Postoperative outcomes of third-generation shoulder hemiarthroplasties for three-and four-part proximal humeral fractures: A systematic review of published studies from 2012 to 2022.

Background: The aim of this study was to provide up-to-date evidence on the outcomes for hemiarthroplasties (HAs) that were performed using modern third-generation prostheses (post-2004) for isolated (excluding head-splits and fracture-dislocations) three-and four-part proximal humerus fractures (PHFs). Methods: PubMed, Medline, Embase and the Cochrane register were searched from January 1, 2012, to November 15, 2022, conforming to the PRISMA guidelines. The outcome measures were the complication rates, revision rates, surgery-related postoperative mortality, post-operative clinical outcome scores and radiological outcomes. Results: 432 hemiarthroplasties in 432 patients were performed across the 11 eligible studies (two prospective and 9 retrospective). Three studies compared HA versus reverse shoulder replacement (RSR); one study compared HA with locking plate fixation (LPF) and RSR; one study compared HA with LPF. 61.1 % and 19.4 % of hemiarthroplasties were performed using cemented and uncemented techniques respectively, while cementing data was ill-defined in 19.4 % of shoulders. The results for the outcome measures have been derived directly from the included studies and no statistical pooling was performed, due to heterogeneity in the different study designs and outcomes. Descriptive data synthesis from the included studies showed that third generation HAs have higher overall postoperative complication rates, with similar revision and mortality rates when compared to RSR and LPF for three-and four-part PHFs. RSR and LPF showed better statistically significant improvements than HA for the Constant-Murley score, Quick DASH, forward flexion and abduction. Mixed results were observed for the DASH score, ASES score and internal rotation ROM between RSR/LPF versus HA. Conclusion: Low to moderate quality evidence from this review showed that even third-generation HA prostheses provided worse overall outcomes than RSR and LPF for three-and four-part PHFs.

Long-term survival of resurfacing humeral hemiarthroplasty.

INTRODUCTION: The indication for shoulder resurfacing arthroplasty is controversial, and survival of these implants is somewhat inconsistent. This study aimed to evaluate the long-term survivorship of resurfacing humeral head implants (RHHIs) and determine risk factors for complications and revisions. MATERIALS AND METHODS: This retrospective cohort study consisted of 275 cases and two types of RHHIs. The survival rate was evaluated using the Kaplan-Meier method and Cox regression for risk factor analysis. Demographic factors were studied, and the change in the humerus centre of rotation (COR) was measured. RESULTS: The mean follow-up time was 8.7 years (SD 2.7 months, range 2.8-15.9 years). The mean age of the patients was 67.6 years (SD 9.6, range 33.5-84.9). Ten-year cumulative RHHI survival was 94.1%. The cumulative estimate without any complication was 98.9% at 5 years, 80.0% at 10 years and at 15 years it was 61.5%. The most common complication was persistent pain in 13.8% of the RHHIs. The risk factors for complications and revisions were implant type, preoperative conditions and change of COR > 5 mm. CONCLUSIONS: RRHIs showed excellent long-term survival, but many complications were found. The most common complication was persistent pain, which seemed to be caused by a change of COR and was more related to one type of implant.

OUTCOME OF SHOULDER HEMIARTHROPLASTY FOR COMPLEX PROXIMAL HUMERAL FRACTURE IN VIETDUC UNIVERSITY HOSPITAL.

ABSTRACTS: Translational Study Introduction: The proximal humeral fracture accounts for 4-5% of all fractures1 and traffic accidents are often the main cause of this injury in Vietnam. Shoulder hemiarthroplasty is a suitable option in treating a complex proximal humeral fracture, especially in the elderly, and improves quality of life. This study describes clinical and radiographic characteristics of complex proximal humerus fractures and evaluates the results of shoulder hemiarthroplasty for this type of fracture at Viet Duc University Hospital Materials and methods: A retrospective study of 78 cases with complex proximal humeral fractures underwent shoulder hemiarthroplasty in Viet Duc University Hospital from January 2017 to December 2021. RESULTS: Traffic accidents (42 cases, 53.8%); daily-life accidents (34 cases, 43.6%), other causes were less common (2 cases, 2.6%). 74.4% of the patients had no pain, 17.4% mild pain, 7.7% moderate pain, and no patients suffered from severe pain that required regular narcotic analgesics. The mean postoperative Constant score was 67.45 ± 13.20. CONCLUSION: In Viet Nam, the most common cause of injury was a traffic accident, primarily occurring in young males with complex proximal humerus fractures, shoulder hemiarthroplasty for complex proximal humerus fractures improves postoperative pain and shoulder function.

Timing of Surgery for Proximal Humeral Fracture Treated with Shoulder Hemiarthroplasty, Best Results with Surgery Within 2 Weeks.

Background: Preoperative delay may affect the outcome of proximal humerus fractures treated with shoulder hemiarthroplasty. There is currently no consensus for the recommended preoperative time interval. The aim was to examine how the time to surgery with shoulder hemiarthroplasty after a proximal humerus fracture affected the patient-reported outcome. Methods: 380 patients with proximal humerus fractures treated with shoulder hemiarthroplasty recorded from the Swedish Shoulder Arthroplasty Registry were included. Three self-reporting outcome instruments were used at follow-up after 1-5 years: a shoulder-specific score, the Western Ontario Osteoarthritis of the Shoulder index (WOOS), the EuroQol-5 Dimension index (EQ-5D), and subjective patient satisfaction assessment. Results: The preoperative delay had a negative impact on the WOOS, EQ-5D, and patient satisfaction level (p < 0.01). The best result, measured with WOOS at a minimum 1-year follow-up, was found when surgery was performed 6-10 days after the reported date of fracture. WOOS% 8-14 days was 69.4% (± 24.2). A delay of more than 10 days was shown to be correlated with poorer outcomes. WOOS% 15-60 days was 55.8% (± 25.0) and continued to decrease. Conclusion: The current recommendation in Sweden to perform shoulder hemiarthroplasty within 2 weeks after sustaining a proximal humerus fracture is considered valid.

A Systematic Review of Heterotopic Ossification Following Shoulder Arthroplasty: Is There a Clinical Value?

This systematic review aims to assess the contemporary literature on the incidence rate, functional scores, and clinical outcomes of heterotopic ossification (HO) following shoulder arthroplasty. We conducted a thorough literature search on EMBASE, MEDLINE, and Ortho Search to identify studies that directly compared patients with and without HO following hemiarthroplasty, anatomic total shoulder arthroplasty (aTSA), or reverse total shoulder arthroplasty (rTSA). We included studies with a minimum follow-up period of one year published from January 2000 to March 2023. We excluded case reports, editorials, and reviews. We performed the systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of the 297 studies initially identified, seven met our inclusion criteria. These studies evaluated a total of 1,134 arthroplasties (212 hemiarthroplasties, 376 aTSAs, and 546 rTSAs). The mean follow-up period was 30.52 (12-120) months and the mean age was 68.69 (20-92). The overall incidence rate of HO was 26.8% (304/1,134). Male gender was associated with a higher incidence rate of HO in three studies. No statistically significant difference was noted in symptoms at follow-up or in Constant-Murley score at two years of follow-up (HO vs. non-HO: 70 vs. 75, p = 0.081). Only one study reported a significant difference in the post-arthroplasty range of motion, specifically in forward elevation (121° vs. 133°, p = 0.0087) and external rotation (19° vs. 25°, p-value = 0.0266). We conclude that HO after shoulder arthroplasty does not display a significant impact on postoperative symptoms or functional outcomes in the majority of patients. To fully comprehend its effect, further research and consensus among experts is necessary.

Treatment of Epiphyseal Metastasis to the Proximal Humerus Secondary to Breast Carcinoma: A Case Report.

Metastasis to the bone is a known risk of breast cancer, with the humerus being the most common upper extremity site of metastases, with most lesions located at the humeral diaphysis. We present a unique case of proximal humeral metastasis involving the epiphysis secondary to primary invasive ductal carcinoma in a middle-aged Caucasian female. It is important to have a high degree of suspicion for metastasis when musculoskeletal pain occurs in breast cancer patients, as it may be masked by common, degenerative conditions about the shoulder girdle. When humeral metastases involve the epiphysis, treatment options are complicated by its location, which jeopardizes the integrity of articular cartilage and the function of the shoulder girdle. External beam irradiation provides pain control in a non-invasive manner, sans surgical risks. Surgical intervention will vary depending on the characteristics of the bony lesion, but the use of endoprosthetics has emerged as the most effective option for restoring range of motion and pain control with acceptable rates of implant survival.

Primary Total Shoulder Arthroplasty is Superior to Hemiarthroplasty for the Treatment of Glenohumeral Arthritis: Analysis of 5-year Outcomes in a Large Surgical Database.

Background: Total shoulder arthroplasty (TSA) is the preferred treatment for glenohumeral arthritis refractory to nonoperative measures. However, some surgeons have argued for a role for hemiarthroplasty (HA) in the setting of a smooth glenoid that articulates appropriately with the humeral head. The purpose of this study is to evaluate long-term revision rates and short-term postoperative complications in patients undergoing either HA or TSA for glenohumeral arthritis. Methods: A retrospective review of patients who underwent HA and TSA was conducted using a commercially available national database. Demographics, postoperative complications, risk factors, revision rates, and costs were analyzed using 2 sample t-tests, chi-squared tests, and multivariate logistic regressions. Results: Patients were stratified by operation: (1) HA (n = 1615) or 2) TSA (n = 7845). Patients undergoing primary TSA had higher rates of prior ipsilateral rotator cuff repair and corticosteroid injections. At 2 years, patients who underwent HA, 3.0% of patients had revision surgery, compared to 1.6% of patients who underwent TSA (P = .002); at 5 years, 3.7% of the HA cohort (P < .0001) had revision surgery, compared to 1.9% of patients who underwent TSA. Conclusions: Patients undergoing TSA or RTSA for glenohumeral arthritis had higher preoperative co-morbidities but had no difference in short-term complication rates with a lower risk of revision surgery at both 2-year and 5-year follow-up when compared to HA. Increasing age, female sex, hyperlipidemia, postoperative infection, shoulder instability, and thromboembolism all independently increased odds for revision shoulder arthroplasty for glenohumeral arthritis. Level of evidence Level: III.

The impact of glenoid parameters and implant overstuffing on functional outcomes of shoulder hemiarthroplasty in patients with glenohumeral joint arthritis.

PURPOSE: The outcomes of shoulder hemiarthroplasty are highly dependent on the baseline glenoid morphology and the rotator cuff integrity. The objective of this study was to assess whether certain glenoid parameters and implant overstuffing are associated with worse clinical outcomes following shoulder hemiarthroplasty. METHODS: We retrospectively reviewed 25 patients who underwent shoulder hemiarthroplasty for shoulder arthritis, with a mean follow-up of 5.3 years. The baseline glenoid morphology, the glenoid wear rate, the proximal humeral head migration and implant overstuffing were evaluated radiologically in all patients. The radiological parameters were correlated with the functional outcomes. RESULTS: The Constant-Murley score, the ASES score, and the OSS score were significantly better for patients with a concentric baseline glenoid compared to those with an eccentric glenoid. The Constant-Murley score and the ASES score were also improved in patients without implant overstuffing compared to patients with implant overstuffing (p < 0.05). However, glenoid wear was not associated with worse functional outcomes (p = 0.23 for Constant-Murley score, p = 0.15 for ASES score and p = 0.27 for OSS score). Last, a worse Constant-Murley score was strongly correlated with proximal humeral head migration (p < 0.001), while worse ASES and OSS scores were moderately correlated with proximal humeral head migration (p < 0.001). CONCLUSION: Our findings indicate that the results of hemiarthroplasty can be improved through careful selection of patients upon the baseline glenoid type morphology and proper implant sizing to avoid implant overstuffing. Moreover, glenoid wear is not associated with worse clinical outcomes, therefore shoulder hemiarthroplasty should be reconsidered as an alternative in younger patients with shoulder arthritis.

Evaluating trunnionosis in modular anatomic shoulder arthroplasties: a retrieval study.

BACKGROUND: Shoulder arthroplasty procedures are widely indicated, and the number of shoulder arthroplasty procedures has drastically increased over the years. Rapid expansion of the utilization of reverse total shoulder arthroplasty has outpaced the more modest growth of anatomic total shoulder arthroplasty (aTSA) while shoulder hemiarthroplasty (HA) has trended down. Recently, shoulder prostheses have transitioned to increasingly modular systems offering more individualized options with the potential for decreased pain and increased range of motion. However, increased primary procedures has resulted in increased revision surgeries, with one potential cause being fretting and corrosion damage within these modular systems. METHODS: Following institutional review board approval, 130 retrieved aTSA and 135 HA explants were identified through database query. Humeral stem and head components were included in all 265 explants, whereas 108 included polyethylene glenoid liner components. All explanted components were macroscopically evaluated for standard damage modes, and taper junctions were microscopically examined for fretting/corrosion using a modified Goldberg-Cusick classification system that was 4-quadrant graded for both the male and female component. Medical records were reviewed for patient demographics and surgical information. RESULTS: In this series, 158 of explants were from female patients (male = 107), and 162 explants were from the right shoulder. Average age at implantation was 61 years (range: 24-83), average age at explanation was 66 years (range, 32-90), and average duration of implantation was 61.4 months (range, 0.5-240). Scratching, edge deformation, and burnishing were the most commonly observed standard damage modes. Of the 265 explants, 146 had a male stem component vs. 118 with a female stem component. Average summed fretting grades on male and female stem components were 8.3 and 5.9, respectively (P < .001). Average summed corrosion grades for male and female stem components were 8.2 and 6.2, respectively (P < .001). Wider male tapers (>11 mm) showed significantly less fretting and corrosion (P < .001). Lastly, mismatched metal compositions between the head and stem components showed greater fretting and corrosion damage (P = .002). CONCLUSION: In this series of 265 aTSA and HA explants, there was substantial damage present on the explanted components. All components demonstrated macroscopic damage. In this retrieval study, small-tapered male stems with small, thin female heads and mismatched metal composition between components were risk factors for increased implant wear. As shoulder arthroplasty volume increases, optimizing design is paramount for long-term success. Additional work could determine the clinical significance of these findings.

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.

Development of a New Model of Humeral Hemiarthroplasty in Rats.

PURPOSE: In vivo models are anatomically comparable to humans allowing to reproduce the patterns and progression of the disease and giving the opportunity to study the symptoms and responses to new treatments and materials. This study aimed to establish a valid and cost-effective in vivo rat model to assess the effects of implanted shoulder hemiarthroplasty materials on glenoid articular cartilage wear. METHODS: Eight adult male Wistar rats underwent right shoulder hemi-arthroplasty. A stainless steel metal bearing was used as a shoulder joint prosthesis. X-rays were performed one week after surgery to verify correct implant position. Additional X-rays were performed 30 and 60 days post-implantation. Animals were sacrificed 24 weeks after implantation. All specimens were evaluated with micro-CT for cartilage and bone wear characteristics as well as histologically for signs of osteoarthritis. Samples were compared to the non-operated shoulders. RESULTS: All animals recovered and resumed normal cage activity. All X-rays demonstrated correct implant positioning except for one in which the implant was displaced. Histologic evaluation demonstrated arthritic changes in the implanted shoulder. Decreased Trabecular thickness and Trabecular Spacing were documented among the implanted parties (p < .05). Bone Mineral Density and Tissue Mineral Density were reduced in the operated shoulder although not significantly (p = .07). CONCLUSIONS: This study demonstrated significant glenoid cartilage wearing in the operated shoulder. Furthermore, the presence of an intra-articular hemiarthroplasty implant diminished underlying glenoid bone quality. This novel, in vivo-model will enable researchers to test implant materials and their effects on cartilage and bone tissue in a cost-effective reproducible rat model.

Short to Early-Mid Term Clinical Outcomes and Survival of Pyrocarbon Shoulder Implants: A Systematic Review and Meta-Analysis.

Background: The appropriate surgical treatment option for young and active patients undergoing shoulder arthroplasty for arthritis remains questionable. Pyrolitic carbon (pyrocarbon) has been shown to improve implant longevity and decrease wear when in contact with cartilage or bone. The present systematic review aimed to evaluate clinical and radiological outcomes as well as the survivorship of pyrocarbon shoulder implants. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. A systematic search was performed using the MEDLINE, EMBASE and Cochrane Library databases. All the studies dealing with the use of pyrolitic shoulder implants were pooled, data of interest were extracted and statistically analyzed through meta-analysis. Results: A total of 9 studies were included for a total of 477 shoulders treated. The overall mean rate of survival of the implants was 93.4 ± 5.8% and 80% ± 26.5% at 2 years and final follow up, respectively, while resulting 82.4% ± 22.1% and 92.3% ± 3.5% for PISA (pyrocarbon interposition shoulder arthroplasty) and hemi-arthroplasty/hemi-resurfacing, respectively. Conclusions: Pyrolitic carbon shoulder implants showed good survivorship and clinical outcomes at an early to early-midterm follow-up. More studies and better-designed trials are needed in order to enrich the evidence on long-term outcomes and comparison with other shoulder replacement options for young and active patients. Level of Evidence: IV.

Pyrocarbon hemiarthroplasty of the shoulder: a systematic review and meta-analysis of clinical results.

BACKGROUND: Hemiarthroplasty is often considered in the setting of preserved glenoid cartilage given the high risk of revision associated with total shoulder arthroplasty. Pyrocarbon (PyC) has been used as an implant material that theoretically allows for formation of a neo-membrane that would act like cartilage to reduce glenoid wear. The purpose of this study was to evaluate the clinical outcomes, radiographic outcomes, revision rates, and complication rates in the existing literature on shoulder hemiarthroplasty using PyC. METHODS: The MEDLINE, Embase, and Scopus databases were searched for articles relating to shoulder hemiarthroplasty using the terms "pyrocarbon" or "pyrolytic carbon." Abstracts and articles were screened against predefined inclusion and exclusion criteria, with a minimum of 24 months' follow-up required. Data on patient demographic characteristics, clinical outcome scores, complications, revision rates, and radiographic findings were recorded. Where appropriate, meta-analysis was performed. RESULTS: Twelve studies were selected for final inclusion, with a total of 536 patients. Among the studies reporting preoperative and postoperative range of motion (ROM), an overall improvement in ROM was observed. The mean Constant score was 70.9 points postoperatively, with a mean improvement of 36.2 points (n = 359, 9 studies). Radiographically, 22.8% of patients (n = 536, 8 studies) had evidence of glenoid erosion, 10.4% had changes in implant positioning, and 9.9% had tuberosity thinning. In addition, 1.5% of patients had radiographic subacromial space reduction, whereas 0.7% had an increase in tuberosity thickness. Across all studies, there was an 8.6% complication rate, with the most common cause being glenoid erosion (2.6%, n = 14). There was an overall 7.7% revision rate (n = 41), with 63% of revisions (n = 26) undergoing conversion to reverse or total shoulder arthroplasty. CONCLUSION: PyC hemiarthroplasty shows overall improvements in ROM and patient-reported outcomes for patients. However, there remains concern for glenoid erosion on radiographic evaluation at minimum 2-year follow-up. Although preliminary studies have shown encouraging results, this systematic review emphasizes the need for longer-term follow-up studies with further radiographic evaluation of the severity of glenoid erosion and the association with functional outcomes and failure risk.

Tuberosity reconstruction baseplate for shoulder hemiarthroplasty: Morphological design and biomaterial application.

Background: Shoulder hemiarthroplasty is prone to tuberosity malposition and migration, reducing the rate of tuberosity healing. We proposed to design a tuberosity reconstruction baseplate to assist in tuberosity integration and to evaluate the mechanical properties of baseplate made from the novel biomaterial carbon fiber reinforced polymer (CFRP) composites. Methods: The three-dimensional model of native proximal humerus was constructed by computed tomography (CT) data. The morphological design of baseplate was based on the tuberosity contour and rotator cuff footprint. Finite element models were created for different thicknesses of CFRP composites, poly (ether-ether-ketone) (PEEK) and titanium-nickel (TiNi) alloy. The permissible load and suture hole displacements were applied to evaluate the mechanical properties. Results: The structurally optimized model made of CFRP composites provided superior strength and deformability, compared to the PEEK material and TiNi alloy. Its permissible load was above 200 N and the suture hole displacement was between 0.9 and 1.4 mm. Conclusion: This study proposed a method for designing tuberosity reconstruction baseplate based on morphological data and extended the application of biomaterial CFRP composites in orthopedics field. The optimized model made of CFRP composites allowed a certain extent of elastic deformation and showed the possibility for dynamic compression of tuberosity bone blocks.

Shoulder replacement: an epidemiological nationwide study from 2009 to 2019.

BACKGROUND: Shoulder replacement (SR) constitutes the gold standard treatment for severe shoulder diseases, including osteoarthritis, rheumatoid arthritis, complex fractures, avascular necrosis and rotator cuff arthropathy. Although several countries have national registries, there is a lack of epidemiological data on SR. Sharing national statistics and correlating those to other countries could be helpful to compare outcomes and costs internationally. This paper aims to evaluate the trend of hospitalizations for SR (both first implants and revisions of anatomical and reverse prosthesis) in Italy from 2009 to 2019, based on the National Hospital Discharge Reports (S.D.O) provided by the Italian National Health Service (INHS). Moreover, the economic impact on the healthcare system of SR and SR revisions was assessed, providing a statistical prediction for the next ten years. METHODS: The data used in this paper were about patients who underwent Total Shoulder Replacement (TSR), Shoulder Hemiarthroplasty (SH) or Revision of shoulder joint replacement (RSR) from 2009 to 2019 in Italy. Information about patients was anonymous and included age, sex, days of hospitalization, procedures and diagnoses codes. RESULTS: From 2009 to 2019, 73,046 TSR and SH were performed in adult Italian residents, with a cumulative incidence of 13.6 cases per 100,000 adult Italian residents. While, 2,129 revisions of shoulder replacement were performed, with a cumulative incidence of 0.4 cases per 100,000 residents. Overall, females represented the majority of the cases (72.4% of patients who underwent TSR or SH and 59.1% of patients who underwent RSR). From 2009 to 2019, has been assessed an overall cost of 625,638,990€ for TSR or SH procedures in Italy. While, an overall cost of 9,855,141€ for RSR procedures in Italy was calculated. CONCLUSIONS: The incidence of SR and RSR is expected to increase in the following years, constituting a burden for the healthcare systems. Overall, in Italy, the females represented the majority of patients. Further prospective studies on this topic in different countries can be con-ducted to make comparisons.

Long-stemmed Hemiarthroplasty with Cerclage Wiring for the Treatment of Split-Head Fractures of the Proximal Humerus with Metaphyseal Extension: A Report of 2 Cases.

Introduction: Complex fractures of the proximal humerus with splitting-head component and metaphyseal propagation are very rare injuries that are difficult to treat. Preservation of the humeral head is always considered except in cases with severe comminution and compromised vascularity where shoulder hemiarthroplasty is an alternative option. Case Report: We present two male patients, 57- and 62-years-old who sustained such a complex proximal humeral fracture after a high-energy injury. They both managed with long-stemmed shoulder hemiarthroplasty and cerclage wiring of the metaphyseal area. They both demonstrated good clinical and radiological outcome at 32- and 24-months postoperatively. Conclusion: We report the functional and radiological outcomes of two cases of a rare proximal humeral fracture's pattern - combination of splitting-head and metaphyseal comminution - that were managed with long-stemmed hemiarthroplasty and cerclage wire and demonstrated good midterm clinical outcome.

Bilateral Posterior Fracture-Dislocation of the Shoulder after Electrical Shock Treated with Bilateral Hemiarthroplasty: A Case Report.

This is a case report of a bilateral posterior fracture-dislocation of the shoulder after electrical shock and presents the first such patient treated with bilateral shoulder hemiarthroplasty. At first presentation, the upper limbs of the patient were in a position of internal rotation, and passive and active external rotations were painful. Radiographs and computed tomography of both shoulders showed bilateral posterior fracture-dislocation. Defects over 50% of the head articular surfaces led to unstable and unsuccessful initial closed and open reductions. The patient was then treated with cemented hemiarthroplasties with very good functional results two years post-operatively. This case presentation underlines the critical value of systematic clinical and radiographic evaluation of severe bilateral shoulder fracture-dislocations, prior to the ultimate proper treatment with cemented humeral shoulder hemiarthroplasties, followed by appropriate rehabilitation programme, for successful patient outcomes.

Survivorship of total shoulder arthroplasty vs. hemiarthroplasty for the treatment of avascular necrosis at greater than 10-year follow-up.

BACKGROUND: Avascular necrosis (AVN) of the humeral head is a debilitating pathology that can be managed with an array of treatments depending on disease staging. Humeral head arthroplasty for AVN has demonstrated good short-term improvements in pain and range of motion, but the published long-term outcomes data are limited. The objective of this study was to report long-term survivorship and outcomes for patients undergoing hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) for the treatment of AVN of the humeral head. METHODS: The practice of one fellowship-trained shoulder surgeon was queried for the surgical treatment of AVN of the humeral head via appropriate International Classification of Diseases, Ninth and Tenth Revision, codes. Sixteen shoulders that met inclusion criteria were identified. Demographics included the radiographic stage, age, sex, American Society of Anesthesiologists (ASA) score, and body mass index. The primary endpoint was survivorship of the implant. Secondary endpoints were range of motion in forward elevation, internal and external rotation, visual analog scale for pain, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, and the Simple Shoulder Test score. RESULTS: Of the 16 shoulders included in the study, 10 underwent HA and 6 underwent TSA. The TSA cohort was significantly older (mean 60.5 vs. 44.2, P = .005), with a higher mean ASA score (mean 3.0 vs. 2.13, P = .02) than the HA group. The 10-year survivorship rates were 88.9% for HA and 80% for TSA with no significant difference between groups. Survivorship data were available for a mean 13.0 ± 5.6 years' follow-up in the HA group and 13.8 ± 4.8 years in the TSA group. When compared to one another, the results between HA and TSA only differed in internal rotation, which was statistically significantly improved in the TSA group compared with HA (2.3 ± 2.6 compared with -3.0 ± 5.0, P = .03). CONCLUSION: The survivorship of both TSA and HA for the treatment of AVN was at least 80% at 10 years. Secondary endpoints, such as range of motion, pain, and shoulder function, improved significantly postoperatively in each cohort and were similar between the 2 groups, except for internal rotation, which had improved significantly more in the TSA group than in HA. Both TSA and HA are viable options for the treatment of AVN, each with durable long-term survival.