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Research supports hemiarthroplasty for shoulder fractures in elderly patients
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MANCHESTER — Primary hemiarthroplasty to treat proximal humeral fractures in elderly patients older than 70 years in whom shoulder replacement is indicated proved a reliable surgical option, according to a presenter registrar from University Hospitals of Leicester NHS Trust, in Leicester, United Kingdom.
However, the complication rate associated with the procedures in this series remains the biggest concern to clinicians, Jennifer Nichols MBChB, FRCS (Tr & Orth), AHEA, noted in her presentation during the Best of the Best free paper session at the British Orthopaedic Association Congress 2012, here. The session featured 25 papers by orthopaedic surgery trainees from programs throughout Great Britain.
Jennifer Nichols
Nichols presented results of a retrospective study conducted from 1997 to 2010 at her institution. It included 113 older patients with proximal humeral fractures treated by four surgeons at her hospital’s shoulder surgery unit. Eighty-five cases were available for Nichols and colleagues to study. They analyzed 82 cases.
Patients operated on in the early years of the study received cemented monoblock prostheses, and in the subsequent years 59 patients that were studied received cemented modular implants, she said.
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“We found no significant difference in either implant survival between the two age groups, functional outcome or complication rate. Although there was a high complication rate at all, we feel that the hemiarthroplasty is a viable option in this age group and reverse arthroplasty should be preserved as a salvage procedure,” Nichols said.
The researchers mailed postal Oxford Shoulder Score forms to the 64 patients alive at the time of the investigation and based their conclusions on those outcomes. A Kaplan-Meier analysis the team performed showed no difference in survival for implants used in either age group.
“Complications occurred in 14 patients, with five tuberosity fixation failures,” Nichols said. Other complications included four rotator cuff tears, and one superficial and one deep infection, however, the rate and types of infections were similar between the two age groups, Nichols said.
Reference:
Ferran, NA, Nichols J, Pandey RA, et al. Outcome of primary hemiarthroplasty for proximal humerus fractures. Does age affect outcome? Presented at the British Orthopaedic Association Congress 2012. Sept. 11-14. Manchester.
Disclosure: Nichols has no relevant financial disclosures.
Perspective
Back to TopW. Angus Wallace, FRCS(Ed&Eng), FRCSEd(Orth)
W. Angus Wallace
An Oxford score at outcome of 30 or 32, which was the result, is pretty poor. But, that is actually pretty consistent with everybody else treating fractures, and I think these are difficult problems.
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