Patients Undergoing Shoulder Arthroplasty for Failed Nonoperative Treatment of Proximal Humerus Fracture Have Low Implant Survival and Low Patient-reported Outcomes: 837 Cases from the Danish Shoulder Arthroplasty Registry

Overview

Journal Acta Orthop

Specialty Orthopedics

Date 2020 Feb 27

PMID 32098560

Citations 12

Authors

Inger Mechlenburg

Sigrid Rasmussen

Ditte Unbehaun

Alexander Amundsen

Jeppe Vejlgaard Rasmussen

Affiliations

Soon will be listed here.

Abstract

Background and purpose - When nonoperative treatment of proximal humerus fracture (PHF) fails, shoulder arthroplasty may be indicated. We investigated risk factors for revision and evaluated patient-reported outcome 1 year after treatment with either stemmed hemiarthroplasty (SHA) or reverse total shoulder arthroplasty (RTSA) after previous nonoperative treatment of PHF sequelae.Patients and methods - Data were derived from the Danish Shoulder Arthroplasty Registry and included 837 shoulder arthroplasties performed for PHF sequelae between 2006 and 2015. Type of arthroplasty, sex, age, and surgery period were investigated as risk factors. The Western Ontario Osteoarthritis of the Shoulder index (WOOS) was used to evaluate patient-reported outcome (0-100, 0 indicates worst outcome). Cox regression and linear regression models were used in the statistical analyses.Results - 644 patients undergoing SHA and 127 patients undergoing RTSA were included. During a mean follow-up of 3.7 years, 48 (7%) SHA and 14 (11%) RTSA were revised. Men undergoing RTSA had a higher revision rate than men undergoing SHA (hazard ratio [HR] 6, 95% confidence interval [CI] 2-19). 454 (62%) patients returned a complete WOOS questionnaire. The mean WOOS score was 53 for SHA and 53 for RTSA. Patients who were 65 years or older had a better WOOS score than younger patients (mean difference 7, CI 1-12). Half of patients had WOOS scores below 50.Interpretation - Shoulder arthroplasty for PHF sequelae was associated with a high risk of revision and a poor patient-reported outcome. Men treated with RTSA had a high risk of revision.

Citing Articles

Reverse shoulder arthroplasty following failed rotator cuff repair: A systematic review and meta-analysis.

Welch J, Hurley E, Lorentz S, Bethell M, Crook B, Dickens J Shoulder Elbow. 2024; 16(5):474-480.

PMID: 39493405 PMC: 11528785. DOI: 10.1177/17585732231194785.

Does primary treatment of proximal humerus fractures show favourable functional outcomes over secondary treatment with reverse shoulder arthroplasty?.

Blaas L, Lameijer C, Alta T, Yuan J, van Dieren S, Bloemers F Shoulder Elbow. 2024; 16(5):559-568.

PMID: 39493403 PMC: 11528779. DOI: 10.1177/17585732231190038.

Patient-Reported Outcome Measures in High-Risk Medical Device Registries: A Scoping Review.

Merenda M, Earnest A, Ruseckaite R, Tse W, Elder E, Hopper I Aesthet Surg J Open Forum. 2024; 6:ojae015.

PMID: 38650972 PMC: 11033681. DOI: 10.1093/asjof/ojae015.

Two-day staged bilateral reverse shoulder arthroplasty for traumatic proximal humerus fractures: a case report.

Romiyo V, Patel M, Rivera-Pintado C, Fedorka C JSES Rev Rep Tech. 2023; 3(1):111-115.

PMID: 37588077 PMC: 10426508. DOI: 10.1016/j.xrrt.2022.09.003.

Response rates in clinical quality registries and databases that collect patient reported outcome measures: a scoping review.

Ruseckaite R, Mudunna C, Caruso M, Ahern S Health Qual Life Outcomes. 2023; 21(1):71.

PMID: 37434146 PMC: 10337187. DOI: 10.1186/s12955-023-02155-5.

References

Launonen A, Lepola V, Flinkkila T, Laitinen M, Paavola M, Malmivaara A . Treatment of proximal humerus fractures in the elderly: a systemic review of 409 patients. Acta Orthop. 2015; 86(3):280-5. PMC: 4443467. DOI: 10.3109/17453674.2014.999299. View

Boons H, Goosen J, van Grinsven S, van Susante J, van Loon C . Hemiarthroplasty for humeral four-part fractures for patients 65 years and older: a randomized controlled trial. Clin Orthop Relat Res. 2012; 470(12):3483-91. PMC: 3492647. DOI: 10.1007/s11999-012-2531-0. View

Beks R, Ochen Y, Frima H, Smeeing D, van der Meijden O, Timmers T . Operative versus nonoperative treatment of proximal humeral fractures: a systematic review, meta-analysis, and comparison of observational studies and randomized controlled trials. J Shoulder Elbow Surg. 2018; 27(8):1526-1534. DOI: 10.1016/j.jse.2018.03.009. View

Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J . Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg. 2011; 20(5):747-55. DOI: 10.1016/j.jse.2010.12.018. View

Launonen A, Fjalestad T, Laitinen M, Lahdeoja T, Ekholm C, Wagle T . Nordic Innovative Trials to Evaluate osteoPorotic Fractures (NITEP) Collaboration: The Nordic DeltaCon Trial protocol-non-operative treatment versus reversed total shoulder arthroplasty in patients 65 years of age and older with a displaced proximal.... BMJ Open. 2019; 9(1):e024916. PMC: 6352806. DOI: 10.1136/bmjopen-2018-024916. View

Raiss P, Edwards T, Collin P, Bruckner T, Zeifang F, Loew M . Reverse Shoulder Arthroplasty for Malunions of the Proximal Part of the Humerus (Type-4 Fracture Sequelae). J Bone Joint Surg Am. 2016; 98(11):893-9. DOI: 10.2106/JBJS.15.00506. View

Rasmussen J, Polk A, Sorensen A, Olsen B, Brorson S . Outcome, revision rate and indication for revision following resurfacing hemiarthroplasty for osteoarthritis of the shoulder: 837 operations reported to the Danish Shoulder Arthroplasty Registry. Bone Joint J. 2014; 96-B(4):519-25. DOI: 10.1302/0301-620X.96B4.31850. View

Holton J, Yousri T, Arealis G, Levy O . The Role of Reverse Shoulder Arthroplasty in Management of Proximal Humerus Fractures with Fracture Sequelae: A Systematic Review of the Literature. Orthop Rev (Pavia). 2017; 9(1):6977. PMC: 5337776. DOI: 10.4081/or.2017.6977. View

Han R, Sing D, Feeley B, Ma C, Zhang A . Proximal humerus fragility fractures: recent trends in nonoperative and operative treatment in the Medicare population. J Shoulder Elbow Surg. 2015; 25(2):256-61. DOI: 10.1016/j.jse.2015.07.015. View

10.

Fjalestad T, Hole M . Displaced proximal humeral fractures: operative versus non-operative treatment--a 2-year extension of a randomized controlled trial. Eur J Orthop Surg Traumatol. 2014; 24(7):1067-73. DOI: 10.1007/s00590-013-1403-y. View

11.

Murray I, Amin A, White T, Robinson C . Proximal humeral fractures: current concepts in classification, treatment and outcomes. J Bone Joint Surg Br. 2011; 93(1):1-11. DOI: 10.1302/0301-620X.93B1.25702. View

12.

Hernandez N, Chalmers B, Wagner E, Sperling J, Cofield R, Sanchez-Sotelo J . Revision to Reverse Total Shoulder Arthroplasty Restores Stability for Patients With Unstable Shoulder Prostheses. Clin Orthop Relat Res. 2017; 475(11):2716-2722. PMC: 5638732. DOI: 10.1007/s11999-017-5429-z. View

13.

Mansat P, Bonnevialle N . Treatment of fracture sequelae of the proximal humerus: anatomical vs reverse shoulder prosthesis. Int Orthop. 2015; 39(2):349-54. DOI: 10.1007/s00264-014-2651-0. View

14.

Rangan A, Handoll H, Brealey S, Jefferson L, Keding A, Corbacho Martin B . Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial. JAMA. 2015; 313(10):1037-47. DOI: 10.1001/jama.2015.1629. View

15.

Rasmussen J, Jakobsen J, Olsen B, Brorson S . Translation and validation of the Western Ontario Osteoarthritis of the Shoulder (WOOS) index - the Danish version. Patient Relat Outcome Meas. 2013; 4:49-54. PMC: 3796868. DOI: 10.2147/PROM.S50976. View

16.

Handoll H, Brorson S . Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2015; (11):CD000434. DOI: 10.1002/14651858.CD000434.pub4. View

17.

Rasmussen J, Jakobsen J, Brorson S, Olsen B . The Danish Shoulder Arthroplasty Registry: clinical outcome and short-term survival of 2,137 primary shoulder replacements. Acta Orthop. 2012; 83(2):171-3. PMC: 3339532. DOI: 10.3109/17453674.2012.665327. View

18.

Kristensen M, Rasmussen J, Elmengaard B, Jensen S, Olsen B, Brorson S . High risk for revision after shoulder arthroplasty for failed osteosynthesis of proximal humeral fractures. Acta Orthop. 2018; 89(3):345-350. PMC: 6055779. DOI: 10.1080/17453674.2018.1450207. View

19.

Brorson S, Salomonsson B, Jensen S, Fenstad A, Demir Y, Rasmussen J . Revision after shoulder replacement for acute fracture of the proximal humerus. Acta Orthop. 2017; 88(4):446-450. PMC: 5499339. DOI: 10.1080/17453674.2017.1307032. View

20.

Raiss P, Edwards T, Ribeiro da Silva M, Bruckner T, Loew M, Walch G . Reverse shoulder arthroplasty for the treatment of nonunions of the surgical neck of the proximal part of the humerus (type-3 fracture sequelae). J Bone Joint Surg Am. 2014; 96(24):2070-6. DOI: 10.2106/JBJS.N.00405. View