Primary Hemiarthroplasty for Proximal Humeral Fractures in the Elderly: Long-Term Functional Outcome and Social Implications

Abstract

Background: Primary shoulder hemiarthroplasty is an established treatment modality for complex fractures of the proximal humerus. Long-term functional outcome is often disappointing. However, little is known about social implications particularly in the elderly. Methods: A single-institution case series of consecutive geriatric patients (age > 70 years) treated with shoulder hemiarthroplasty for complex fractures of the proximal humerus between 1994 and 1997 was analysed. Postoperative morbidity, long-term function, radiological outcome and social implications were evaluated. Results: Seventy-seven patients fulfilled the study criteria. Median age at the time of operation was 80 years (range 70-93 years). Systemic and local postoperative complications were observed in 8% including 2 patients (3%) with revision surgery. Postoperative mortality was 1%. Forty-eight patients (62%) were available for follow-up (median 49 months, range 25-80 months), 22 (29%) died from causes unrelated to hemiarthroplasty before follow-up and 7 patients (9%) did not attend follow-up examination. Median Constant-Murley score was 41 points (range 17-77 points). Long-term results concerning pain were satisfying. The Oxford shoulder score ranged from 14 to 40 (median 30). Forty-one patients (85%) still lived in their original environment and managed their daily life independently despite poor shoulder function. Four patients (8%) lived in a retirement home and 3 (6%) in a nursery home. Eighty percent of our patients were still able to use public transportation, do the daily shopping and wash their whole body by themselves. Conclusion: Most patients managed their daily life independently despite poor shoulder function.

Low revision rate despite poor functional outcome after stemmed hemiarthroplasty for acute proximal humeral fractures: 2,750 cases reported to the Danish Shoulder Arthroplasty Registry

“…A study on the social implications of SHA for proximal humeral fractures in patients older than 70 years found that 85% of patients lived in their own environment and managed daily life despite poor shoulder function (Dietrich et al. 2007). Furthermore, the difference in functional outcome between younger and elderly patients might be due to differences in general health condition and in the mechanisms of trauma.…”

Stemmed hemiarthroplasty with a suture collar and a common platform system for acute proximal humeral fractures

“…A similar discrepancy was found in another study reporting functional outcome scores and social implications of hemiarthroplasty treatment of proximal humeral fractures in the elderly. 11 The patients had a median age of 80 years and suffered from mainly 3- and 4-part fractures. The authors found that 41 out of 48 elderly patients managed their daily lives and lived in their own homes for four years after their hemiarthroplasty, despite a mean CMS of 41.…”

“…The outcome of stemmed hemiarthroplasty for acute fractures are, however, unpredictable and often disappointing. 1 , 7 , 11 , 17 , 22 , 25 Randomized clinical trials have reported similar poor functional outcome of hemiarthroplasty and nonoperative treatment for displaced 4-part fractures. 6 , 23 …”