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Study details factors for function after hemiarthroplasty in fracture cases
In a retrospective study, researchers identified age, gender and stem type as factors linked with function after hemiarthroplasty in patients with three- and four-part proximal humeral fractures.
The study also revealed better function, greater rates of tuberosity healing and fewer complications with the use of a fracture-specific stem compared to a conventional stem.
“The Constant score was significantly better when the greater tuberosity [GT] healed in an anatomic position. Risk factors associated with poor functional results and anatomic failures are: patient age (≥ 75 years), patient gender (women) and use of conventional stem,” Pascal Boileau, MD, and colleagues wrote in their study.
The investigators studied 60 consecutive patients (61 shoulders) with three- or four-part fractures who were treated with hemiarthroplasty (HA) between 1991 and 2005. Thirty-one shoulders were treated with a conventional standard stem, and 30 shoulders were treated with a fracture-specific stem. The groups were followed for a minimum of 64 months.
At final follow-up, the investigators discovered that the GT healed in 87% of the fracture-specific stem group and 45% of the patients in the standard stem group.
“Another interesting and important finding of this study is that the use of a specific ‘low-profile’ fracture stem (allowing bone grafting) does reduce the chance of tuberosity complications after surgery and is associated with better anatomic and functional outcomes compared with a conventional standard stem … ,” Boileau and colleagues wrote.
Regardless of implant type, men had better function than women and function was better in patients younger than 75 years compared to older patients.
“Our findings put into question the potential benefit of using an HA in patients aged 75 years or older, specifically in elderly women, when the risk of tuberosity detachment, migration and nonunion is too high,” the researchers wrote in their abstract.
Disclosure:Boileau and Walch receive royalties from Tornier for work related to this study.