Reverse shoulder arthroplasty versus hemiarthroplasty for treatment of proximal humerus fractures

Background: Whereas most proximal humerus fractures are treated nonoperatively, complex 3- and 4-part fractures may require shoulder arthroplasty. Hemi-shoulder arthroplasty (HSA) has been the standard treatment, but recently there has been discussion and utilization of reverse total shoulder arthroplasty (RTSA) as a viable treatment option. This study evaluated the national utilization of RTSA and HSA for proximal humerus fractures and compared patient and hospital characteristics associated with each procedure. Methods: This study used the Nationwide Inpatient Sample database for 2011, which allows national estimates of inpatient hospital discharges. Patients were selected by diagnosis and procedure codes to identify those who underwent RTSA or HSA for treatment of proximal humerus fractures. Patient and hospital characteristics associated with each procedure as well as in-hospital complication rates were identified. Results: An estimated 7714 patients with proximal humerus fractures were selected, 27.4% of whom were treated with RTSA. Except for increased age, patient characteristics were similar between groups, as were complication rates. RTSA was more likely to be performed over HSA in small, rural, nonteaching hospitals and also in those that had already adopted and performed a high volume of RTSA procedures for other diagnoses. Conclusions: Although HSA remains the most common arthroplasty choice for proximal humerus fractures, RTSA is becoming widely used. Patient characteristics and complications were similar between the 2 procedures, and as clinical evidence appears to show improved outcomes with RTSA, it is likely that acceptance of RTSA will continue to grow.