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Injury. 2019 Jan 30. pii: S0020-1383(19)30034-8. doi: 10.1016/j.injury.2019.01.034. [Epub ahead of print]

The increasing role of reverse total shoulder arthroplasty in the treatment of proximal humerus fractures.

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Department of Orthopedic Surgery, The Permanente Medical Group, Sacramento, CA, USA. Electronic address:
Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA, USA.
Department of Orthopedic Surgery, Southern California Permanente Medical Group, Harbor City, CA USA.



Hemiarthroplasty of the shoulder is a well established treatment for proximal humerus fractures not amenable to open reduction internal fixation. However, orthopedic surgeons have recently increased utilization of reverse total shoulder arthroplasty (RTSA) in the treatment of these injuries. The purpose of this study was to evaluate the use of hemiarthroplasty and RTSA between 2009 and 2016 for the treatment of proximal humerus fractures within a large United States integrated healthcare system.


A descriptive study was conducted using our integrated healthcare system's Shoulder Arthroplasty Registry. Shoulder arthroplasty cases performed for an acute proximal humerus fracture between the years of 2009 and 2016 were identified. Revision rates were determined, as well as changes in age and gender distribution of the cohort during the study period.


In 2015, RTSA utilization surpassed that of hemiarthroplasty for the first time in the healthcare system. The utilization of RTSA in the treatment of proximal humerus fractures increased from 4.5% of all arthroplasties in 2009 to 67.4% of arthroplasties in 2016. During the study period, patients undergoing hemiarthroplasty were younger and less likely to be female. Crude revision rate was 4.0% for hemiarthroplasty and 3.2% for RTSA.


RTSA is increasingly being utilized for the treatment of proximal humerus fractures and now appears to be the treatment of choice. While hemiarthroplasty appears to be falling out of favor in the treatment of fractures of the shoulder, surgeons may still be preferentially using the procedure in younger patients.


Hemiarthroplasty; Proximal humerus fracture; Reverse total shoulder arthroplasty

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