Abstract
Purpose
The best care paradigm for the older patient with proximal humeral fracture/dislocation is typically hemiarthroplasty, yet post-operative instability and suboptimal functional outcomes are commonplace. The aim of this study was to compare innovative treatment strategies designed to improve outcomes including: hemiarthroplasty combined with capsulolabral repair versus reverse total shoulder arthroplasty.
Methods
After IRB approval, analysis was performed on patients treated with arthroplasty for proximal humeral fracture/dislocation. Functional results and evidence of complication including instability (subluxation, dislocation) was determined. rTSA and hemiarthroplasty with capsulolabral repair were compared to hemiarthroplasy alone (control group).
Results
21 patients with proximal humeral fracture/dislocation (OTA 11-B3 & 11-C3) met the inclusion criteria and underwent hemiarthroplasty (n=8), hemiarthroplasty with capsulolabral repair (n=7), or rTSA (n=6). Patients undergoing rTSA (average age 70) were significantly older than patients undergoing hemiarthroplasty with capsulolabral repair (average age 59). Patients managed with rTSA had superior outcomes compared to hemiarthroplasty with or without capsulolabral repair. Forward flexion following rTSA was 115 degrees compared to hemiarthroplasty (85 degrees) and hemiarthroplasty with capsulolabral repair (85 degrees). Forward flexion was equivalent for both hemiarthroplasty groups but greater variability was noted for hemiarthroplasty without capsulolabral repair compared to hemiarthroplasty with capsulolabral repair reflected by a standard deviation of 48 vs 13 respectively. Instability was noted radiographically in the hemiarthroplasty cohorts including 37.5% versus 14% of cases when capsulolabral repair was performed. No patients underwent revision surgery at current followup (4 yr Hemiarthroplasty, 3yr Hemiarthroplasty with capsulolabral repair, 1yr rTSA).
Conclusion
The best treatment option for the older patient with proximal humeral fracture/dislocation is yet to be determined. The addition of capsulolabral repair to hemiarthroplasty is a novel approach to improve stability yet stiffness continues to plague the hemiarthroplasty technique. Reverse TSA improves functional outcomes for proximal humeral fracture/dislocation compared to hemiarthroplasty yet long term implant durability and lack of significant revision options should be considered when this treatment option is utilized.
