Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study

Background: There is no consensus on what type of arthroplasty is best for the treatment of complex proximal humeral fractures in elderly patients. The purpose of this prospective study was to compare the outcomes of reverse shoulder arthroplasty (RSA) and hemiarthroplasty (HA). Methods: Sixty-two patients older than 70 years were randomized to RSA (31 patients) and HA (31 patients). One HA patient died at 1 year, and she was excluded. The mean follow-up was 28.5 months (range, 24-49 months). Results: Compared with HA patients, RSA patients had significantly higher (P = .001) mean University of California-Los Angeles (29.1 vs 21.1) and Constant (56.1 vs 40.0) scores, forward elevation (120.3 degrees vs 79.8 degrees), and abduction (112.9 degrees vs 78.7 degrees) but no difference in internal rotation (2.7 degrees vs 2.6 degrees; P = .91). The Disabilities of the Arm, Shoulder, and Hand score was higher in the HA patients (17 vs 29; P = .001). In the HA group, 56.6% of tuberosities healed and 30% resorbed. Patients with failure of tuberosities had significantly worse functional outcomes. There were 2 complications (intraoperative humeral fracture and superficial infection). One patient was manipulated under general anesthesia because of postoperative stiffness. Six patients with HA had proximal migration that required revision to RSA. In the RSA group, 64.5% of tuberosities healed and 13.2% resorbed. Functional outcome was irrespective of healing of the tuberosities. Notching was observed in only 1 RSA patient. One patient developed a hematoma and another a deep infection requiring a 2-stage revision to another RSA. Conclusion: RSA resulted in better pain and function and lower revision rate. Revision from HA to RSA does not appear to improve outcomes. (C) 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.