Increasing Use of Reverse Total Shoulder Arthroplasty for Proximal Humerus Fractures in Elderly Patients

Abstract

This study described surgical treatment patterns for proximal humerus fractures among elderly patients, focusing on reverse total shoulder arthroplasty (TSA), and evaluated how the type of fixation affects inpatient factors (cost, length of stay), transfusion rates, and patient disposition (home vs skilled nursing facility). With Nationwide Inpatient Sample data from 2011 to 2013, the authors identified patients 65 years and older who had proximal humerus fractures and divided them into 3 groups: (1) open reduction and internal fixation (ORIF); (2) hemiarthroplasty; and (3) reverse TSA. From 2011 to 2013, 38,729 surgically treated proximal humerus fractures were identified. The rate of reverse TSA increased 1.8-fold during this time, from 13% of operative cases in 2011 to 24% of operative cases in 2013 (P<.001). At the same time, the rates of hemiarthroplasty and ORIF decreased (hemiarthroplasty, from 28% to 21%; ORIF, from 59% to 55%). Although reverse TSA accounted for 32.2% of arthroplasty procedures for proximal humerus fractures in 2011, this value was 53.3% in 2013 (P<.001). In 2013, mean total hospital cost for reverse TSA was $24,154, which was significantly higher than that for ORIF ($16,269) or hemiarthroplasty ($19,175) (P<.001). In a multivariable model, patients undergoing reverse TSA were less likely than those undergoing hemiarthroplasty to be discharged to a skilled nursing facility (odds ratio, 0.75; P=.027). The national rate of reverse TSA nearly doubled from 2011 to 2013. As of 2013, reverse TSA replaced hemiarthroplasty as the most commonly performed arthroplasty procedure for proximal humerus fractures for patients 65 years and older. Patients undergoing reverse TSA were more likely than those undergoing hemiarthroplasty to be discharged home. [Orthopedics. 2017; 40(6):e982-e989.].

Surgical trends in elderly patients with proximal humeral fractures in South Korea: a population-based study

“…We conducted a survey of patients aged ≥65 years with newly diagnosed PHFs in South Korea between 2008 and 2016 [7, 21, 22]. First, patients with PHFs who received surgical treatment were identified with the ICD-10 codes (S42.2) and the operation codes (ORIF: N0602 and N0612; CRIF: N0992; HA: N2711 and N2716; RSA: N2071 and N2076) from the HIRA database (Table 1) [23].…”

Reverse Total Shoulder Arthroplasty: Biomechanics and Indications

“…3). From 2011 to 2013, the rates of RTSA in management of PHF increased 1.8fold, comprising 3 to 24% of surgical management of PHF [75]. One of the challenges with either primary fixation or hemiarthroplasty for PHF is achieving tuberosity healing, which is associated with improved outcomes.…”

Reverse Shoulder Arthroplasty for Proximal Humerus Fracture

“…Proximal humerus fractures make up 5% of all fractures and are the third most common fracture in patients who are 65 years and older [1]. These fractures predominantly occur in women (70%) and occur at the highest frequency from ages 80 to 84 years old [2][3][4][5][6][7][8]. Initial projections suggested a potential three-fold increase in the rate of proximal humerus fractures by 2030 [7], but newer data showed a flat incidence from 2006 to 2012 and subsequent projections are tempered [9].…”