Meta-analysis suggests that reverse shoulder arthroplasty in proximal humerus fractures is a better option than hemiarthroplasty in the elderly

Wang, Juan; Zhu, Yanbin; Zhang, Fei; Chen, Wei; Tian, Ye; Zhang, Yingze

doi:10.1007/s00264-015-2811-x

Cited by 73 publications

(57 citation statements)

References 36 publications

(74 reference statements)

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“…The NMA provided hierarchies for the Constant score, incidence of total complications and additional surgery in adult with displaced proximal humeral fracture treated with different methods, which had advantages over comparison with traditional pairwise meta-analyses [3, 5–8]. The meta-analysis indicated that: (1) HA significantly decreased Constant score compared with the other groups and RSA resulted in significantly higher Constant score compared with the other groups; (2) RSA resulted in a lower incidence of complications than ORIF, HA and IN; (3) RSA caused a lower incidence of additional surgery than ORIF and IN.…”

Section: Discussionmentioning

confidence: 99%

“…Wang [7] stated that treatment with ORIF caused no significant difference in Constant score and total number of complications compared with IN. Compared with HA, Shukla [53] reported that RSA resulted in more favorable Constant scores and Zhang [8] demonstrated that RSA was associated with a lower rate of total complications. Our network analysis showed that RSA resulted in significantly higher Constant score compared with the other four interventions.…”

Section: Discussionmentioning

confidence: 99%

“…The debate among surgeons regarding which treatment should be used is still unresolved today and has been since the 1980s. Previous pairwise meta-analyses [3, 5–8] could not obtain hierarchies of these treatments because some had not been compared one by one.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness and Safety of Interventions for Treating Adults with Displaced Proximal Humeral Fracture: A Network Meta-Analysis and Systematic Review

2016

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PurposeNetwork meta-analysis (NMA) is a comparatively new evidence-based technique in medical disciplines which compares the relative benefits associated with multiple interventions and obtains hierarchies of these interventions for various treatment options. We evaluated the effectiveness and safety of open reduction and internal fixation (ORIF), hemiarthroplasty (HA), reverse shoulder arthroplasty (RSA), intramedullary nailing (IN) and non-operative treatment (NOT) of displaced proximal humeral fractures in adults using Bayesian NMA of data from clinical trials.MethodPUBMED, EMBASE and CENTRAL in July 2016 were searched and clinical trials that evaluated interventions for treating adults with displaced proximal humeral fractures were identified. Methodological qualities of studies were assessed by the Newcastle—Ottawa Scale and risk of bias using the Cochrane Collaboration tool.ResultThirty-four trials involving 2165 participants were included in the study. RSA had significantly the highest Constant score and lower total incidence of complications than ORIF, HA and IN. Moreover, RSA resulted in a lower incidence of additional surgery than ORIF and IN. The rank of treatments in terms high Constant score was: RSA, ORIF, IN, NOT and HA. The rank for reduction in total incidence of complications was: RSA, NOT, HA, IN and ORIF. For lowering the risk of additional surgery, the rank was: RSA, NOT, HA, IN and ORIF.ConclusionRSA had the highest probability for improving functional outcome and reduction in the total incidence of complications and requiring additional surgery among the five interventions for treating adults with displaced proximal humeral fracture.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effectiveness and Safety of Interventions for Treating Adults with Displaced Proximal Humeral Fracture: A Network Meta-Analysis and Systematic Review

2016

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“…Although these initial reports have shown good results, further studies have disclosed the high incidence of scapular notching, neurologic complications, and component loosening seen at midterm follow-up using the RSA for the treatment of fractures. According to previous studies, RSA in patients for proximal humeral fractures has shown better outcomes at short and midterm follow-up with forward flexion improvement, compared to hemiarthroplasty [53, 54]. Limitations of these studies are retrospective design, small population with short follow-up period and heterogeneity of the results [55].…”

Section: Results Of Rsa In Fracturesmentioning

confidence: 99%

Reverse Shoulder Arthroplasty for the Treatment of 3 and 4- Part Fractures of the Humeral Head in the Elderly

Gigis¹,

Nenopoulos²,

Giannekas³

et al. 2017

TOORTHJ

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Background:Proximal humeral fractures in elderly patients present with severe comminution and osteoporotic bone quality.Reverse shoulder arthroplasty has lately been proven beneficial in treating patients with complex proximal humeral fractures. The above technique is recommended and has better results in elderly than in younger individuals.Methods:We performed a literature search in the databases Pubmed, Medline, EMBASE and Cochrane Library for published articles between 1970 and 2016 using the terms: proximal humerus fractures and reverse shoulder arthroplasty.Results:Significant benefits with the use of reverse prosthesis, especially in patients older than 70 years with a proximal humeral fracture, include reduced rehabilitation time as well as conservation of a fixed fulcrum for deltoid action in case of rotator cuff failure.Compared with hemiarthroplasty and internal fixation, reverse prosthesis may be particularly useful and give superior outcomes in older patients, due to comminuted fractures in osteopenic bones.However, significant disadvantages of this technique are potential complications and a demanding learning curve.Therefore, trained surgeons should follow specific indications when applying the particular treatment of proximal humeral fractures and be familiar with the surgical technique.Conclusion:Although long-term results and randomized studies for reverse prosthesis are lacking, short and mid- term outcomes have given promising results encouraging more shoulder surgeons to use this type of prosthesis in proximal humeral fractures.

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“…Reverse shoulder arthroplasty (RSA) is a treatment option in proximal humerus nonunion or malunion with humeral head collapse and/or a non-functioning rotator cuff. 10 Few studies in the literature focus on RSA for proximal humerus non-union and established fracture sequelae.…”

Section: Introductionmentioning

confidence: 99%

The role of reverse shoulder arthroplasty in management of proximal humerus fractures with fracture sequelae: a systematic review of the literature

et al. 2017

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Fracture sequelae of the proximal humerus poses a complex management decision due to the frequent deformity and its consequences on the peri-articular soft tissues. These patients are frequently elderly with significant medical comorbidities. Due to the age of the patient there is frequently rotator cuff deficiency and therefore the reverse shoulder arthroplasty (RSA) becomes the arthroplasty of choice. We have performed a systematic review of the literature and report nine studies presenting RSA for the treatment of fracture sequelae of the proximal humerus. It is clear that RSA can improve the range of movement and function following proximal humerus fracture sequelae. However, there is a risk of significant complications including dislocation (16.7%), infection (6.7%), intra-operative fracture (3%) and neurological injury (2.6%). There is a need to invest in future prospective comparative studies and randomised trials to further test RSA in fracture sequelae patients. This will provide us with information regarding the longevity of different prosthesis, outcomes and cost-effectiveness of treatment.

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Meta-analysis suggests that reverse shoulder arthroplasty in proximal humerus fractures is a better option than hemiarthroplasty in the elderly

Abstract: The present evidence from this meta-analysis suggested that RSA was a more advantaged method for the treatment of complex proximal humeral fractures. Clinical decision should be preferred to RSA on the condition that patients' medical conditions are indicated.

Cited by 73 publications

References 36 publications

Effectiveness and Safety of Interventions for Treating Adults with Displaced Proximal Humeral Fracture: A Network Meta-Analysis and Systematic Review

Effectiveness and Safety of Interventions for Treating Adults with Displaced Proximal Humeral Fracture: A Network Meta-Analysis and Systematic Review

Reverse Shoulder Arthroplasty for the Treatment of 3 and 4- Part Fractures of the Humeral Head in the Elderly

The role of reverse shoulder arthroplasty in management of proximal humerus fractures with fracture sequelae: a systematic review of the literature

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