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Meta-analysis suggests that reverse shoulder arthroplasty in proximal humerus fractures is a better option than hemiarthroplasty in the elderly

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Abstract

Purpose

This systematic meta-analysis and review aims to critically compare the outcome of reverse shoulder arthroplasty versus hemiarthroplasty for the treatment of complex proximal humeral fracture.

Methods

Relevant original studies were searched in the electronic databases of Medline, Embase, Cochrane central database and China National Knowledge Infrastructure (CNKI) (all through December 2014). Studies that investigated and compared the effectiveness or complications in both groups and provided sufficient data of interest were included in this meta-analysis. Participants in both groups were significantly the same in the demography and injury mechanism.

Results

Eight studies that fulfilled inclusion and exclusion criteria were included in this meta-analysis, which included 421 participants in hemiarthroplasty (HA) and 160 in reverse shoulder arthroplasty (RSA). Patients were followed-up for at least one year in each study. Compared with HA, RSA was associated with a lower rate of total complications, higher American Shoulder and Elbow Surgeons (ASES) score, more healed tuberosities and improved active forward elevation. Both treatments were comparable in term of revision surgeries, mortality, subjective satisfaction and active external rotation.

Conclusions

The present evidence from this meta-analysis suggested that RSA was a more advantaged method for the treatment of complex proximal humeral fractures. Clinical decision should be preferred to RSA on the condition that patients’ medical conditions are indicated.

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Acknowledgments

We are grateful to G. Xu and B. Liu of the Department of Orthopedics, to X. Zhang and Q. Zhang of the Department of Statistics and applications and Lei Fu of the Drawings Department for their kind assistance.

Yingze Zhang designed the study; Yanbin Zhu and Fei Zhang searched relevant studies and abstracted the data; Wei Chen and Ye Tian analyzed and interpreted the data; Juan Wang and Yanbin Zhu wrote the manuscript and Yingze Zhang approved the final version of the manuscript.

Conflicts of interest

All the authors declare that they have no conflicts of interest. No organization sponsored the research.

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    Authors and Affiliations

    1. Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People’s Republic of China

      Juan Wang, Yanbin Zhu, Fei Zhang, Wei Chen, Ye Tian & Yingze Zhang

    2. Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People’s Republic of China

      Juan Wang, Yanbin Zhu, Fei Zhang, Wei Chen, Ye Tian & Yingze Zhang

    3. Department of Arthroplasty Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China

      Juan Wang

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    1. Juan Wang
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    Correspondence to Yingze Zhang.

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    Juan Wang and Yanbin Zhu contributed equally to this work

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    Wang, J., Zhu, Y., Zhang, F. et al. Meta-analysis suggests that reverse shoulder arthroplasty in proximal humerus fractures is a better option than hemiarthroplasty in the elderly. International Orthopaedics (SICOT) 40, 531–539 (2016). https://doi.org/10.1007/s00264-015-2811-x

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