Long-term outcomes of shoulder hemiarthroplasty for acute proximal humeral fractures.

PURPOSE: Shoulder hemiarthroplasty (HA) is now rarely indicated for complex proximal humeral fractures due to its unpredictable characteristic of the greater tuberosity (GT) healing. Despite the increasing popularity of reverse shoulder arthroplasty (RSA) in fracture treatment, there are still concerns about failure revision and its application in young populations. The complete negation of HA for fracture treatment is still under debate. METHODS: Eighty-seven out of 135 patients with acute proximal humeral fractures treated with HA were enrolled. Clinical and radiographic evaluations were performed. RESULTS: With a mean follow-up time of 14.7 years, the 10-year prosthetic survival rate was 96.6%. The mean ASES score and Constant score were 79.3 and 81.3, respectively, the mean VAS was 1.1, the average forward flexion was 125.9°, external rotation was 37.2°, and internal rotation was at the L4 level. Nineteen patients (21.8%) displayed GT complications and showed significantly worse outcomes. Glenoid erosion was observed in 64.9% of the patients and resulted in inferior outcomes. The patients who showed good postoperative two year functional outcomes and good acromiohumeral distances usually maintained their results without deterioration over time. CONCLUSIONS: With strict patient selection, a proper surgical technique and closely supervised postoperative rehabilitation, HA could achieve a 96.6% ten year survival rate and good pain relief at an average follow-up of 15 years. Although rarely indicated, HA should have a role in the treatment of acute complex proximal humeral fractures in relatively young and active patients with good GT bone and intact cuff.