Reverse total shoulder arthroplasty vs non-operative management for proximal humerus fracture: Systemic review and meta-analysis of comparative studies.

Abstract

BackgroundProximal humerus fractures (PHF) are the third most common osteoporotic fracture. Non-operative management and reverse total shoulder arthroplasty (rTSA) have become the mainstay of management for elderly patients, however there is yet to be a consensus on the best treatment modality. This systematic review aims to compare the clinical outcomes of non-operative management and rTSA in the management of PHF.MethodsA systematic review was performed in accordance with PRISMA guidelines. A search was conducted using MEDLINE, CINAHL, EMBASE and CENTRAL databases.ResultsThis study analysed the results of 536 study participants published in the 9 studies. There was statistically significant improvement in forward elevation in the rTSA cohort (105 vs 83.3, p<0.01). Patients who underwent a rTSA also had a statistically significant reduction in VAS scores (1.4 vs 2.3, p = 0.02).DiscussionThe greatest differences in range of motion and VAS scores were observable within the first 3 months of follow-up. However, the translation of these results to functional outcomes is still yet to be determined.ConclusionrTSA may provide earlier pain relief and range of motion. This may be key treatment consideration in functionally active patients who would like to prioritise early return to activity.