Reverse Total Shoulder Arthroplasty Versus Hemiarthroplasty for Proximal Humeral Fractures: A Systematic Review

OBJECTIVE:To report and compare the clinical and radiographic outcomes of patients treated with reverse shoulder arthroplasty (RSA) or hemiarthroplasty for acute complex proximal humeral fractures. DATA SOURCES:A systematic review of PubMed, Cumulative Index to Nursing and Allied Health Literature, SportDiscus, and Cochrane Central Register of Controlled Trials was conducted. All published English language studies before January 2014 were reviewed for possible inclusion. Search terms included the followingproximal humerus, fracture, arthroplasty, hemiarthroplasty, RSA, and reverse total shoulder arthroplasty. STUDY SELECTION:Studies reporting outcomes in human subjects after either RSA or hemiarthroplasty for acute proximal humeral fractures were assessed for inclusion. Additional inclusion criteria included a minimum clinical follow-up of 1 year. Level V evidence, basic science/cadaveric studies, and those studies reporting outcomes after revision arthroplasty were excluded. DATA EXTRACTION:Patient demographics, clinical/radiographic outcomes, and complications were recorded. Posttreatment weighted means were calculated and reported. Homogenous outcome measures were analyzed, and a direct comparison of outcomes between treatment groups was performed. CONCLUSIONS:Patients treated with RSA possess improved forward flexion (RSA118 degrees, Hemi108 degrees) but decreased external rotation (RSA20 degrees, Hemi30 degrees) compared with patients undergoing hemiarthroplasty after acute proximal humeral fracture. No significant clinical difference in either American Shoulder and Elbow Surgeons Shoulder Score (RSA64.7, Hemi63.0) or Constant score (RSA54.6, Hemi58.0) was identified. RSA was associated with an increased rate of clinical complications (9.6%) and a lower revision rate (0.93%) at short-term to midterm follow-up compared with hemiarthroplasty. RSA offers an acceptable surgical option for patients after complex acute proximal humeral fractures. LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.