Introduction and Aims: The aim was to prospectively assess shoulder hemiarthroplasty for un-reconstructable proximal humeral fractures at a minimum of 12 months and identify factors that aid prognosis.
Method: Inclusion criteria were patients with a displaced fracture requiring shoulder hemiarthroplasty. Constant scoring was done at a minimum follow-up of one year. Patients were treated using a Neer or Osteonics prosthesis, the decision for hemiarthroplasty being made at the time of surgery. Post-operative management was standardised. An independent functional assessment, record review establishing a physiological index according to co-morbidities, and radiological analysis were carried out. Survival analysis was performed for one and five-year results and data was analysed by linear regression to identify prognostic factors.
Results: From 163 patients there were 138 fitting the criteria, 42 males and 96 females, average age of 68.5 (range 30–90) years and follow-up of 6.3 (range 1–15) years. The fracture pattern was three and four part in 133 cases and five head split fractures; 58 were associated with dislocation. Survival was 96.4 percent at one year and 93.6 percent at five years, with no significant difference between prostheses. There were eight revisions, (one deep infection, four dislocations and three peri-prosthetic fractures), by 12 months. The average Constant score was 67.1 at one year.
Conclusion: Prognostic factors on presentation were age of the patient and their physiological index, and at three months any complication, the position of the implant, tuberosity union and persistent neurological deficit. Overall optimum outcome was in patients aged 55 to 60, with minimal co-morbidities and uncomplicated recovery.
