A COMPARISON OF SHOULDER HEMIARTHROPLASTY WITH REVERSE SHOULDER ARTHROPLASTY FOR PROXIMAL HUMERAL FRACTURES - AN AVERAGE 2 YEAR FOLLOW UP STUDY

摘要

Introduction: Recent evidence has shown a better range of motion (ROM) and functional outcome scores with reverse total shoulder replacement (RTSR) than hemiarthroplasty (HA) for proximal humeral fractures (PHF). Purpose: To determine whether the type of shoulder arthroplasty performed affects the functional outcome of patients in our trust. Methods: We used a prospectively-collected hospital orthopaedic database to identify 23 patients who underwent surgery for PHF not amenable to fixation (10HA, 13RTSR) between May 2012 and January 2016. Patients with incomplete data or < 1 year follow-up were excluded (3 deceased and 2 advanced dementia in care). At follow-up, the remaining 18 patients (9HA, 9RTSR) had radiographs, their ROM and power measured and completed Oxford Shoulder Scores (OSS). Statistical analysis was performed using GraphPad Prism. Results: Of the 18 patients, 15 had four-part fractures (3 dislocations), 1 had a non-union of a 2-part fracture with significant displacement and the remaining 2 had two-part and three-part fracture dislocations, respectively. The average age was 77 (69-91) and 14 were female and 4 male. After an average follow-up of 2.2 years (range, 1.0-3.9), there was no difference between HA and RTSR in OSS (34.4 v 31.0 respectively, p = 0.34), forward flexion (76.3 v 90.0, p = 0.75) or abduction (68.8 v 85.7, p = 0.26). Tuberosity healing in post-operative radiographs was satisfactory in all HA and RTSR, with the exception of one RTSR patient who showed lucency throughout the cement bone interface of the shaft at 30 months but had no symptoms (OSS 37). 6 patients (3 post-HA, 3 post-RTSR) had stiffness where OSS was <27. There were no infections, dislocations or nerve injuries from surgery. Conclusion: There is no discernible difference between RTSR and HA in our trust. Data collected from the National Joint Registry will determine whether this is the case nationally.