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Primary Uncemented Hemiarthroplasty for Severe Fractures of the Proximal Humerus

Objectives: The purpose of this study is to evaluate a consecutive series of proximally porous-coated hemiarthroplasty for the treatment of severe proximal humeral fractures with special emphasis on aseptic loosening and functional outcome. Design: Observational cohort of a consecutive series of a single prosthetic design. Setting: Orthopaedic clinic, nonacademic institutional hospital. Patients/Participants: All patients (n = 30) treated with hemiarthroplasty for severe fractures of the proximal humerus with informed consent and at least 1 year follow-up were included. Follow-up averaged 37 months (range, 13-62 months). Intervention: Uncemented proximally porous-coated hemiarthroplasty. Main Outcome Measurements: We evaluated clinical and radiologic aseptic loosening, Constant score, patient satisfaction and visual analog scale score, range of motion, radiologic parameters such as head-to-tuberosity distance, lateral projection, and lateral offset. Results: The overall Constant score was 68 (standard deviation [SD] 18), the mean patient satisfaction 7.1 (SD 1.8), and the average visual analog scale score 3.7 (SD 2.5). We observed no cases of radiographic tilting or subsidence. In 17 cases (57%), radiolucent lines 1.0 mm or less were observed in less than three zones. None of the cases met the criteria for radiographic loosening. No revision was performed for aseptic loosening. The average head-to-tuberosity distance was 7.6 (SD 8.7 mm). We found that traumatic neurologic deficit and head-to-tuberosity distance significantly influenced Constant score. Lateral projection significantly correlated with Constant score, active forward flexion, and abduction. Conclusions: Proximally porous-coated hemiarthroplasty is a valuable alternative alongside cemented hemiarthroplasty for the treatment of severe fractures of the proximal humerus. The radiographic finding of increased lateral projection was associated with an improved range of motion.