Reverse or Hemi Shoulder Arthroplasty in Proximal Humerus Fractures: A Single-Blinded Prospective Multicenter Randomized Clinical Trial

Laas, Niels; Engelsma, Yde; Hagemans, Frans J A; Hoelen, Max A; Deurzen, Derek F.P. van; Burger, Bart J.

doi:10.1097/bot.0000000000001978

Cited by 25 publications

(17 citation statements)

References 55 publications

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“…At 12 months, the RTSA group demonstrated greater forward flexion and a greater Constant score. However, there were no differences in terms of external or internal rotation or VAS, DASH, or SF-12 (12-Item Short Form Health Survey) scores 56 .…”

Section: Critical Analysis Review Of Rtsa In Comparison With Other Tr...mentioning

confidence: 78%

Operative Treatment of Proximal Humeral Fractures with Reverse Total Shoulder Arthroplasty in Patients ≥65 Years Old

et al. 2022

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The majority of proximal humeral fractures (PHFs) in patients who are ≥65 years of age are treated nonoperatively, but certain complex fracture patterns benefit from surgical intervention. However, there continues to be debate regarding the indications for surgery and the optimal surgical treatment (repair versus replacement) in this population.Reverse total shoulder arthroplasty (RTSA) has grown in popularity for surgical treatment of fracture-dislocations and displaced complex PHFs in patients who are ≥65 years of age; it has definite advantages over surgical repair and hemiarthroplasty, but this finding requires additional higher-quality evidence.RTSA provides early pain relief and return of shoulder function as well as predictable elevation above shoulder level in the forward plane, but the indications for and understanding of the effect of timing on RTSA after a PHF continue to evolve.RTSA for an acute PHF is indicated in patients who are ≥65 years of age with 3- and 4-part fracture-dislocations, head-split fractures, and severely displaced fractures, and is an option in patients who are not able to tolerate nonoperative treatment of severely displaced 3- and 4-part fractures.RTSA is also indicated as a salvage operation for PHFs that have failed initial surgical repair (i.e., fixation failure, implant failure, rotator cuff failure, or osteonecrosis) and is an option for symptomatic nonunion or malunion after nonoperative treatment.

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Section: Critical Analysis Review Of Rtsa In Comparison With Other Tr...mentioning

confidence: 78%

Operative Treatment of Proximal Humeral Fractures with Reverse Total Shoulder Arthroplasty in Patients ≥65 Years Old

et al. 2022

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“…We found that surgeons are increasingly treating PHFs in the elderly with RSA instead of HA or ORIF, which is generally corroborated by recent literature. 18,24 We also identified differences based on fellowship training; shoulder surgeons more commonly recommended arthroplasty in tuberosity comminution and significant metaphyseal comminution, whereas trauma surgeons preferred ORIF or nonoperative management.…”

Section: Discussionmentioning

confidence: 99%

“…In the aforementioned metaanalysis, 35 only 28% of 4-part fractures were treated with ORIF; HA was more common (56%). 35 Most studies demonstrate superior outcomes in 3-and 4-part PHFs treated with RSA compared with HA 6,8,15,24 and ORIF, 6 but superiority to nonoperative management has yet to be shown. 27,37 Although 2-part fractures are typically well managed with ORIF or nonoperative management, the best surgical treatment for 3-and 4-part fractures may depend on other factors besides fracture morphology.…”

Section: Discussionmentioning

confidence: 99%

“…In 2015, a Cochrane Review of 31 PHF randomized controlled trials concluded that there was insufficient evidence to inform choices between different surgical interventions. 20 Despite this, many clinical studies in elderly patients with PHFs have reported superior outcomes in favor of RSA 3,6,8,15,18,24,41 over ORIF, 31 HA, 32 and equivalent outcomes for nonoperative management. 11,25,27,37 Systematic reviews analyzing PHFs in the elderly population have found superior outcomes for ORIF 19,35 and similar or more favorable outcomes for RSA compared with HA.…”

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confidence: 99%

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Factors influencing surgical management of proximal humerus fractures: do shoulder and trauma surgeons differ?

Hao¹,

Patch²,

Reed³

et al. 2022

Journal of Shoulder and Elbow Surgery

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“…There were no differences between the two groups with respect to WOOS index score, EQ-5D index score, and tuberosity healing. Another recent RCT [ 44 ] comparing RTSA to HA for acute PHF ( n = 33) in patients greater than 65 years demonstrated improved DASH score and range of motion (forward flexion and abduction) with RTSA. There are multiple non-randomized prospective and retrospective studies [ 35 , 41 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ] comparing RTSA and HA in the treatment of PHF ( Table 3 ).…”

Section: Evidence For the Use Of Rtsa In Phf Compared To Other Surgic...mentioning

confidence: 99%

The Evolution of Reverse Total Shoulder Arthroplasty and Its Current Use in the Treatment of Proximal Humerus Fractures in the Older Population

Larose

Virk

2022

JCM

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Proximal humerus fracture (PHF) is a common injury in the older population. While the majority of these fractures are treated non-operatively, a small subset of patients may benefit from surgical treatment. However, there continues to be an ongoing debate regarding the indications and ideal surgical treatment strategy. The use of reverse total shoulder arthroplasty (RTSA) has resulted in a paradigm shift in the treatment of PHFs in the older population. Unique biomechanical principles and design features of RTSA make it a suitable treatment option for PHFs in the older population. RTSA has distinct advantages over hemiarthroplasty and internal fixation and provides good pain relief and a reliable and reproducible improvement in functional outcomes. As a result, there has been an exponential increase in the volume of RTSA in the older population in last decade. The aim of this paper is to review the current concepts, outcomes and controversies regarding the use of RTSA for the treatment of PHFs in the older population.

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Reverse or Hemi Shoulder Arthroplasty in Proximal Humerus Fractures: A Single-Blinded Prospective Multicenter Randomized Clinical Trial

Abstract: Objectives: To compare outcomes between hemiarthroplasty (HA) and reversed shoulder arthroplasty (RSA) as a treatment for dislocated 3-part and 4-part proximal humerus fractures in the elderly population.

Cited by 25 publications

References 55 publications

Operative Treatment of Proximal Humeral Fractures with Reverse Total Shoulder Arthroplasty in Patients ≥65 Years Old

Operative Treatment of Proximal Humeral Fractures with Reverse Total Shoulder Arthroplasty in Patients ≥65 Years Old

Factors influencing surgical management of proximal humerus fractures: do shoulder and trauma surgeons differ?

The Evolution of Reverse Total Shoulder Arthroplasty and Its Current Use in the Treatment of Proximal Humerus Fractures in the Older Population

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