Meta-analysis suggests that reverse shoulder arthroplasty in proximal humerus fractures is a better option than hemiarthroplasty in the elderly

Abstract

Purpose: This systematic meta-analysis and review aims to critically compare the outcome of reverse shoulder arthroplasty versus hemiarthroplasty for the treatment of complex proximal humeral fracture.

Methods: Relevant original studies were searched in the electronic databases of Medline, Embase, Cochrane central database and China National Knowledge Infrastructure (CNKI) (all through December 2014). Studies that investigated and compared the effectiveness or complications in both groups and provided sufficient data of interest were included in this meta-analysis. Participants in both groups were significantly the same in the demography and injury mechanism.

Results: Eight studies that fulfilled inclusion and exclusion criteria were included in this meta-analysis, which included 421 participants in hemiarthroplasty (HA) and 160 in reverse shoulder arthroplasty (RSA). Patients were followed-up for at least one year in each study. Compared with HA, RSA was associated with a lower rate of total complications, higher American Shoulder and Elbow Surgeons (ASES) score, more healed tuberosities and improved active forward elevation. Both treatments were comparable in term of revision surgeries, mortality, subjective satisfaction and active external rotation.

Conclusions: The present evidence from this meta-analysis suggested that RSA was a more advantaged method for the treatment of complex proximal humeral fractures. Clinical decision should be preferred to RSA on the condition that patients' medical conditions are indicated.

Keywords: Hemiarthroplasty; Meta-Analysis; Proximal humeral fracture; Reverse shoulder arthroplasty.