Reverse total shoulder arthroplasty compared to stemmed hemiarthroplasty for proximal humeral fractures: a registry analysis of 5946 patients

Owain Critchley; Andrew McLean; Richard Page; Fraser Taylor; Stephen Graves; Michelle Lorimer; Yi Peng; Alesha Hatton; Gregory Bain

doi:10.1016/j.jse.2020.04.005

Reverse total shoulder arthroplasty compared to stemmed hemiarthroplasty for proximal humeral fractures: a registry analysis of 5946 patients

J Shoulder Elbow Surg. 2020 Dec;29(12):2538-2547. doi: 10.1016/j.jse.2020.04.005. Epub 2020 Jun 9.

Authors

Owain Critchley¹, Andrew McLean², Richard Page³, Fraser Taylor², Stephen Graves⁴, Michelle Lorimer⁵, Yi Peng⁵, Alesha Hatton⁵, Gregory Bain⁶

Affiliations

¹ Department of Orthopaedics and Trauma Surgery, Flinders University, Adelaide, SA, Australia; Department of Orthopaedic Surgery, University Hospital Geelong - Barwon Health, Geelong, VIC, Australia. Electronic address: owain.critchley@gmail.com.
² Department of Orthopaedics, Gold Coast University Hospital, Gold Coast, QLD, Australia.
³ Department of Orthopaedic Surgery, University Hospital Geelong - Barwon Health, Geelong, VIC, Australia; School of Medicine, Deakin University, Geelong, VIC, Australia; Barwon Centre for Orthopaedic Research and Education, Education and Research Center, St John of God Hospital, Geelong, VIC, Australia.
⁴ Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, SA, Australia.
⁵ South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
⁶ Department of Orthopaedics and Trauma Surgery, Flinders University, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Flinders Medical Center, Adelaide, SA, Australia.

PMID: 32684280
DOI: 10.1016/j.jse.2020.04.005

Abstract

Background: There is an increasing trend toward the use of reverse total shoulder arthroplasty (RTSA) over stemmed hemiarthroplasty (HA) for the management of proximal humeral fractures. There are limited data available comparing the revision rates for RTSA and HA in the setting of a fracture. The aim of this study was to compare the revision rates for RTSA and HA when used for the treatment of a fracture and to analyze the effect of demographics and prosthesis fixation on these revision rates.

Methods: Data obtained from the Australian Orthopaedic Association National Joint Replacement Registry from April 16, 2004, to December 31, 2017, included all procedures for primary diagnosis proximal humeral fracture. The analyses were performed using Kaplan-Meier estimates of survivorship and hazard ratios from Cox proportional hazards models.

Results: Over the study period, there were 3049 (51%) RTSA and 2897 (49%) HA procedures. The cumulative percent revision rate at 9 years was lower for the RTSA than for the HA: 7.0% (95% confidence interval [CI], 4.8-10.1) compared with 11.7% (95% CI, 10.3-13.2). Between 0 and 6 months, the HA had a significantly lower revision rate than the RTSA (hazard ratio, 0.50; 95% CI, 0.34-0.72; P < .001). Between 6 month and 3 years, the HA had a significantly higher revision rate. For the RTSA, males have a significantly higher rate of revision compared with females. There is a higher rate of early revision due to instability in younger persons (55-64) and males. For both RTSA and HA, cemented prostheses have lower revision rates compared with cementless prostheses.

Conclusions: RTSA has a significantly lower revision rate compared with HA for the treatment of proximal humeral fractures in females. Younger patients (<65) and males are at risk of early revision secondary to instability. In these patient groups, either alternatives to RTSA or further attention to fixation of tuberosities and shoulder rehabilitation may be indicated.

Keywords: Proximal humerus fracture; arthroplasty; hemiarthroplasty; joint registry; reverse shoulder arthroplasty; revision rate; shoulder joint.

MeSH terms

Arthroplasty, Replacement, Shoulder*
Australia
Female
Hemiarthroplasty*
Humans
Male
Registries
Reoperation
Shoulder Fractures* / diagnostic imaging
Shoulder Fractures* / surgery
Shoulder Joint* / surgery
Treatment Outcome