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Arthroplasty may not be best option for young men with proximal humeral fractures
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LISBON, Portugal — Among primary hemi-arthroplasty and reverse shoulder arthroplasty performed for proximal humeral fractures, rotator cuff insufficiency and early instability or dislocation, respectively, were the most frequent reasons for revision surgery among procedures performed from April 2004 to December 2016 and recorded in the Australian Orthopaedic Association National Joint Replacement Registry.
Based on the findings Richard Page, MD, FRACS, of Flinders University in Adelaide, South Australia, presented at the EFORT Annual Congress, total and partial shoulder arthroplasty of all kinds, including reverse arthroplasty, performed for proximal humeral fractures increased substantially from about 18% in 2008 to about 83% of all shoulder replacement performed for this indication.
This trend led Page and his colleagues to analyze the outcomes of 5,176 patients in the Australian Orthopaedic Association National Joint Replacement Registry who had complex proximal humeral fractures that were treated with either type of arthroplasty.
Concerning gender as a factor in hemiarthroplasty (HA) outcomes of the patients studied, “there is a significant difference with males having an 8% revision risk in the first month vs. 2% for females,” Page said.
“Reverses have fewer revisions. Cemented stems have the lowest revisions overall. Reverse shoulders for fractures are at risk of instability, but so is HA and rotator cuff failure, which is not surprising,” he said. “But, there is a high-risk group in reverses, which is males, particularly young males, particularly with uncemented stems. This certainly makes me think, sort of strongly reconsider the indication of arthroplasty, particularly with reverses, in young males with fractures. And, larger glenospheres do not impart better stability,”
Page noted. However, he said that to some extent, the effort to have patients mobilize early after reverse arthroplasty or HA may have accounted for the greater risk of early dislocation seen in the study.
The cumulative percent revision rate in the study was 2.8% at 1 year postoperatively for reverse arthroplasty. The rate at 8 years was 5%, but it was more than 10% at the same time point for HA, based on the findings.
By comparison, however, the results showed patients aged younger than 64 years had lower cumulative percent revision rates.
For women who underwent reverse shoulder arthroplasty, the cumulative revision rate at 5 years postoperatively was 7%, which was lower than the rates for men. – by Susan M. Rapp
Reference:
Page R, et al. Abstract 1114. Presented at: EFORT Annual Congress; June 5-7, 2019; Lisbon, Portugal.
Disclosure: Page reports no relevant financial disclosures.