Open Access
Table 1.
Hemiarthroplasty review of literature.
| Series No. patients, age, % women, followup (months) | Fracture type, approach, tub suturing | Global Constant (GC), weighted Constant (WC), DASH | Tuberosity union | Clinical complications | Radiol. complications | Comments |
|---|---|---|---|---|---|---|
| Goldman (9), n = 22, age = 68 14 F (63.6%), F/U = 30 |
3-part fracture: 10, 4-part fracture: 12, deltopectoral all cases |
N/R | 100% anatomical tuberosity union | No infections, No nerve injuries 1 wound dehiscence |
3 proximal implant migration (13.6%) - 7 humeral loosening (31.8%) - 3 ectopic ossification (13.6%) |
Being female, having a 4-part fracture and being > 70 y/o were predictors of negative joint range of motion results |
| Boileau (7), n = 66, age = 66, 45 F (68%), F/U = 27 |
4-part fracture: 59, 3-part fracture: 7, deltopectoral all cases |
GC: 56, WC: 74% |
33 malpositioned (50%), 11 nonunion (17%), 26 malunion (39%) |
- 3 transient axillary nerve damage (4.5%) - 1 anterior dislocation (1.5%) |
- 7 ectopic ossification (10.5%) - 15 proximal implant migration (22%) - no loosening - 16 radiolucent lines < 1 mm (24%) |
- Wrong humeral stem height (>10 mm lengthening or >15 mm shortening) or retroversion (> 40°) is correlated with poor functional results and incorrect tuberosity positioning - Final malpositioning of the tuberosities is correlated with a poor functional result - Being female and being > 75 y/o are significantly correlated with poor functional results and tuberosity migration |
| Prakash (30), n = 22, age = 69, 19 F (86%), F/U = 33 |
4-part fracture: 12, 4-part dislocated fracture: 3, 3-part fracture: 7, deltopectoral approach in all cases |
N/R | - 2/16 lesser tuberosity malunion (12.5%) - 1/16 lesser trochanter nonunion (6.2%) - 13/16 anatomical lesser tuberosity union (81.2%) |
- 1 anterior dislocation (4.5%) | - 1 aseptic loosening at 7 years F/U (surgical revision) (4.5%) - 1 ectopic ossification (4.5%) - 1 anterior subluxation (4.5%) |
Range of motion was significantly better in patients 65 years of age or younger |
| Mighell (11), n = 72, age = 66, 54 F (76%), F/U = 36 |
4-part fracture: 41, 3-part fracture: 22, intra-articular fracture: 8, anatomical neck fracture: 1, deltopectoral approach in all cases |
ASES: 76.6 (25–100) | - 69 tuberosity union (96%) - 54 anatomical tuberosity union (75%) - 15 malunion (21%) - 3 nonunion (4%) |
- 1 deep infection (1.4%) - 1 CRPS (1.4%) |
- 15 proximal implant migration (20.8%) - 1 aseptic loosening (1.4%) (surgical revision) - -1 septic loosening (1.4%) - - 18 ectopic ossification (25%) |
Proximal implant migration is correlated with poor functional results |
| Kralinger (15), n = 167, age = 70, 127 F (76%), F/U = 29 |
3-part fracture: 17, 4-part fracture: 109, fracture-dislocation: 41, Not specified |
GC: 55.4 | - 28 (16.8%) union with > 0.5 cm displacement - 62 (37.1%) union with < 0.5 cm displacement - 77 (46.1%): osteolysis, nonunion, malunion |
- 1 superficial infection (0.6%) - 1 deep infection (0.6%) |
- 3 anterosuperior subluxation (1.8%) | - Tuberosity union is significantly affected by age but not by bone graft use - Anatomical tuberosity union positively affects the Constant score |
| Gronhagen (6), n = 46, age = 69, 37 F (80.4%), F/U = 53 |
2-part fracture: 2, 3-part fracture: 10, 4-part fracture: 34, deltopectoral approach in all cases |
GC: 42 | - 5 secondary displacement | - 1 superficial infection (2%) - 1 dislocation (2%) |
- 24 proximal implant migration (52%) - 16 glenoid erosion (35%) - 25 ectopic ossification (54%) - no loosening |
- Constant score is significantly higher in patients under 60 years of age. - Fracture types does not significantly affect Constant score - Constant score is significantly better in the "no migration" group than the implant migration group |
| Antuna (16), n = 57, age = 66, 44 F (77%), F/U = 126 |
4-part fracture: 32, 3-part fracture: 7, 4-part dislocated fracture: 9, 3-part dislocated, fracture: 4 intra-articular fracture: 5, deltopectoral approach in all cases |
N/R | 22/35 anatomical tuberosity union (62.8%) | - 1 early posterior dislocation (1.7%) | 85% subluxation: - 18 superior - 6 anterior - 2 posterior - 13 humeral radiolucent lines - 1 stem loosening (surgical revision) |
Anatomical tuberosity union and being under 70 years of age are significantly correlated with better forward flexion |
| Kontakis (17), n = 28, age = 66.4, 23 F (82%), F/U = 39.3 |
4-part fracture: 18, 3-part fracture: 2, 4-part dislocated fracture: 4, 3-part dislocated fracture: 4, deltopectoral approach in all cases |
GC: 68.2 | 13 anatomical reduction 14 acceptable reduction 1 initial malpositioning - 0 nonunion |
No dislocation, infection, nerve damage or instability | - 5 proximal implant migration (17.8%) - no loosening - no radiolucent lines |
Anatomical tuberosity union leads to non- statistically significant improvements in Constant score and ROM (P > 0.05) |
| Esen (18), n = 42, age = 68.9, 28 F (67%), F/U = 78.8 |
4-part fracture: 25, 3-part fracture: 7, 3-part dislocated fracture: 6, intra-articular fracture: 4, deltopectoral approach in all cases |
GC: 73.6 | - 3 osteolysis - 37 anatomical tuberosity union (88%) - 0 nonunion |
- 2 transient axillary nerve damage (4.8%) - 1 CRPS (2.4%) - 1 postoperative hematoma with surgical revision |
- 2 proximal implant migration (4.8%) (surgical revision) - 9 RLL around stem (30%) - no stem loosening |
- Anatomical tuberosity union significantly improves forward flexion - Positive correlation between humeral offset and flexion ROM - Positive correlation between acromiohumeral height and flexion ROM - Negative correlation between implant height and flexion ROM |
| Reuther (5), n = 102, age = 71.5, 88 F (86%), F/U = 28.1 |
4-part fracture: 60.9%, 3-part fracture: 20.7%, intra-articular fracture, other: 18.4%, deltopectoral approach in all cases |
GC: 44.7 - pain: 10.4/15 - activity: 12.3/20 - mobility 13.7/40 - strength: 8.3/25 - WC: 62.8% ASES: 61.5 |
- 36 anatomical tuberosity union (35.3%) - 66 malunion or nonunion (64.7%) |
N/R | N/R | - Anatomical tuberosity union significantly improves the Constant score and ASES score - Being female, having osteoporosis and being older are predictors of tuberosity nonunion - No significant differences in tuberosity union when bone graft used |
| Shah (27), n = 32, age = 72.2, 24 F (75%), F/U = 25.3 |
4-part fracture: 21, 4-part dislocated fracture: 7, 3-part fracture: 3, deltopectoral approach in all cases |
ASES: 67.2, UCLA: 24.8 |
- 31 tuberosity union (97%) - 1 lesser trochanter nonunion (3%) |
- 1 superficial infection (3%) - 1 transient axillary nerve damage (3%) |
- 10 proximal implant migration (31%) - 1 anterior subluxation - no RLL |
Functional outcomes are significantly affected by the preoperative condition of the rotator cuff, but also by age, gender and proximal implant migration |
| Padua (36), n = 50, age = 73, 38 F (76%), F/U = 38.4 |
Fracture type not recorded, deltopectoral approach in all cases |
ASES: 56.85, DASH: 39.29 |
N/R | N/R | N/R | No correlation between implant height and functional scores (DASH, ASES) No correlation between joint range of motion and implant height or retroversion Significant correlation between retroversion and functional scores (DASH, ASES) |
| Castricini (34), n = 57, age = 72.2, 53 F (93%), F/U = 52 |
3-part fracture: 7 (12%), 4-part fracture: 42 (73%), fracture- dislocation: 8 (14%), deltopectoral approach in all cases |
GC: 59.2 - pain: 14/15 - mobility: 25.3/40 - activity: 16.3/20 - strength: 3.3/25 |
- 41 anatomical lesser tuberosity union (73.2%) - 9 lesser tuberosity malunion (16.1%) - 6 lesser tuberosity osteolysis (10.7%) |
No infections - No nerve injuries - No dislocations |
- 7 proximal implant migration (12.5%) - 5 ectopic ossification (8.9%) - No loosening or radiolucent lines |
Better Constant scores achieved in patients with anatomical tuberosity union and no proximal implant migration |
| Fucentese (37), n = 30, age = 63.3, 10 F (33.3%), F/U = 25 |
3-part fracture: 3 (10%), 3-part dislocated fracture: 4 (13.3%), 4-part fracture: 23 (76.6%), deltopectoral approach in all cases |
GC: 59, WC: 75% |
- 23 anatomical lesser tuberosity union (85%) - 4 secondary lesser tuberosity displacement (2 surgical revisions, RSA conversion) |
No infections - No nerve injuries - No dislocations |
- 3 ectopic ossification - 20 lesser trochanter osteolysis (12 severe, 8 medium) - no loosening |
Large metaphysis implant that results in good rate of anatomical tuberosity union, but no control group included |
| Boileau (10), n = 60 (61 shoulders), age = 67, 38 F (63.3%), F/U = 64 group A: standard stem (n = 31), group B: fracture-specific stem (n = 30) |
4-part fracture: 56 (92%), 3-part fracture: 5 (8%), deltopectoral approach in all cases |
GC: - all patients: 63 - group A: 58.9 - group B: 68.2 WC: all patients: 89% - group A: 84% - group B: 93% |
Anatomical lesser tuberosity union:
- all patients: n = 40 (66%) - group A: n = 14 (45%) - group B: n = 26 (87%) Lesser tuberosity malunion: - all patients: n = 17 (27.9%) - group A: n = 14 (45%) - group B: n = 3 (10%) - Lesser tuberositie nonunion: - all patients: n = 4 (6.5%) - group A: n = 3 (9.7%) - group B: n = 1 (3.3%) |
- 1 axillary artery damage (1.6%) - 1 deep infection (1.6%) - 2 transient axillary nerve damage (3.3%) - 2 capsulitis (3.3%) |
- 2 glenoid erosion (3.3%) (surgical revision) | Study comparing standard humeral stem to fracture-specific stem
- Use of fracture-specific stem led to significant improvements in: - anatomical lesser tuberosity union rate - all parameters of the Constant score, except pain and internal rotation Being 75 y/o or greater, being female and using a standard stem are risk factors for tuberosity nonunion and poor functional outcomes Anatomical lesser tuberosity union significantly improves the Constant score |
| Brandao B (38), n = 67, age = 65, 47 F (70%), F/U = 38 |
4-part fracture: 46, 3-part fracture: 18, deltopectoral approach in all cases |
UCLA: 26 | 33 anatomical union of lesser tuberositie (49%) | - 1 periprosthetic fracture intraoperative - 1 periprosthetic fracture at 11 months followup - 2 recessive nerve damage (median and axillary nerves) - 1 deep infection (1.5%) |
N/R | Anatomical tuberosity union significantly improves the functional outcomes Men had significantly better forward flexion and UCLA scores than women |
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