Hemiarthroplasty Versus Reverse Shoulder Arthroplasty For The Treatment Of Complex Proximal Humeral Fractures In The Older:a Meta-analysis

Objective:For the treatment of proximal humerus fractures in elderly patients,shoulder arthroplasty has become a viable therapeutic choice.In recent years,Surgeons are gradually focusing their attention from Hemiarthroplasty(HA)to reverse shoulder arthroplasty(RSA).The best treatment is still up for discussion.It has not been determined whether RSA is superior to HA in terms of improving functional outcomes and complication rates in these patients.We hypothesized that using RSA will improve complication rates and functional results in patients with complex proximal humeral fractures elderly patients,thus improving their clinical benefits.Methods:From 2000 to 2020,we gathered literature on HA and RSA for the treatment of complex proximal humerus fractures in the elderly.We filtered the literature using predefined inclusion and exclusion criteria,evaluated the quality of the included literature,and extracted data on radiology、complications and functional scores.The data was analyzed using Stata 14.0 software.Results:A total of 10 cohort studies and 1 randomized controlled trial were included,with a total sample size of 771 cases,including 396 cases in the HA group and 375 cases in the RSA group.The longest postoperative follow-up period was 8 years,with a mean of 2.93 years.RSA was superior to HA in forward elevation(P=0.000),abduction(P=0.016),Constant score(P=0.001),ASES score(P=0.000),and SST score(P=0,044).The HA group had a higher complication rate(P=0.024)joint stiffness rate(P=0.003)and revision rate(P=0.002).There were no statistically significant variations between the two groups in the tuber healing rate(P=0.182),internal rotation(P=0.259),external rotation(P=0.192),nerve injury(P=0.847),internal plant infection(P=0.579)and DASH score(P=0.032).In terms of pain score,VAS score(P=0.119)showed no statistically significant difference between the two groups,but RSA had a better Constant pain score(P=0.029).Conclusions:For patients over 60 years of age with complex proximal humeral fractures,the latest literature indicates that RSA is a successful surgical intervention.Early to middle follow-up of RSA has better clinical efficacy than HA..