The outcome of hemiarthroplasty for proximal humeral fractures is dependent on the status of the rotator cuff

Abstract

Purpose: The purpose of this study was to evaluate clinical and radiological outcomes of hemiarthroplasty for proximal humerus fractures.

Methods: Thirty-five patients (33 women and two men), average age at the time of surgery of 75.1 (range, 64-92) years, who underwent hemiarthroplasty for proximal humerus fracture or fracture-dislocation of the shoulder were enrolled in this study. The Constant score was used for clinical evaluation of outcomes, and X-rays were performed after a minimum follow-up period of 12 months postoperatively. Parameters for radiological evaluation were as follows: value of acromiohumeral interval (AHI), humeral offset, medial and lateral projection, and the existence of subacromial spur, a radiolucent zone around humeral stem and an osteolytic change of the greater tuberosity.

Results: The average follow-up after surgery was 45.8 (range, 13-114) months. The average postoperative Constant score was 76.2 (range, 53-96) points. The mean values of AHI and humeral offset were 8.4 and 28.3 mm, respectively. A subacromial spur was observed in ten patients, and an osteolytic change of the greater tuberosity in seven patients. There was a significant correlation between Constant score and values of AHI or humeral offset. The Constant score in patients with a subacromial spur or radiolucent zone around humeral stem was markedly lower than that in patients without them.

Conclusions: The clinical outcome of hemiarthroplasty was influenced by factors reflecting function and conditions of the rotator cuff. Anatomical reconstruction and bone union of the tuberosities need to ensure clinical success in hemiarthroplasty.