# Long-term outcomes of hemiarthroplasty for complex proximal humerus fractures: a systematic review of clinical studies with minimum 10-year follow-up

## TL;DR

This study reviews long-term results of hemiarthroplasty for complex shoulder fractures and finds variable outcomes with high failure rates, mainly due to healing issues.

## Contribution

The study provides the first systematic review of hemiarthroplasty outcomes with a minimum 10-year follow-up for complex proximal humerus fractures.

## Key findings

- Failure rates ranged from 0% to 29%, primarily due to greater tuberosity malunion or nonunion.
- Anatomic healing of the greater tuberosity was linked to better clinical outcomes and lower failure risk.
- Glenoid erosion occurred in up to 72.7% of patients after 20.3 years of follow-up.

## Abstract

While hemiarthroplasty (HA) has decreased in use as a surgical treatment for complex proximal humerus fractures, its long-term performance remains poorly defined. This systematic review evaluates clinical and functional outcomes and complication rates following HA with minimum 10-year follow-up.

A systematic search of PubMed, Embase, and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify clinical studies reporting ≥10-year outcomes of HA for acute complex (3- or 4-part, fracture dislocations, or head split) proximal humerus fractures. Included studies reported functional or patient-reported outcomes and had a minimum average follow-up of 10 years. Study quality was assessed using the Methodological Index for Non-Randomized Studies criteria.

Five studies encompassing 198 patients met the inclusion criteria. Mean follow-up ranged from 10.3 to 20.5 years. Postoperative Constant scores ranged from 63.9 to 82.8. Mean forward flexion ranged from 100.0° to 126.0°, and external rotation ranged from 28.0° to 46.0°. Greater tuberosity healing rates ranged from 30.0% to 91.0%, with improved clinical outcomes associated with anatomic healing at the greater tuberosity. Failure rates ranged from 0% to 29%, most commonly due to tuberosity malunion or nonunion. Glenoid erosion was reported in up to 72.7% of patients at a mean follow-up of 20.3 years. The overall complication (range, 0%-3.2%) and reoperation (range, 0%-12.9%) rates were low. Most failures were converted to reverse total shoulder arthroplasty.

HA for the treatment of complex proximal humerus fractures yields variable long-term clinical outcomes and high rates of failure, with the majority due to greater tuberosity malunion or nonunion. Anatomic greater tuberosity healing appears to result in improved function and lower failure risk. These findings suggest limited utility of HA in the long term, supporting the need for careful patient selection and consideration of alternative surgical options such as reverse shoulder arthroplasty for treatment of complex proximal humerus fractures.