This Article Full Text Full Text (PDF) CME: Take the activity for this article: Shoulder and Elbow Test 1: The Shoulder [Supplementary Material] Letters to the Editor: Submit a response Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Robinson, C. M. Articles by Wakefield, A. E. Search for Related Content PubMed PubMed Citation Articles by Robinson, C. M. Articles by Wakefield, A. E. Social Bookmarking                   What's this?

Primary Hemiarthroplasty for Treatment of Proximal Humeral Fractures

Investigation performed at the Edinburgh Orthopaedic Trauma Unit, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom

C. Michael Robinson, BMedSci, FRCS Ed (Orth)
Richard S. Page, BMedSci, FRACS (Orth)
Richard M.F. Hill, FRCS Ed (Orth)
David L. Sanders, BSc
Charles M. Court-Brown, MD, FRCS Ed (Orth)
Alison E. Wakefield, MSc
Edinburgh Orthopaedic Trauma Unit, The Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SU, United Kingdom. E-mail address for C.M. Robinson: c.mike.robinson{at}ed.ac.uk

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: Primary hemiarthroplasty of the shoulder is used to treat complex proximal humeral fractures, although the reported functional results following this method of treatment have varied widely. The aim of this study was to prospectively assess the prosthetic survival and functional outcomes in a large series of patients treated with shoulder hemiarthroplasty for a proximal humeral fracture. By determining the factors that affected the outcome, we also aimed to produce models that could be used clinically to estimate the functional outcome at one year following surgery.

Methods: A thirteen-year observational cohort study of 163 consecutive patients treated with hemiarthroplasty for a proximal humeral fracture was performed. Twenty-five patients died or were lost to follow-up in the first year after treatment, leaving 138 patients who had assessment of shoulder function with use of the modified Constant score at one year postinjury.

Results: The overall rate of prosthetic survival was 96.9% at one year, 95.3% at five years, and 93.9% at ten years. The overall median modified Constant score was 64 points at one year, with a typically good score for pain relief (median, 15 points) and poorer scores, with a greater scatter of values, for function (median, 12 points), range of motion (median, 24 points), and muscle power (median, 14 points). Of the factors that were assessed immediately after the injury, only patient age, the presence of a neurological deficit, tobacco usage, and alcohol consumption were significantly predictive of the one-year Constant score (p < 0.05). Of the factors that were assessed at six weeks postinjury, those that predicted the one-year Constant score included the age of the patient, the presence of a persistent neurological deficit, the need for an early reoperation, the degree of displacement of the prosthetic head from the central axis of the glenoid seen radiographically, and the degree of displacement of the tuberosities seen radiographically.

Conclusions: Primary shoulder hemiarthroplasty performed for the treatment of a proximal humeral fracture in medically fit and cooperative adults is associated with satisfactory prosthetic survival at an average of 6.3 years. Although the shoulder is usually free of pain following this procedure, the overall functional result, in terms of range of motion, function, and power, at one year varies. A good functional outcome can be anticipated for a younger individual who has no preoperative neurological deficit, no postoperative complications, and a satisfactory radiographic appearance of the shoulder at six weeks. The results are poorer in the larger group of elderly patients who undergo this procedure, especially if they have a neurological deficit, a postoperative complication requiring a reoperation, or an eccentrically located prosthesis with retracted tuberosities.

Level of Evidence: Prognostic study, Level II-1 (retospective study). See Instructions to Authors for a complete description of levels of evidence.

CiteULike

Connotea

Del.icio.us

Facebook

Technorati

Twitter

This article has been cited by other articles:

				J. M. Wiater and M. H. Fabing Shoulder Arthroplasty: Prosthetic Options and Indications J. Am. Acad. Ortho. Surg., July 1, 2009; 17(7): 415 - 425. [Abstract] [Full Text] [PDF]

				H. Ahn, C. M. Court-Brown, M. M. McQueen, and E. H. Schemitsch The Use of Hospital Registries in Orthopaedic Surgery J. Bone Joint Surg. Am., May 1, 2009; 91(Supplement_3): 68 - 72. [Abstract] [Full Text] [PDF]

				G. J. Haidukewych and W. Ricci Locked Plating in Orthopaedic Trauma: A Clinical Update J. Am. Acad. Ortho. Surg., June 1, 2008; 16(6): 347 - 355. [Abstract] [Full Text] [PDF]

				S. J. Nho, R. H. Brophy, J. U. Barker, C. N. Cornell, and J. D. MacGillivray Management of Proximal Humeral Fractures Based on Current Literature J. Bone Joint Surg. Am., October 1, 2007; 89(suppl_3): 44 - 58. [Full Text] [PDF]

				C. M. Robinson, A. Akhtar, M. Mitchell, and C. Beavis Complex Posterior Fracture-Dislocation of the Shoulder. Epidemiology, Injury Patterns, and Results of Operative Treatment J. Bone Joint Surg. Am., July 1, 2007; 89(7): 1454 - 1466. [Abstract] [Full Text] [PDF]

				J. Levy, M. Frankle, M. Mighell, and D. Pupello The Use of the Reverse Shoulder Prosthesis for the Treatment of Failed Hemiarthroplasty for Proximal Humeral Fracture J. Bone Joint Surg. Am., February 1, 2007; 89(2): 292 - 300. [Abstract] [Full Text] [PDF]

				S. J. Nho, R. H. Brophy, J. U. Barker, C. N. Cornell, and J. D. MacGillivray Innovations in the Management of Displaced Proximal Humerus Fractures J. Am. Acad. Ortho. Surg., January 1, 2007; 15(1): 12 - 26. [Abstract] [Full Text] [PDF]

				C. M. Robinson, L. A. K. Khan, and M. A. Akhtar Treatment of anterior fracture-dislocations of the proximal humerus by open reduction and internal fixation J Bone Joint Surg Br, April 1, 2006; 88-B(4): 502 - 508. [Abstract] [Full Text] [PDF]

				M. Loew, S. Heitkemper, D. Parsch, S. Schneider, and M. Rickert Influence of the design of the prosthesis on the outcome after hemiarthroplasty of the shoulder in displaced fractures of the head of the humerus J Bone Joint Surg Br, March 1, 2006; 88-B(3): 345 - 350. [Abstract] [Full Text] [PDF]

				C. M. Robinson and J. Aderinto Posterior Shoulder Dislocations and Fracture-Dislocations J. Bone Joint Surg. Am., March 1, 2005; 87(3): 639 - 650. [Abstract] [Full Text] [PDF]

				D. Plausinis, Y. W. Kwon, and J. D. Zuckerman Complications Of Humeral Head Replacement for Proximal Humeral Fractures J. Bone Joint Surg. Am., January 1, 2005; 87(1): 204 - 213. [Full Text] [PDF]

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2003 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.