In Older Adults with 3- or 4-Part Dislocated Proximal Humeral Fractures, Reverse Shoulder Arthroplasty Improved Anterior Elevation and Constant Score, but Not DASH Scores, Quality of Life, or Radiographic Outcomes Compared with Hemiarthroplasty

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Xinning Li
Author(s):  
Luciano A. Rossi ◽  
Bruchmann Maria Guillermina ◽  
Martin Buljubasich ◽  
Nicolás Atala ◽  
Ignacio Tanoira ◽  
...  

2017 ◽  
Vol 11 (1) ◽  
pp. 1108-1114 ◽  
Author(s):  
Aaron Andrew Frombach ◽  
Kendra Brett ◽  
Peter Lapner

Acute proximal humeral fractures in the elderly are generally treated non-operatively if alignment is acceptable and in stable fracture patterns. When operative treatment is indicated, surgical fixation is often difficult or impossible to obtain. Hemiarthroplasty has long been the standard of care. However, with its reliance on tuberosity healing, functional outcomes and patient satisfaction are often poor. Reverse shoulder arthroplasty has emerged as a new technology for treating proximal humeral fractures but the indications for its use remain uncertain. While not conclusive, the evidence suggests that reverse shoulder arthroplasty yields more consistent results, with improved forward elevation and higher functional outcome scores. The primary advantages of hemiarthroplasty are improved shoulder rotation and shorter operative time. Complication rates do not vary significantly between the two options. Although higher quality trials are needed to further define the role of reverse shoulder arthroplasty, current evidence suggests that this is a reasonable option for surgeons who are highly familiar with its use.


BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e040591
Author(s):  
Alex Marzel ◽  
Hans-Kaspar Schwyzer ◽  
Christoph Kolling ◽  
Fabrizio Moro ◽  
Matthias Flury ◽  
...  

PurposeClinical registries are essential for evaluation of surgical outcomes. The Schulthess Shoulder Arthroplasty Registry (SAR) was established in 2006 to evaluate safety, function, quality-of-life and patient satisfaction in patients undergoing shoulder arthroplasty.ParticipantsAdult patients undergoing anatomic or reverse shoulder joint replacement at the Schulthess Klinik, a high-volume, leading orthopaedic surgery centre in Zürich, Switzerland.Findings to dateBetween March 2006 and December 2019, the registry covered 98% of eligible operations. Overall, 2332 patients were enrolled with a total of 2796 operations and 11 147 person-years of follow-up. Mean age at baseline was 71 (range: 20–95), 65% were women. Most common indication was rotator cuff tears with osteoarthritis (42%) and the mean preoperative Constant Score was 31 (±15). The most frequent arthroplasty type was reverse, increasing from 61% in 2006–2010 to 86% in 2015–2019. Functional recovery peaked at 12-month postoperatively and did not show a clinically relevant deterioration during the first ten follow-up years. Since its establishment, the registry was used to address multiple pertinent clinical and methodological questions. Primary focus was on comparing different implant configurations (eg, glenosphere diameter) and surgical techniques (eg, latissimus dorsi transfer) to maximise functional recovery. Additionally, the cohort contributed to the determination of the clinical relevance and validity of radiological monitoring of cortical bone resorption and scapular notching. Finally, SAR data helped to demonstrate that returning to sports was among key patient expectations after reverse shoulder arthroplasty.Future plansAs first patients are approaching the 15 years follow-up landmark, the registry will continue providing essential data on long-term functional outcomes, implant stability, revision rates and aetiologies as well as patient satisfaction and quality-of-life. In addition to research and quality-control, the cohort data will be brought back to the patients by bolstering real-time clinical decision support.


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