Revision after shoulder replacement for acute fracture of the proximal humerus

Abstract

Background and purposeFor more than half a century, stemmed hemiarthroplasty (SHA) has been used in the treatment of comminuted and displaced fractures of the proximal humerus. Reverse shoulder arthroplasty (RSA) has been increasingly popular in cases where it is difficult to obtain satisfactory fixation of the tuberosities. We report revision rates and reasons for revision after shoulder arthroplasty for acute fractures of the proximal humerus.Patients and methodsThis study was based on a common dataset from the Nordic Arthroplasty Register Association (NARA), which includes data reported to the national shoulder arthroplasty registries in Denmark, Sweden, and Norway. We included 6,756 shoulder arthroplasties performed for acute fractures between 2004 and 2013.ResultsThere were 6,112 SHAs (90%) and 565 RSAs (8.4%). The cumulative arthroplasty survival rate after 5 years was 0.96 for both SHA and RSA. The relative risk of revision of RSA was 1.4 (95% CI: 0.9–2.2) with SHA as reference. For both types of arthroplasty, the most common reason for revision was infection (SHA 0.8%, RSA 2.1%). The relative risk of revision due to infection was 3.1 (95% CI: 1.6–5.9) for RSA with SHA as reference. The relative risk of revision for patients who were less than 75 years of age was 2.8 (95% CI: 2.0–3.8) compared to older patients.InterpretationRevision after shoulder arthroplasty for acute fractures was rare. Survival rates were similar between SHA and RSA, but RSA had a statistically significant and clinically relevant higher risk of revision because of infection.

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

“…The proportion of revisions in our study corresponds with the 3% reported by both the NARA group (Brorson et al. 2017) and in a study of 422 Norwegian patients undergoing SHA for acute proximal humeral fractures (Fevang et al. 2009).…”

“…2013, Brorson et al. 2017). However, revision rates do not necessarily reflect the functional outcome as some arthroplasties are never revised due to patient- or surgery-related factors.…”

Low arthroplasty survival after treatment for proximal humerus fracture sequelae: 3,245 shoulder replacements from the Nordic Arthroplasty Register Association

“…We found that the 12-year cumulative survival rate after PHFS was 85% for SHA and 86% for RSA. This is clearly lower than survival rates found for acute PHF (Brorson et al 2017). A plausible explanation may be that it is more difficult, with more surgical trauma added, to insert an arthroplasty when the indication is PHFS relative to acute PHF.…”

“…However, a revision after failed RSA can be more challenging than after hemiarthroplasty and some surgeons may hesitate to revise an RSA despite a poor functional outcome. This would lead to an underestimation of failures of RSA overall and relative to hemiarthroplasty (Namdari et al 2013, Brorson et al 2017. There may be different indications for both primary and revision arthroplasty not only among countries but also among regions, hospitals, surgeons, and maybe also for the same surgeon from time to time.…”

Resurfacing hemiarthroplasty versus stemmed hemiarthroplasty for glenohumeral osteoarthritis: a meta-analysis

“…Clinically, conventional HA, i.e., SHA (Fig. 1a), is commonly performed but has some disadvantages, such as erosion of the native glenoid, loss of joint space and posterior humeral subluxation, which contribute to poor satisfaction and high revision rates in many cases, especially in young population [27][28][29]. To reduce the aforementioned potential risks, the Copeland Mark 3 resurfacing arthroplasty was, for the first time, introduced in 1993 as the first-generation RHA (Fig.…”