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Updated: Nov 4, 2025
Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
Reverse Total Shoulder Arthroplasty Versus Hemiarthroplasty for the Treatment of Proximal Humerus Fractures: A
Shahin Sheibani-Rad1, Andrew W Kuhn, Patrick S Berrigan
1From the Los Angeles Bone and Joint Institute, Encino, CA (Sheibani-Rad); the Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Kuhn); the School of Public Policy, University of Calgary, Calgary, Alberta, Canada (Berrigan), and the Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI (Bedi).
Introduction:
Compared with hemiarthroplasty (HA), reverse total shoulder arthroplasty (RTSA) may provide greater cost and health-related benefits for patients with complex three- and four-part proximal humeral fractures. This study set out to compare RTSA versus HA for the incremental cost per incremental improvement in quality adjusted life years (QALYs) for a hypothetical cohort of patients with proximal humerus fractures.
Methods:
Parameters and characteristics for a hypothetical cohort of elderly patients with proximal humerus fractures were collected through the literature. A cohort-level Markov decision model was constructed. Incremental cost-effectiveness ratios representing the difference in cost divided by the difference in QALYs were calculated, and scenario, one-way, and probabilistic analysis were conducted.
Results:
RTSA was associated with lower cost and greater effectiveness compared with HA. The predicted cost difference corresponded to a saving of $99,626 per 100 individuals treated, and the predicted difference in QALY was 16.8 per 100 individuals treated. Results were sensitive to the discount rate, the health-related quality of life assigned to health states, and the cost of the surgical procedures. In probabilistic analysis, 77.1% of iterations were cost-effective at a threshold willingness-to-pay for a QALY of $100,000 US dollars.
Discussion:
Findings suggest that RTSA may be a cost-effective alternative to HA for treating elderly patients requiring surgery for proximal humerus fractures.
Data Availability:
The model and corresponding code are available on request to the corresponding author.
Level Of Evidence Using The Journal Of The American Academy Of Orthopedic Surgeons Guidance:
Level III.
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