Hemiarthroplasty versus reverse shoulder arthroplasty for complex proximal humeral fractures in the aged: a meta-analysis / 中华创伤骨科杂志

ABSTRACT

Objective:To compare the advantages and disadvantages of hemiarthroplasty (HA) and reverse shoulder arthroplasty (RSA) in the treatment of complex proximal humeral fractures in the elderly patients.Methods:Pubmed, the Cochrane Library, EMBASE, and Chinese databases like CNKI, Wanfang Data and Weipu were searched for studies comparing HA and RSA in the treatment of complex proximal humeral fractures in the elderly (>60 years) from 2000 to 2020. After the studies were included and excluded by a set of inclusion and exclusion criteria and evaluated for their quality, their radiological and functional data were extracted and analyzed using software Stata 14.0.Results:Included in this meta-analysis were 11 studies with a total of 771 patients. RSA was superior to HA in outcomes like forward flexion ( SMD=-1.043, 95% CI -1.551 to -0.534, P=0.000), abduction ( SMD=-0.811, 95% CI -1.470 to -0.153, P=0.016), Constant score ( SMD=-0.699, 95% CI -1.118 to -0.280, P=0.001), American Shoulder Elbow Surgeons’ Form (ASES) ( SMD=-0.931, 95% CI -1.256 to -0.606, P<0.001), and Simple Shoulder Test (SST) ( SMD=-0.598, 95% CI -1.181 to -0.016, P=0.044). HA led to a higher complication rate ( RR=2.14, 95% CI 1.11 to 4.14, P=0.024), a higher joint stiffness rate ( RR=6.467,95% CI 1.923 to 21.755, P=0.003) and a higher revision rate ( RR=5.796, 95% CI 1.927 to 17.434, P=0.002). There were no statistically significant differences between RSA and HA in tuber healing rate ( RR=0.850, 95% CI 0.669 to 1.080, P=0.182), internal rotation ( SMD=0.536, 95% CI -0.394 to 1.466, P=0.259), external rotation ( SMD=-0.366, 95% CI -0.916 to 0.184, P=0.192), implant infection ( RR=1.550, 95% CI 0.330 to 7.286, P=0.579) or Disabilities of the Arm, Shoulder and Hand (DASH) score ( SMD=0.286, 95% CI -0.278 to 0.850, P=0.032). Although there was no significant difference between RSA and HA in visual analogue scale (VAS) score ( SMD=0.440, 95% CI -0.113 to 0.993, P=0.119), RSA scored better ( SMD=-1.101, 95% CI -2.090 to -0.112, P=0.029). Conclusion:For elderly patients (>60 years) with complex proximal humeral fracture, RSA may be a more effective surgical intervention which can lead to better early and mid-term clinical outcomes than HA.