department of Orthopaedic Surgery, Aalborg
University Hospital and Clinical Medicine, Aalborg University, Aalborg,
Denmark
| | - Stig BRORSON
- Department of Orthopaedic Surgery, Zealand
University Hospital, Department of Clinical Medicine, University of Copenhagen,
Denmark
| | - Ville ÄÄRIMAA
- Departments of Orthopaedics and Traumatology,
Turku University and University Hospital, Turku, Finland
| | - Inger MECHLENBURG
- Department of Orthopaedic Surgery, Aarhus
University Hospital, Department of Clinical Medicine, Aarhus University
| | - Jeppe Vejlgaard RASMUSSEN
- Department of Orthopaedic Surgery, Herlev
Hospital, Department of Clinical Medicine, University of Copenhagen,
Denmark
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Abstract
Shoulder replacement surgery is a common elective surgical procedure for those with progressive osteoarthritis and rheumatoid arthritis. This review explores the history of shoulder replacements, the different types of replacements and their advantages or disadvantages.
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Affiliation(s)
- Ahmed Mehmood
- 5th year Medical Student, UCL Medical School, University College London, London WC1E 6BT
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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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