Comparison of hemiarthroplasty and reverse arthroplasty for treatment of proximal humeral fractures: a systematic review.

BACKGROUND Complex proximal humeral fractures that are not amenable to surgical fixation represent a difficult treatment problem. The purpose of this systematic review was to critically examine the outcomes of reverse shoulder arthroplasty and hemiarthroplasty (with use of a fracture-specific stem) for the treatment of proximal humeral fractures. METHODS A systematic review of the literature was performed by means of a search of electronic databases. Two reviewers independently assessed the methodological quality and extracted relevant data from each included study. When outcomes data were similar among studies, the data were pooled by means of frequency-weighted values to generate summary outcomes. RESULTS Fourteen studies fulfilled all inclusion and exclusion criteria and were included. Patients were followed for a frequency-weighted mean of 43.5 months in the reverse arthroplasty group and 31.1 months in the hemiarthroplasty group (p = 0.228). Subjective outcomes (including the Constant score, Constant pain subscore, and American Shoulder and Elbow Surgeons [ASES] score) and range-of-motion parameters (including active forward elevation, abduction, and external rotation) were similar between the two groups. Compared with hemiarthroplasty, reverse arthroplasty was associated with 4.0 times greater odds of a postoperative complication. CONCLUSIONS The compiled data and frequency-weighted means demonstrated improvement in function, pain, and range of motion after reverse arthroplasty and hemiarthroplasty. Patients and physicians should consider projected functional outcomes, implant costs, and complication rates when selecting an appropriate arthroplasty technique for this indication.