Reverse total shoulder arthroplasty compared to stemmed hemiarthroplasty for proximal humeral fractures: a registry analysis of 5,946 patients

Background There is an increasing trend towards the use of reverse total shoulder arthroplasty (RTSA) over stemmed hemiarthroplasty (HA) for the management of proximal humeral fractures. There is limited data available comparing the revision rates for RTSA and HA in the setting of fracture. The aim of this study was to compare the revision rates for the RTSA and the HA when used for the treatment of fracture and to analyze the effect of demographics and prosthesis fixation on these revision rates. Methods Data obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) from 16 April 2004 to 31 December 2017 included all procedures for primary diagnosis proximal humeral fracture. The analyzes were undertaken using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazards models. Results Over the study period, there were 3,049 (51%) RTSA and 2,897 (49%) HA procedures. The cumulative percent revision (CPR) rate at 9 years was lower for the RTSA than for the HA: 7.0% [95% CI, 4.8-10.1] compared to 11.7% [95% CI, 10.3-13.2]. Between 0 and 6 months, the HA had a significantly lower revision rate than the RTSA (HR, 0.50; 95% CI, 0.34-0.72; P For the RTSA, males have a significantly higher rate of revision compared to females. There is a higher rate of early revision due to instability/dislocation in younger persons (55-64) and males. For both RTSA and HA, cemented prostheses have lower revision rates compared to cementless prostheses. Conclusions The RTSA has a significantly lower revision rate compared to HA for the treatment of proximal humeral fractures in females. Younger patients ( Level of evidence Level III; Retrospective Cohort Comparison using Large Database Analysis; Treatment Study