How good is hemiarthroplasty for acute proximal - Academy News at the 2007 AAOS Annual Meeting

How good is hemiarthroplasty for acute proximal humeral fractures?

By Jennie McKee

Retrospective study designed to evaluate long-term outcome of patients who underwent hemiarthroplasty for acute proximal humerus fracture

The results of a minimum five-year follow-up study on hemiarthroplasty for acute proximal humerus fractures, as reported in poster exhibit P290, indicate that although long-term pain relief is satisfactory, overall shoulder function in terms of motion is less predictable.

Researchers note that significant discrepancies regarding the functional outcome of hemiarthroplasty for proximal humerus fractures have been reported with short- or mid-term follow-up. Long-term outcomes, however, have not been studied as well. This retrospective study was designed to evaluate the long-term outcome of patients who underwent hemiarthroplasty for an acute proximal humerus fracture to determine the results, risk factors for an unsatisfactory result, and rates of revision surgery.

Researchers examined the records of 57 patients (44 females and 13 males) who underwent a shoulder hemiarthroplasty between 1976 and 1996 as treatment of a proximal humerus fracture. The mean age of the patients at the time of surgery was 66 years old (range: 23 years to 89 years old).

At a minimum five-year follow-up (mean follow-up: 10.3 years), researchers found that 27 patients had a satisfactory result, and 30 patients had an unsatisfactory result, according to a modified Neer result rating system.

The mean active elevation was 100 (range: 20 to 180) and the mean external rotation was 30 (range: 0 to 90). Nine patients (16 percent) had moderate or severe pain at the most recent follow-up; two of them required implant revision or removal.

Based on these results, researchers concluded that patients who have hemiarthroplasty to treat an acute fracture of the proximal humerus may achieve satisfactory long-term pain relief. However, the overall shoulder function in terms of motion is less predictable. In view of these results, the researchers suggest a review of accepted current indications, surgical technique and postoperative treatment for these fractures.

The lead researcher is Samuel A. Antuna, MD, of Madrid, Spain. Additional researchers include John W. Sperling, MD, MBA and Robert H. Cofield, MD, of Rochester, Minn. Dr. Sperling is a consultant for Biomet; Dr. Cofield receives royalties from Smith+Nephew.


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