JSES - 2026-06-17 - Journal Article
Long-term outcomes of reverse shoulder arthroplasty versus nonoperative treatment for 3- or 4-part proximal humerus fractures in elderly patients: results from a prior randomized clinical trial.
Lopiz Y, Alcobía-Díaz B, Coderch J, Rodrigo-Muro S, García-Fernandez C, Echevarría-Marín M, Galán-Olleros M, Marco F
Topics
Key Takeaway
At mean 7.5-year follow-up, RSA produced a significantly higher Constant score (62 vs 51, P=.039) compared to nonoperative treatment for displaced 3- or 4-part PHFs in patients aged ≥80 years.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study reports long-term follow-up of a prior RCT comparing RSA versus nonoperative management for displaced 3- or 4-part PHFs in patients ≥80 years old. At mean 7.5 years, RSA demonstrated superior Constant scores (62 vs 51, P=.039), with the functional gap attributed to progressive deterioration in the nonoperative cohort over time. DASH trended in favor of RSA (16 vs 25, P=.069), while pain and quality-of-life scores were equivalent; all nonoperatively treated fractures healed in malposition but none required conversion to RSA.
Key Limitation
Attrition from 62 to 29 patients (53%) over follow-up severely limits statistical power and introduces survivorship bias, as the patients available for long-term assessment likely represent the healthiest subset of each cohort.
Original Abstract
BACKGROUND
Proximal humerus fractures (PHFs) are among the most common fractures in elderly patients, yet there is insufficient evidence from randomized controlled trials (RCTs) to determine the most appropriate interventions for their management. This study presents the long-term results of the first prospective RCT comparing surgical treatment with reverse shoulder arthroplasty (RSA) versus nonoperative treatment in displaced PHFs in elderly patients.
MATERIALS AND METHODS
Patients from a previously published RCT of 62 patients, in which RSA was compared with nonoperative treatment, were followed up long term. All patients were aged 80 years or older with 3- or 4-part displaced PHFs. Functional (Constant, Disabilities of the Arm, Shoulder and Hand questionnaire, Short Form 12 [SF-12], and visual analog scale) and radiographic outcomes were assessed.
RESULTS
From the initial series, 12 patients treated conservatively and 17 with RSA were included, with mean ages of 88 and 92 years (P = .004) and mean follow-up of 7.4 and 7.6 years (P = .171), respectively. Functional outcomes for RSA versus conservative treatment were as follows: Constant 62/51 (P = .039), Disabilities of the Arm, Shoulder and Hand questionnaire 16/25 (P = .069), SF-12 Physical 42/43 (P = .808), SF-12 Mental 59/60 (P = .690), and visual analog scale 1.5/1.4 (P = .274). All nonoperatively treated fractures healed in malposition, but none required revision to RSA. Among patients treated with RSA, one required revision surgery due to prosthesis dislocation.
CONCLUSIONS
These results suggest that long term treatment with RSA for displaced 3- or 4- part PHF provides better functional outcomes compared to nonoperative treatment. This difference is attributed to the deterioration of functional outcomes of the nonoperative treatment over time.